Community Organizations, Local Health Equity Action Teams, and a Learning Collaborative to Address COVID-19 Disparities in Urban and Rural Communities.

Rapid Acceleration of Diagnostics-Underserved Populations (RADx-UP) Kansas worked with 10 Kansas counties from November 2020 through June 2022 to form local health equity action teams (LHEATs), develop COVID-19 testing strategies, foster communication about COVID-19, and share best practices through a learning collaborative. Participating counties documented 693 distinct COVID-19 testing and 178 communication activities. Although the intervention was not associated with changes in the proportion of positive COVID-19 tests, LHEATs in the learning collaborative implemented new testing strategies and responded to emerging COVID-19 challenges. (Am J Public Health. Published online ahead of print August 22, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307771).

Impact of the COVID-19 Pandemic on Latino Families With Alzheimer Disease and Related Dementias: Qualitative Interviews With Family Caregivers and Primary Care Providers.

Background: Latino individuals experience disparities in the care of Alzheimer disease and related dementias (ADRD) and have disproportionately high COVID-19 infection and death outcomes. Objective: We aimed to gain an in-depth understanding of the impact of the COVID-19 pandemic among Latino families with ADRD in the United States. Methods: This was a qualitative study of 21 informal caregivers of Latino individuals with ADRD and 23 primary care providers who serve Latino patients. We recruited participants nationwide using convenience and snowball sampling methods and conducted remote interviews in English and Spanish. We organized the transcripts for qualitative review to identify codes and themes, using a pragmatic approach, a qualitative description methodology, and thematic analysis methods. Results: Qualitative analysis of transcripts revealed eight themes, including (1) the pandemic influenced mental and emotional health; (2) the pandemic impacted physical domains of health; (3) caregivers and care recipients lost access to engaging activities during the confinement; (4) the pandemic impacted Latino caregivers' working situation; (5) the pandemic impacted health care and community care systems; (6) health care and community care systems took measures to reduce the impact of the pandemic; (7) Latino families experienced barriers to remote communication during the pandemic; and (8) caregiver social support was critical for reducing social isolation and its sequalae. Conclusions: Latino families with ADRD experienced similar but also unique impacts compared to those reported in the general population. Unique impacts may result from Latino individuals' underserved status in the United States, commonly held cultural values, and their intersectionality with ADRD-related disability. Family caregiver social support was crucial during this time of adversity. These findings suggest the need for more equitable access, culturally appropriate and trustworthy content and delivery of health care and community services, as well as stronger financial and social supports for family caregivers.

Chasing the chill: Unveiling the dynamic flavors and textures of ice cream formulations.

In this study, nine commercial ice creams and four prototypes were assessed. For the sensory analysis, quantitative descriptive analysis (QDA), and temporal dominance of sensations (TDS) methodology were used. According to the QDA results, full-composition ice cream showed significantly higher differences (p < .05) in terms such as vanilla and sweet flavors, brightness, creamy texture and appearance, and viscosity, exhibiting longer melting times. Functional ice creams showed significantly higher differences (p < .05) in terms like viscosity, creamy texture, and appearance. On the other hand, agave fructans in prototype ice creams were found to be able to reduce fat, but not fat and sugar simultaneously, showing a significant decrease (p < .05) in terms such as hardness, crystallized texture, gummy texture, and porosity. Based on the PCA results, the analysis accounted for 75.28% of data variability. Full-composition ice creams and one functional ice cream were related to terms such as viscosity, fatty sensation, creamy texture and appearance, dense, gummy, among others. The rest of the commercial ice creams were related to vanilla and caramel flavor and smell, artificial aftertaste, aerated, porosity, among others. Prototype ice creams were related to hard texture, salty and milk flavor, and crystallized texture. Based on the results of the TDS method, all formulations were found to be significantly dominant (5%) in terms such as vanilla flavor and sweet flavor at the beginning of the test. Formulations containing butyric fat and/or vegetable fat, or agave fructans were significantly dominant (5%) in fatty sensation.

Linking genetic counseling communication skills to patient outcomes and experiences using a community-engagement and provider-engagement approach: research protocol for the GC-PRO mixed methods sequential explanatory study.

INTRODUCTION: In over 50 years since the genetic counseling (GC) profession began, a systematic study of GC communication skills and patient-reported outcomes in actual sessions across multiple clinical specialties has never been conducted. To optimize GC quality and improve efficiency of care, the field must first be able to comprehensively measure GC skills and determine which skills are most critical to achieving positive patient experiences and outcomes. This study aims to characterise GC communication skills using a novel and pragmatic measure and link variations in communication skills to patient-reported outcomes, across clinical specialties and with patients from diverse backgrounds in the USA. Our community-engagement and provider-engagement approach is crucial to develop recommendations for quality, culturally informed GC care, which are greatly needed to improve GC practice. METHODS AND ANALYSIS: A mixed methods, sequential explanatory design will be used to collect and analyze: audio-recorded GC sessions in cancer, cardiac, and prenatal/reproductive genetic indications; pre-visit and post-visit quantitative surveys capturing patient experiences and outcomes and post-visit qualitative interview data. A novel, practical checklist will measure GC communication skills. Coincidence analysis will identify patterns of GC skills that are consistent with high scores on patient-reported measures. Two-level, multilevel models will be used to evaluate how GC communication skills and other session/patient characteristics predict patient-reported outcomes. Four community advisory boards (CABs) and a genetic counselor advisory board will inform the study design and analysis. ETHICS AND DISSEMINATION: This study has been approved by the single Institutional Review Board of the University of Minnesota. This research poses no greater than minimal risk to participants. Results from this study will be shared through national and international conferences and through community-based dissemination as guided by the study's CABs. A lay summary will also be disseminated to all participants.

