El anillo vaginal de progesterona como soporte de la fase lútea en fertilización in vitro

Objetivo. Comparar la efectividad del anillo vaginal y las cápsulas vaginales de progesterona en el soporte de la fase lútea en procedimientos de fertilización in vitro. Métodos. Estudio retrospectivo que evaluó los resultados de embarazo en mujeres receptoras de embriones logrados de donación de ambos gametos al comparar la efectividad del anillo vaginal y las cápsulas vaginales de progesterona en el soporte de la fase lútea en procedimientos de fertilización in vitro. Resultados. 38 mujeres usaron el anillo vaginal y 46 aplicaron las cápsulas vaginales como soporte de la fase lútea. Se halló tasas similares de implantación (36,5% versus 36,9%), embarazo clínico (52,6% versus 50,0%) y nacido vivo (50,0% versus 45,7%). Conclusiones. Se halló tasas similares de implantación, embarazo clínico y nacido vivo con el empleo del anillo vaginal y las cápsulas vaginales de progesterona en el soporte de la fase lútea en procedimientos de fertilización in vitro. Debido a la comodidad de su uso y a las adecuadas tasas de embarazo, el anillo vaginal de progesterona se constituye como una alternativa importante en el soporte de la fase lútea en la fertilización in vitro.

Objective: To compare the effectiveness of the vaginal ring and vaginal progesterone capsules in supporting the luteal phase in in vitro fertilization procedures. Methods: Retrospective study that evaluated pregnancy outcomes in female recipients of embryos obtained from donation of both gametes by comparing the effectiveness of the vaginal ring and vaginal progesterone capsules in supporting the luteal phase in in vitro fertilization procedures. Results: Thirty-eight women used the vaginal ring and 46 applied vaginal capsules as luteal phase support. Similar rates of implantation (36.5% versus 36.9%), clinical pregnancy (52.6% versus 50.0%) and live birth (50.0% versus 45.7%) were found. Conclusions: Similar implantation, clinical pregnancy and live birth rates were found with the use of the vaginal ring and vaginal progesterone capsules in the support of the luteal phase in in vitro fertilization procedures. Due to the convenience of its use and adequate pregnancy rates, the progesterone vaginal ring is an important alternative in the support of the luteal phase in in vitro fertilization.

Aspectos bioéticos en la decisión terapéutica del neonato prematuro extremo / Bioethical aspects in the therapeutic decisión of the extremely premature infant

RESUMEN El artículo plantea la problemática en la toma de decisiones terapéuticas frente al niño prematuro extremo, en particular, aquel de menos de 25 semanas de gestación, sometido a tecnología de soporte vital avanzado. Para ello, se tuvieron en cuenta tanto su pronóstico como las posibles secuelas. Expone la forma en que las decisiones pueden ser tomadas y la manera en que los actores se pueden involucrar. La perspectiva ética de los actos terapéuticos analiza los argumentos de calidad de vida y mejores intereses para el paciente. Adicionalmente, intenta analizar las repercusiones para la salud pública, centrándose particularmente en la asignación y distribución de recursos. Se concluye que la toma de decisiones no puede ser realizada aisladamente por el equipo de salud, sino que requiere de la participación de los padres. El uso desproporcionado de tecnología diagnóstica y terapéutica conllevaría para las niñas, niños y sus padres importantes cargas de sufrimiento y gastos tanto individuales como para el Estado. La calidad de vida debe ser ponderada y adoptada como criterio analizando el mejor interés para el niño, sus padres y la sociedad, en defensa del bien común y equidad.

ABSTRACT The article raises the issue of therapeutic decision-making in the face of extreme premature infants, particularly under 25 weeks of gestation, undergoing advanced life support technology. For this, their prognosis and possible sequelae were considered. It exposes the way in which decisions can be made and the actors involved. The ethical perspective of therapeutic acts analyzes the arguments of quality of life and best interests for the patient. Additionally, it attempts to analyze the repercussions for public health, focusing particularly on the allocation and distribution of resources. It is concluded that decision-making cannot be done in isolation by the health team but requires the participation of parents. The dis-proportionate use of diagnostic and therapeutic technology would lead girls, boys and their parents to significant burdens of suffering, individual and state expenses. The quality of life must be weighted and adopted as a criterion analyzing the best interest for the child, his parents and society, in defense of the common benefit and equity.

Aspectos bioéticos en la decisión terapéutica del neonato prematuro extremo / Bioethical aspects in the therapeutic decisión of the extremely premature infant

RESUMEN El artículo plantea la problemática en la toma de decisiones terapéuticas frente al niño prematuro extremo, en particular, aquel de menos de 25 semanas de gestación, sometido a tecnología de soporte vital avanzado. Para ello, se tuvieron en cuenta tanto su pronóstico como las posibles secuelas. Expone la forma en que las decisiones pueden ser tomadas y la manera en que los actores se pueden involucrar. La perspectiva ética de los actos terapéuticos analiza los argumentos de calidad de vida y mejores intereses para el paciente. Adicionalmente, intenta analizar las repercusiones para la salud pública, centrándose particularmente en la asignación y distribución de recursos. Se concluye que la toma de decisiones no puede ser realizada aisladamente por el equipo de salud, sino que requiere de la participación de los padres. El uso desproporcionado de tecnología diagnóstica y terapéutica conllevaría para las niñas, niños y sus padres importantes cargas de sufrimiento y gastos tanto individuales como para el Estado. La calidad de vida debe ser ponderada y adoptada como criterio analizando el mejor interés para el niño, sus padres y la sociedad, en defensa del bien común y equidad.

ABSTRACT The article raises the issue of therapeutic decision-making in the face of extreme premature infants, particularly under 25 weeks of gestation, undergoing advanced life support technology. For this, their prognosis and possible sequelae were considered. It exposes the way in which decisions can be made and the actors involved. The ethical perspective of therapeutic acts analyzes the arguments of quality of life and best interests for the patient. Additionally, it attempts to analyze the repercussions for public health, focusing particularly on the allocation and distribution of resources. It is concluded that decision-making cannot be done in isolation by the health team but requires the participation of parents. The dis-proportionate use of diagnostic and therapeutic technology would lead girls, boys and their parents to significant burdens of suffering, individual and state expenses. The quality of life must be weighted and adopted as a criterion analyzing the best interest for the child, his parents and society, in defense of the common benefit and equity.

Comparación de los resultados clínicos en pacientes con Hiperplasia prostática benigna con tratamiento inicial Farmacológico, no farmacológico y quirúrgico, atendidos en el Hospital Pablo Arturo Suárez de enero 2014 a diciembre 2016 / Comparison of the clinical results in patients with benign prostatic hyperplasia with initial pharmacological, non-pharmacological and surgical treatment, managed at Pablo Arturo Suárez Hospital from january 2014 to december 2016

Contexto: Al momento existen pocos datos científicos que comparen las tres modalidades de tratamiento en Hiperplasia Prostática Benigna para determinar el mejor resultado clínico, considerando que se trata de una patología cuya incidencia aumenta a medida que aumenta la esperanza de vida poblacional. Objetivo: Comparar los resultados clínicos entre el tratamiento inicial farmacológico, no farmacológico y quirúrgico, basándose en la clínica de prostatismo en pacientes con Hiperplasia Prostática Benigna durante el período de enero 2014 a diciembre 2016. Diseño: Estudio Observacional, tipo Cohorte Retrospectiva. Pacientes y Métodos: Se procedió a dividir a 399 pacientes de acuerdo a la modalidad de tratamiento recibida. Se comparó la disminución del cuadro clínico en la primera consulta postratamiento utilizando una matriz de evaluación de síntomas urinarios elaborada por los autores, basada en la escala IPSS, que estratificó a los pacientes por el grado de severidad de la sintomatología. Se utilizó el software SPSS®. Resultados: Dentro del tratamiento no farmacológico, existió una diferencia de medias de 1,67 (IC 95% 0,49 ­ 2,85, p < 0,05); para el farmacológico fue de 0,21 (IC 95% 0,92 ­ 1,34, p = 0,713) y para el quirúrgico fue de 8,23 (IC 95% 7,19 ­ 9,27, p < 0,05). Se encontraron diferencias significativas entre los tres grupos durante la fase pretratamiento, tras estratificarlos de acuerdo al grado de severidad. Post- intervención, se compararon los resultados clínicos de cada tratamiento hallando que en pacientes con síntomas leves no existieron diferencias significativas (p = 0,087), no así para pacientes con sintomatología moderada y severa en donde se encontró una diferencia estadísticamente significativa. Conclusión: En pacientes con sintomatología urinaria catalogada como moderada y severa dentro de esta muestra, el tratamiento quirúrgico disminuyó la sintomatología urinaria en mayor proporción en comparación con el tratamiento farmacológico y el no farmacológico

Background: Currently there are few scientific data comparing the three therapeutic modalities of Benign Prostatic Hyperplasia to determine the best clinical outcome, considering that it is a pathology whose incidence increases as population life expectancy arise. Objectives: To compare the clinical results between the initial pharmacological, nonpharmacological and surgical treatment, based on clinical signs of prostatism in patients with benign prostatic hyperplasia during the period between January 2014 and December 2016. Study Design: Retrospective Cohort Study. Methods: 399 patients were divided according to the modality of treatment received: nonpharmacological, pharmacological and surgical. The decrease of the symptoms was compared with the first post-treatment consultation by using a matrix of evaluation of urinary symptoms elaborated by the authors, based on SPSS International Score; this tool stratified the patients by the severity of the symptomatology. SPSS® software was used. Results: Within the non-pharmacological treatment, there was a mean difference of 1.67 (95% CI 0.49 - 2.85, p <0.05); for the pharmacological it was 0.21 (95% CI 0.92 - 1.34, p = 0.713) and for the surgical was 8.23 (95% CI 7.19 - 9.27, p <0.05). Significant differences were found between the three groups during the pretreatment phase, after stratifying them according to the degree of severity. Post-intervention, the clinical results of each treatment were compared, finding that in patients with mild symptoms there were no significant differences (p = 0.087), not so for patients with moderate and severe symptoms where a statistically significant difference was found. Conclusion: In patients with urinary symptoms classified as moderate and severe within this sample, surgical treatment decreased urinary symptomatology in greater proportion compared to pharmacological and non-pharmacological treatment

Apoyo al automanejo de condiciones crónicas: un desafío de los sistemas de salud de América Latina / Support to Chronic Conditions Self-management: a Challenge of Health Systems in Latin America

El apoyo al automanejo de la condición crónica representa un pilar esencial en el tratamiento y seguimiento de las enfermedades crónicas no trasmisibles, sin embargo, su implementación efectiva implica varios desafíos. Los desafíos van desde la propia comprensión del término, su diferenciación de otras expresiones, la interiorización y aplicación de los componentes, dimensiones, costo, incentivos, formación, motivación, enfoques educativos, barreras de infraestructuras, etc. Se precisa intercambiar experiencias entre los países de la región, adaptando lo positivo y más apropiado del nivel mundial, al contexto cultural, socioeconómico y político de cada país, de una forma costo-efectiva, que garantice una atención de alta calidad al paciente y su familia. El objetivo del trabajo es exponer algunos de los retos que implica la implementación del apoyo al automanejo sobre todo desde la atención primaria, especialmente en la medicina familiar latinoamericana.

Support for the chronic condition self-management represents an essential basis treating and monitoring non-communicable chronic diseases, its effective implementation implies however, several challenges. The challenges range from the comprehension of the term, its differentiation from other expressions, the internalization and application of the components, dimensions, cost, incentives, training, motivation, educational approaches, infrastructure barriers, etc. It is necessary to exchange experiences among the countries of the region, adapting the positive and most appropriate worldwide, to the cultural, socioeconomic and political context of each country, in a cost-effective way, which guarantees a high-quality patient and family care. The objective of the paper is to present some of the challenges involved in self-management support implementation, especially from primary care, especially in Latin American family medicine.

Violencia de pareja en mujeres trabajadoras de empresas maquiladoras de Nuevo Laredo, México / Intimate partner violence in women workers of maquiladoras of Nuevo Laredo, Mexico

PROPÓSITO: Identificar las prevalencias de violencia de pareja (VP) en mujeres mexicanas trabajadoras de maquiladoras, así como determinar la relación entre los indicadores de VP y características sociodemográficas (edad, horas de trabajo, número de hijos y escolaridad). METODOLOGÍA: El estudio tuvo diseño descriptivo correlacional. Mediante un muestreo no probabilístico se seleccionó una muestra de 185 trabajadoras de dos empresas maquiladoras de Nuevo Laredo, México. Se utilizó una cédula de datos sociodemográficos y las escalas HITS y CTS2. RESULTADOS: El 34.1% de las participantes fueron solteras, el 65.9% refirió tener educación básica y laboraron un promedio de 8.89 horas al día. El 49.5% refirió haber experimentado algún tipo de VP alguna vez en la vida, siendo la violencia psicológica (42.2%) la más reportada. Las prevalencias de VP fueron mayores en las participantes de 30 a 39 años de edad. Se identificaron relaciones positivas significativas entre las puntuaciones de VP con la edad (rs = .19, p ≤.01) y la violencia recibida (rs =.15, p ≤ .05). También se relacionó el número de hijos con la violencia recibida (rs= .19, p ≤ .01) y la violencia ejercida (rs = .26, p ≤ .01). CONCLUSIÓN: La VP es un problema altamente prevalente. Más de la mitad de las trabajadoras de maquiladoras han sufrido algún tipo de VP, especialmente psicológica. También se identificó que mayor edad y número de hijos se relacionaron con mayores puntajes de VP, de modo que podrían constituir factores de riesgo que ameritan más.

AIM: To identify the prevalence of intimate partner violence(VP) in Mexican women workers of maquiladoras, as well as to determine the relationship between VP indicators and socio-demographic characteristics (age, hours of work, number of children and levelof education). METHODS: The study was descriptive correlational. Through a non-probabilistic sampling method, asample of 185 female workers was selected from two maquiladora companies in Nuevo Laredo, Mexico. A sociodemographic data record and the HITS and CTS2 scales were used. RESULTS: 34.1% of the participants were single, 65.9% had basic education, and worked an average of 8.89 hours per day. 49.5% reported having experienced any type of VP at some point in their lives, with psychological violence (42.2%) being the most reported. The prevalence of VP was higher in the participants from 30 to 39 years old. Significant positive relationships between VP indicators with age (rs= .19, p≤.01) andreceived violence (rs= .15, p≤ .05) were identified. There was also a significant relationship between number of children with the received violence (rs= .19, p≤ .01), and violence perpetrated against their partner (rs= .26, p≤ .01). CONCLUSION: Intimate violence is a problem withhigh prevalence. More than half of the maquiladora workers have suffered some type of VP, especially psychological. In addition, higher ageand number of children were associated with higher VP scores, so that they could constitute risk factors that warrant further investigation.

Acciones de cuidado y factores psicosociales en mujeres con diabetes mellitus tipo 2 / Caregiving and psychosocial factors in women with type 2 diabetes mellitus

PROPÓSITO. La diabetes es un problema de salud pública y se ha convertido en un desafío internacional, además de ocasionar daños físicos, puede provocar problemas psicosociales, depresión y estrés dificultando el autocuidado. El objetivo es determinar las acciones de cuidado en mujeres con DMT2 y su relación con síntomas depresivos y angustia. METODOLOGÍA. Estudio descriptivo correlacional. Datos obtenidos de 13 centros de salud. Población 215 mujeres entre 18 y 59 años con diagnóstico de diabetes mellitus tipo 2 (>1 año). Instrumentos utilizados: cuestionario de acciones de cuidado, escala de depresión, escala de distrés o angustia por la diabetes. RESULTADOS. Edad promedio de 45 años (DE=10.10). Las acciones de autocuidado se correlacionaron de forma negativa con depresión (r= -.301; p<.01), angustia (r= -.248; p<.01) y estrés emocional (r= -.203; p<.01), estrés relacionado al tratamiento (r= -.324; p<.01) y estrés interpersonal (r= -.193; p<.01). CONCLUSIÓN. La depresión y angustia juegan un papel importante en el cuidado de la diabetes, éstos se asocian con la falta de realización de actividades de autocuidado. Esto se corroboro evidenciando que las mujeres que realizan mayores acciones de autocuidado son las que tienen menos síntomas depresivos, angustia por diabetes, estrés emocional, estrés por el tratamiento y estrés interpersonal.

PURPOSE. Diabetes is a public health problem and has become an international challenge, as well as causing physical damage, can cause psychosocial problems, depression and stress, making self-care difficult. The objective is to determine the care actions in women with T2DM and their relationship with depressive symptoms and distress. METHODOLOGY. Descriptive correlational study. Data obtained from 13 health centers. Population 215 women between 18 and 59 years old with diagnosis of type 2 diabetes mellitus (> 1 year). Instruments used: self-care actions questionnaire, depression scale, distress scale or diabetes distress. RESULTS. Average age of 45 years (SD = 10.10). Self-care actions are (R = -.301, p <.01), distress (r = -.248; p <.01) and emotional stress (r = -.203; p <.01), related stress to treatment (r = -.324; p <.01) and interpersonal stress (r = -.193; p <.01). CONCLUSION. Depression and anxiety play an important role in caring for diabetes; these are associated with the lack of self-care activities. This corroborates evidence that women who perform greater self-care actions are those who have less depressive symptoms, anxiety, emotional stress, treatment stress and interpersonal stress.

Certificación, Recertificación y Acreditación en Medicina Familiar y Comunitaria en Iberoamérica / Certification, Recertification and Accreditation in Family and Community Medicine in Iberoamerica / Certificação, Recertificação e Acreditação em Medicina de Família e Comunidade na Ibero-América

Objetivo: Conocer el estado de la Certificación, Recertificación y Acreditación en los países de la región de Iberoamérica como seguimiento a la primera encuesta realizada en la V Cumbre Iberoamericana de Medicina Familiar en 2014 en Quito, Ecuador. Métodos: Diseño transversal descriptivo. La población estuvo conformada por diez países: Ecuador, Perú, Chile, Venezuela, México, Brasil, Paraguay, Colombia, Puerto Rico y Costa Rica. A los presidentes de las Asociaciones de Medicina Familiar, se les envió por e-mail una encuesta estructurada de doce preguntas acerca de la Certificación, Recertificación y Acreditación; la respuesta se recibió por la misma vía. Se efectuó un análisis estadístico descriptivo, frecuencias simples y relativas. Resultados: Las Sociedades Científicas participan en los procesos de Certificación, Recertificación y Acreditación en los países en los cuáles están instalados. La certificación se realizó en 60% de los países encuestados, este proceso fue voluntario en 40%. La Recertificación está instalada y es operativa en 30% de los países participantes, este proceso es voluntario en 80% y lo ejecutan diferentes organismos, entre los cuales están las sociedades científicas, actuando solas o como parte de un equipo evaluador. De estos países, 50% de los países realizan la Acreditación de los programas de medicina familiar a través de las Universidades. Conclusiones: La Certificación todavía no se instaura en algunos países de Iberoamérica, es voluntaria. Un menor porcentaje de países tienen implementado el proceso de Recertificación, el cual también es voluntario en su mayoría. Apenas la mitad de los países efectúan el proceso de Acreditación de las Unidades Formadoras.

Objective: To determine the status of the Certification, Recertification and Accreditation in the countries of the region of Latin America as a follow up to the first survey in the V Ibero-American Summit Family Medicine in 2014 inQuito, Ecuador. Methods: Cross-sectional descriptive. The population consisted of 10 countries: Ecuador, Peru, Chile, Venezuela, Mexico, Brazil, Paraguay, Colombia, Puerto Rico and Costa Rica. To the presidents of associations of family medicine, they were sent by e-mail a structured survey of twelve questions about certification, recertification and accreditation; the response was received by the same route. Descriptive statistics and simple and relative frequencies was made. Results: Certification is carried out in 60% of the surveyed countries; this process is voluntary in 40% and performs scientific societies. The recertification is installed and is operational in 30% of the participating countries, this process is voluntary in 80% and running different organisms among which are scientific societies. 50% of countries conduct the accreditation of family medicine programs through universities. Conclusions: Certification not yet instituted in some countries in Latin America, continues to be voluntary, and only half of the countries make the accreditation process. Therefore, we must work more in each of the countries in the region to achieve certification, recertification and accreditation to ensure the quality of specialists in Family Medicine.

Objetivo: Conhecer a situação da Certificação, Recertificação e Acreditação nos países da região da Ibero-Americana como seguimento do primeiro levantamento realizado na V Cúpula Ibero-Americana de Medicina de Família em 2014 em Quito, Equador. Métodos: desenho transversal descritivo. A população do estudo foi composta por dez países: Equador, Peru, Chile, Venezuela, México, Brasil, Paraguai, Colômbia, Porto Rico e Costa Rica. Se enviou por email um questionário estruturado de doze perguntas sobre Certificação, Recertificação e Acreditação; a resposta foi recebida pela mesma via. Foi realizada uma análise estatística descritiva, com frequências simples e relativas. Resultados: As sociedades científicas envolvidas participam nos processos de Certificação, Recertificação e Acreditação nos países em que são implementados. A certificação foi realizada em 60% dos países pesquisados, este processo foi voluntário em 40%. Recertificação é implementada e está ativa em 30% dos países participantes, este processo é voluntário para 80% e são realizadas por diferentes organizações, entre as quais sociedades científicas, atuando isoladamente ou como parte de uma equipe de avaliação. Destes países, 50% procedem à acreditação de programas de medicina de família através de universidades. Conclusões: A Certificação ainda não está estabelecida em alguns países da Ibero-América, é voluntária. Uma porcentagem menor de países implementaram o processo de recertificação, o qual é voluntário em sua maioria. Apenas metade dos países realizam o processo de acreditação das Unidades Formadoras.

Evaluación de la exactitud de métodos de Tanaka-Johnston y Moyers en pacientes chilenos del Postgrado de Ortodoncia UNAB Santiago, Chile

Objetivo: Determinar la exactitud del Índice de Tanaka-Johnston e Índice de Moyers mediante el análisis de modelos de estudio iniciales con dentición definitiva de pacientes chilenos del Postgrado de Ortodoncia de la Universidad Andrés Bello sede Santiago. Materiales y métodos: Se seleccionaron por conveniencia 100 pares de modelos según los criterios de inclusión y exclusión establecidos, correspondientes 50 al género femenino y 50 al masculino, y se realizó medición directa con un pie de metro manual, de la suma incisiva inferior y suma de segmentos canino-premolar. La medición fue realizada por dos examinadores previamente calibrados. Se determinó la exactitud de cada uno de los métodos y presencia de diferencias estadísticas significativas. Resultados: Para mujeres, Moyers 65% en maxilar superior y Moyers 50% en maxilar inferior presentan mayor exactitud en predicción de tamaño mesiodistal de caninos y premolares permanentes no erupcionados; en cambio, para hombres, Moyers 75% en maxilar superior y Moyers 65% en maxilar inferior son más exactos. El método de Tanaka-Johnston a pesar que solo presenta diferencias estadísticamente significativas en maxilar inferior en el género femenino (p<0,05), es menos exacto tendiendo a sobrestimar valores reales en mujeres, y a subestimar en hombres. Conclusión: Método de Moyers es más exacto en la predicción del espacio necesario en pacientes chilenos, su nivel de confianza varía según género y maxilar. Diferencias son explicadas por dimorfismo sexual y variaciones étnicas con respecto a la población de origen de métodos de predicción.

Objetive: Determine the accuracy of Tanaka-Johnston and Moyers indexes through the initial analysis of study models with permanent teeth of Chilean patients of the Graduate School Orthodontics of University Andres Bello in Santiago. Materials and Methods: 100 pairs of models were selected by convenience as the inclusion and exclusion criteria established, corresponding to 50 female and 50 male. Direct measurement was performed with a manual caliper gauge by two examiners previously calibrated. The sum of permanent mandibular incisors and sum of segments canine-premolar were measured. The accuracy of each of the present methods and statistical differences were determined. Results: In females, the prediction of width of unerupted canines and premolars is more accurate on maxilla with Moyers 65% and mandible with Moyers 50%. For males, Moyers 75% on maxilla and Moyers 65% in mandible are more accurate. Tanaka-Johnston method although only presented statistically significant differences in mandible of female gender (p <0.05), is less accurate tending to overestimate actual values in women as in men underestimated. Conclusion: Moyers method is more accurate in predicting space required in Chilean patients, the confidence level varies according to gender and jaw. Differences are explained by sexual dimorphism and ethnic variations from the source population of prediction methods.

Corticotomía: perspectiva histórica / Corticotomy: historical perspective

Introducción: Se expone la evolución de las diferentes técnicas y filosofías que a través del tiempo ha presentado la corticotomía, desde su origen o primer registro en 1892 hasta el momento presente o última modificación del 2012. Método: Se realiza una búsqueda bibliográfica sobre el tema de corticotomía con la finalidad de documentar las modificaciones que ha tenido esta técnica quirúrgica y ofrecer la evidencia que permita la toma de decisiones basadas en una evidencia científica. Resultados: Se presenta una serie de cuadros en los cuales se registra cada una de las técnicas, su o sus autores y el año en el que fue descrita o propuesta. Conclusiones: El mecanismo detrás de la corticotomía puede resumirse como la inducción del metabolismo óseo mediante la decorticación que se realiza alrededor de los dientes que van a moverse para aumentar el recambio óseo, esto mejora y acelera el movimiento dentario ortodóncico.

Introduction: An exposition is presented of different techniques and philosophies provided through time for corticotomy procedures from its origin or first listing in 1892 to the present or last modification in 2012. Method: Bibliographic search was undertaken on the subject of corticotomy in order to document modifications experienced by their surgical technique and offer evidence which might allow to make decisions based on scientific evidence. Results: Presentation of a series of tables where all techniques are recorded, including authors and years of description or proposal. Conclusions: Mechanism behind corticotomy procedures can be summarized as the induction of bone metabolism through decortication executed around teeth that are going to be moved to increase bone replacement, this improves and accelerates orthodontic tooth movement.

Analisis comparativo de la certificación, recertificacion y acreditación en Latinoamerica para la especialidad de Medicina Familiar y Comunitaria / Comparative analysis of certification, certification and accreditation in Latin America for the specialty of Family and Community Medicine / Análise comparada dos processos de certificação, recertificação e acreditação em Medicina de Família e Comunidade na América Latina

La certificación y acreditación de competencias profesionales son actividades de cualquier área de formación profesional que existen en el mundo, y la profesión médica no ha estado ajena a ellas. Este estudio inicia en la V Cumbre Iberoamericana de Medicina Familiar realizada en Quito, Ecuador; en la cual se planifica una investigación de tipo descriptivo basada en la aplicación del método comparado denominado análisis entre países o cross-national, que analiza información comparativa de 8 países de Latinoamérica (México, Ecuador, Brasil, Bolivia, Argentina, Paraguay, Venezuela y Chile). El análisis documental muestra que hay diferencias importantes entre países; desde Ecuador, que no tiene implementado ningún proceso de certificación, recertificación y acreditación; Argentina, que tiene proceso de certificación, y en marcha los procesos de recertificación y acreditación; Brasil, Chile y Venezuela, que tienen sólo los procesos de certificación y acreditación; Venezuela no tiene implementado el proceso de recertificación; México, Paraguay y Bolivia que tienen los tres procesos implementados. El estudio demuestra cómo los países del concierto latinoamericano han avanzado a ritmos distintos en sus procesos de certificación, recertificación y acreditación, y tienen estructuras de organización diferentes para los mismos fines.

The certification and accreditation of professional competences are activities that any area of vocational training in the world puts it, and the medical Profession has not been alien to her. This study began in the V Ibero-American summit of Family Medicine in Quito Ecuador, in which a descriptive research based on the planned application of the method called analysis compared between countries or cross-national, comparative information analyzing 8 countries Latin America (Mexico, Ecuador, Brazil, Bolivia, Argentina, Paraguay, Venezuela and Chile). The documentary analysis in each country shows that there are significant differences between countries, from Ecuador has not implemented any certification process, recertification and accreditation; Argentina has certification process; up processes certification and accreditation, Brazil, Chile and Venezuela, which have only the processes of certification and accreditation; Venezuela has not implemented the process of recertification. Mexico, Paraguay and Bolivia that have implemented the three processes. The study demonstrates how the Latin American countries have advanced concert at different rates in their certification processes, recertification and accreditation, which have different organizational structures for the same purposes.

Certificação e acreditação de competências são atividades de qualquer área de formação profissional no mundo, e a profissão médica não tem sido alheia a elas. Este estudo teve início na V Cumbre Ibero-Americana de Medicina de Família e Comunidade em Quito, Equador, com uma pesquisa descritiva baseada no método de análise comparada entre países, ou método cross-national, que analisa os processos de certificação, recertificação e acreditação em 8 países da América Latina (México, Equador, Brasil, Bolívia, Argentina, Paraguai, Venezuela e Chile). A análise dos resultados mostra que existem diferenças importantes entre os países, desde o Equador, que não implementou qualquer processo de certificação, recertificação ou acreditação; a Argentina tem processo de certificação e processos de recertificação e acreditação em andamento; Brasil, Chile e Venezuela têm apenas os processos de certificação e acreditação; chegando ao México, Paraguai e Bolívia, que contam com os três processos implementados. O estudo demonstra como os países da América Latina têm avançado em ritmos diferentes em seus processos de certificação, recertificação e acreditação e têm diferentes estruturas organizacionais para os mesmos fins.

Prevalência de incontinência urinária em mulheres praticantes de jump / Prevalence of urinary incontinence in women who practice jump

Objetivo: Analisar a qualidade de vida associada a perda urinária em mulheres que praticam jump. Método: A amostra foi composta por 59 mulheres, praticantes de jump há pelo menos 3 meses, com idade entre 20 e 40 anos. Resultados: A média de idade das participantes foi de 29 (± 5,7) anos. O período médio de prática do jump ficou em torno de cinco meses com frequência semanal de três vezes. Houve uma prevalência de 66,1% de incontinência urinária nas mulheres estudadas. Na correlação da qualidade de vida mensurada pelos domínios do King's Health Questionnaire (KHQ) com a variável tempo de prática de jump, pode-se observar que houve associação positiva e significativa, pois quanto maior o tempo de prática, pior a percepção geral de saúde (r = 0,340; p < 0,05), maiores as limitações nos desempenhos de tarefas (r = 0,368; p < 0,05) e maior limitação física (r = 0,328; p < 0,05). Através da análise de correlação, também foi possível detectar que a prática de jump por mais de 3 meses, por mulheres que apresentam IU, influencia negativamente na qualidade de vida em relação as que praticavam até 3 meses. Conclusão: Foi identificada elevada prevalência de IU entre mulheres praticantes de jump, no entanto este fator não influenciou negativamente na qualidade de vida entre as mulheres avaliadas. (AU)

Aim: To analyze the quality of life related to urinary loss in women who practice Jump. Method: The sample was composed by 59 women, Jump practicing for at least 3 months, 20 to 40 years old. Results: The average age of the participants was 29 (± 5.7) years old. The average period of jump practice was about five months three times a week. There was a prevalence of 66.1% of urinary incontinence in the studied women. In the correlation of quality of life, measured by the King's Health Questionnaire (KHQ), with the variable period of jump practice, we can observe that there was a significant and positive association, because the more time spent on practicing, worse self-perceptions of general health (r = 0.340; p < 0.05), more limitations in tasks performance (r = 0.368; p < 0.05) and more physical limitations (r = 0.328; p < 0.05). Also, using correlation analysis, became possible to detect that the jump practice for more than 3 months, by incontinent women, may negatively affect their quality of life in relation to those who practice up to 3 months. Conclusion: It has been identified a high prevalence of UI among women who practice jump, however this factor did not influence negatively in the quality of life among the evaluated women. (AU)

Actividad laboral de médicos egresados de la Universidad de Chile generaciones 2007 a 2010: análisis según sede y año de egreso / Work activity of medical graduates at the University of Chile: Analysis per campus and graduation year

Background: The University promotes practices and values that influence their students in the pursuit of their occupational interests. Aim: To determine working activity features of medical graduates from the University of Chile and their relationship with undergraduate characteristics. Material and Methods: Medical graduates of the University of Chile were invited to complete a survey using a virtual server. The survey collected demographic, socioeconomic, work and guild characteristics. Undergraduate data, as campus and graduation years were obtained. Results: The survey was completed by 333 physicians (167 men) aged 29 ± 2 years, graduated from 2007 to 2010. Ninety four percent had a paid work, 59% were employed in public hospitals and 28% in primary care health centers. The predominant type of work activity was performed in the public health service (55%), while 17% worked in private health services. Activity in public health services or primary care were significantly associated with the pursuit of undergraduate clinical activities in specific campuses of the University. Conclusions: The employment rate of medical graduates was high. Differences observed by graduation campus and type of work may be due to the modeling that students receive from teachers.

Esclerectomía profunda no perforante y facoemulsificación en dos tiempos en pacientes con glaucoma y catarata / Non-penetrating Deep Sclerectomy and Phacoemulsification Performed in Two Stages in Patients with Glaucoma and Cataract

Fundamento: el tratamiento quirúrgico a pacientes con glaucoma crónico primario y catarata sigue siendo un dilema para los oftalmólogos. Objetivo: evaluar los resultados posoperatorios de la esclerectomía profunda no perforante con mitomicina C y la facoemulsificación realizadas en dos tiempos en pacientes con glaucoma crónico primario y catarata. Métodos: estudio descriptivo prospectivo, en 200 pacientes que fueron operados mediante la esclerectomía profunda no perforante con mitomicina C e iridotomía periférica con Nd YAG láser previa, en un primer tiempo y facoemulsificación con implante del lente intraocular de PMMA, en un segundo tiempo. Se analizaron la agudeza visual con corrección, el comportamiento de la tensión ocular y de la bula de filtración, la relación excavación – papila; y las complicaciones intra y posoperatorias. Resultados: la agudeza visual de 0,4 en el preoperatorio mejoró a 0,7 al año. El 62 % de las ampollas de filtración se mantuvieron prominentes y funcionales. Luego de la facoemulsificación el 17 % de los ojos continuaron con el uso de medicamentos y el 83 % mantuvieron presiones intraoculares por debajo de 17 mmHg, sin tratamiento. Las complicaciones posoperatorias fueron: la iridociclitis moderada (74 %) y la opacidad capsular posterior al año (46 %). Hubo 18 ojos (9 %) con descompensación endotelial leve y transitoria.Conclusiones: la esclerectomía profunda no perforante con mitomicina C y la facoemulsificación en dos tiempos permiten obtener el control quirúrgico del glaucoma crónico primario y una buena visión.

Background: surgical treatment of patients with primary chronic glaucoma and cataract remains a dilemma for ophthalmologists. Objective: to assess the postoperative results of non-penetrating deep sclerectomy with mitomycin C and phacoemulsification performed in two stages in patients with primary chronic glaucoma and cataract. Methods: a prospective descriptive study was conducted in 200 patients who underwent non -penetrating deep sclerectomy with mitomycin C and Nd:YAG laser peripheral iridotomy in the first stage and phacoemulsification with intraocular PMMA lens implantation in the second stage. Corrected visual acuity, intraocular pressure and filtering blebs, cup-to-disc ratio and intra -and postoperative complications were analyzed. Results: visual acuity improved from 0.4 before surgery to 0.7 a year after surgery. Sixty-two percent of the filtering blebs remained prominent and functional. After phacoemulsification, 17 % of the eyes continued under medication and 83% maintained the intraocular pressure below 17 mmHg, without treatment. Postoperative complications included moderate iridocyclitis (74 %) and posterior capsular opacity after a year (46%). Eighteen eyes (9 %) developed mild and transient endothelial decompensation. Conclusions: non -penetrating deep sclerectomy with mitomycin C and phacoemulsification performed in two stages lead to the surgical management of primary chronic glaucoma and good vision.

Redução na velocidade da nitrificação no solo após aplicação de cama de aviário com dicianodiamida / Reduction of the nitrification rate in the soil after addition of poultry manure with dicyandiamide

A rápida nitrificação do nitrogênio (N) amoniacal de fontes orgânicas e minerais no solo pode resultar em perdas de nitrato (NO3-) para o ambiente. Uma estratégia para a redução dessas perdas envolve o uso de inibidores de nitrificação. O objetivo do presente trabalho foi o de avaliar, em condições de laboratório, a eficiência da dicianodiamida (DCD), presente no produto Agrotain® Plus (AP), em inibir a nitrificação do N amoniacal de cama de aviário (CA) no solo. Foram avaliados cinco tratamentos, sendo um com CA incorporada ao solo, três com CA incorporada ao solo com AP, nas doses de 3,5, 7,0 e 14,0kg ha-1, além de um tratamento somente com solo. A nitrificação foi monitorada através da determinação periódica dos teores de NH4+ e NO3 no solo durante 69 dias. A maior taxa de nitrificação ocorreu no tratamento em que a CA foi incorporada ao solo sem AP. As doses de 3,5 e 7,0kg de AP ha-1 inibiram parcialmente a nitrificação do N amoniacal da CA na fase inicial da incubação, perdendo a eficiência em inibir esse processo no período entre 12 e 27 dias. O tratamento com a maior dose de AP (14kg ha-1) foi aquele em que a DCD exerceu maior efeito inibitório da nitrificação, preservando maior quantidade de NH4+ e retardando o aparecimento de NO3- no solo. Os resultados deste trabalho indicam que a DCD, contida no Agrotain® Plus, reduz a taxa de nitrificação do N amoniacal da CA no solo, o que poderá contribuir à redução das perdas de NO3- para o ambiente.

The fast nitrification of ammoniacal nitrogen (N) of organic and mineral sources in soil can result in losses of nitrate (NO3-) to the environment. One strategy to reduce these losses involves the use of nitrification inhibitors. The objective of this study was to evaluate, in laboratory conditions, the efficiency of Agrotain® Plus (AP), which contains dicyandiamide (DCD), as a nitrification inhibitor of ammoniacal nitrogen from poultry manure (PM) in soil. Were evaluated five treatments, one with PM incorporated into the soil, three with PM incorporated into the soil with AP at the doses of 3.5, 7.0 e 14.0kg ha-1 and one treatment without PM and AP. Nitrification was monitored by measuring changes in soil mineral N (NH4+ and NO3-) periodically over 69 days. The highest rate of nitrification occurred in the treatment in which PM was incorporated into the soil without AP. The doses of 3.5 and 7.0kg ha-1 of AP inhibited partially the nitrification of ammoniacal nitrogen of PM in the initial phase of incubation, losing the ability to inhibit this process in the period between 12 and 27 days. The treatment with the higher dose of AP (14kg ha-1) was on in which the DCD exerted more inhibitory effect on nitrification, preserving most NH4+ and delaying the onset of NO3- in soil. The results of this study indicate that the DCD, contained in the Agrotain® Plus, reduces the nitrification rate of ammoniacal nitrogen from PM in soil, that may contribute to reduce NO3- losses to the environment.

Encuesta distrital de demografía y salud Bogotá 2011 / Demographic and health district survey Bogotá 2011

La encuesta distrital de demografía y salud de Bogotá (EDDS) es el primer estudio financiado por el gobierno local, que da cuenta del estado de la salud sexual y reproductiva de las personas que habitan la ciudad. Su importancia radica en la especificidad de la información para Bogotá y sus 20 localidades...

Culture, cognition and language in the constitution of reading and writing practices in an adult literacy classroom / Cultura, cognição e linguagem na constituição de práticas de leitura e escrita de adultos em processo de alfabetização

In this article we analyze a discursive interaction between a researcher and an Youth and Adult Education student intending to show the meanings and uses of reading and writing taken by him. We take as our basis for discussion the theoretical-methodological contributions from Historical-Cultural Psychology and Paulo Freire's theories, which are combined with Bakhtin's concept of dialogue. This procedure allowed us, on one hand, getting into the other's perspective and, on the other hand, to make relations between cognition, language and culture to understand the adult students' metacognitive strategies, in the appropriation process of literacy practices of school culture. Thus, we could discuss the intimate relationship between doing and knowing and the importance of school in the transition from concrete thinking to the abstract thinking and vice-versa.

Neste artigo analisamos uma interação discursiva entre uma pesquisadora e um estudante da Educação de Jovens e Adultos objetivando mostrar sentidos e usos da leitura e da escrita por ele mobilizados. Tomamos como base para nossa discussão os aportes teórico-metodológicos da Psicologia Histórico-Cultural e das teorizações de Paulo Freire, que conjugamos com a concepção de diálogo de Bakhtin. Tal procedimento nos possibilitou, por um lado, entrar na perspectiva do outro, e por outro, fazer relações entre cognição, linguagem e cultura para compreendermos as estratégias metacognitivas de alunos da EJA ao se apropriarem da cultura escolar. Pudemos também evidenciar a íntima relação entre fazer e saber e a importância da escola na transição do pensamento concreto para o abstrato e vice-versa.

Arteritis de la temporal con VHS y PCR normales / Temporal arteritis with normal VHS and PCR

Se presenta un caso de arteritis de células gigantes con escasos criterios clínicos, VHS y PCR normal con neuropatía óptica isquémica posterior. Se hace una pequeña revisión del tema discutiéndose la importancia de la sospecha diagnóstica a pesar de los criterios clínicos y de laboratorios clásicamente descritos, destacando la importancia de la biopsia para el diagnóstico definitivo para el comienzo de la terapia específica, pilar fundamental para el pronóstico ocular y sistémico.

A case of giant cell arteritis with low clinical criteria, VHS and normal PCR with posterior ischemic optic neuropathy. A small review of the topic discussed the importance of the suspected diagnosis despite the clinical and laboratory criteria traditionally described, highlighting the importance of biopsy for definitive diagnosis for the commencement of specific therapy, a fundamental pillar for the ocular prognosis and systemic.

Ceratomicose causada por Fusarium solani no interior do Rio Grande do Sul, Brasil / Keratomycosis by Fusarium solani in hinterland of Rio Grande do Sul, Brazil

As ceratomicoses são infecções decorrentes da invasão de fungos na córnea. Embora as espécies fúngicas implicadas nestas infecções sejam muito diversas e Fusarium solani tem sido isolada com freqüência crescente. Relatamos um caso de ceratomicose causada por Fusarium solani no interior do Rio Grande do Sul, chamando a atenção para a importância dos procedimentos microbiológicos adequados para o sucesso do tratamento e cura do paciente.