Solvent-Driven Dynamics: Crafting Tailored Transformations of Cu(II)-Based MOFs.

Metal-organic frameworks (MOFs), a sort of crystalline porous coordination polymers composed of metal ions and organic linkers, have been intensively studied for their ability to take up nonpolar gas-phase molecules such as ethane and ethylene. In this context, interpenetrated MOFs, where multiple framework nets are entwined, have been considered promising materials for capturing nonpolar molecules due to their relatively higher stability and smaller micropores. This study explores a solvent-assisted reversible strategy to interpenetrate and deinterpenetrate a Cu(II)-based MOF, namely, MOF-143 (noninterpenetrated form) and MOF-14 (doubly interpenetrated forms). Interpenetration was achieved using protic solvents with small molecular sizes such as water, methanol, and ethanol, while deinterpenetration was accomplished with a Lewis-basic solvent, pyridine. Additionally, this study investigates the adsorptive separation of ethane and ethylene, which is a significant application in the chemical industry. The results showed that interpenetrated MOF-14 exhibited higher ethane and ethylene uptakes compared to the noninterpenetrated MOF-143 due to narrower micropores. Furthermore, we demonstrate that pristine MOF-14 displayed higher ethane selectivity than transformed MOF-14 from MOF-143 by identifying the "fraction of micropore volume" as a key factor influencing ethane uptake. These findings highlight the potential of controlled transformations between interpenetrated and noninterpenetrated MOFs, anticipating that larger MOF crystals with narrower micropores and higher crystallinity will be more suitable for selective gas capture and separation applications.

Communities organizing to promote equity: engaging local communities in public health responses to health inequities exacerbated by COVID-19-protocol paper.

Background: The COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state's response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis. Methods: To improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county's LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models. Discussion: This protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity.

Sobre la producción de certidumbre en salud pública: biopolítica y objetos especulativos / On the production of certainty in public health: biopolitics and speculative objects

Resumen En este trabajo, analizamos la producción de certidumbre en una política en salud configurada desde el esquema epistémico de la medicina basada en la evidencia: el régimen de Garantías Explícitas en Salud en Chile. Con base en los estudios de ciencia y tecnología, el análisis de material producido mediante etnografías focalizadas en escenarios ministeriales, y considerando entrevistas a expertos y profesionales, exponemos cómo en estos escenarios los objetos vinculados con la evidencia llegan a servir para tres propósitos: reducir la complejidad de procesos globales, conectar lo local con lo global y, fundamentalmente, generar un nuevo continuo que vincula la verdad con la incertidumbre. Caracterizamos a estas entidades como "objetos especulativos", destacando su importante papel en la articulación de retóricas que permiten la configuración local de la biopolítica.

Abstract This article analyzes the production of certainty in a health policy shaped by the epistemic scheme of evidence-based medicine: the Regime of Explicit Health Guarantees in Chile. Based on studies on science and technology, the analysis of material produced through focused ethnographies in ministry settings, and interviews with experts and professionals, this study exposes how objects linked to the evidence serve for three purposes in these scenarios: to reduce the complexity of global processes, to connect the local with the global, and to generate a new continuum that links truth with uncertainty. These objects are characterized here as "speculative objects," highlighting their important role in the articulation of rhetoric that allows the local configuration of biopolitics.

Hemobilia, una causa infrecuente de hemorragia del tracto digestivo superior / Hemobilia, a rare cause of upper gastrointestinal bleeding

Resumen La hemobilia es una causa poco frecuente de hemorragia del tracto gastrointestinal superior. La principal etiología es de origen iatrogénico y la posibilidad de hemobilia debe considerarse en cualquier paciente con hemorragia gastrointestinal y un historial reciente de procedimientos hepatobiliares. Otras causas menos frecuentes incluyen el trauma de abdomen, la enfermedad oncológica de la vía biliar o las enfermedades inflamatorias del páncreas o la vía biliar. La presentación clínica varía según la gravedad del sangrado; generalmente se presenta con dolor abdominal, ictericia y melenas, aunque puede cursar al ingreso con rectorragia e hipotensión. Un alto porcentaje de estas presenta resolución espontánea, sin requerir procedimientos adicionales. La angiografía es el estándar de oro para el diagnóstico de la hemobilia, pero los avances en la angiotomografía permiten que esta sea una opción menos invasiva y con mayor disponibilidad. La angioembolización es el tratamiento principal para estos pacientes, pero existen otras alternativas como la colocación de stent vascular o de stent en el conducto biliar.

Abstract Hemobilia is a rare cause of upper gastrointestinal (GI) tract bleeding. Its main etiology is iatrogenic, and the possibility of hemobilia should be considered in any patient with GI bleeding and a recent history of hepatobiliary surgery. Other less frequent causes include abdominal trauma, oncologic disease of the biliary tract, or inflammatory diseases of the pancreas or bile duct. Its clinical presentation varies depending on the severity of the bleeding. It usually presents with abdominal pain, jaundice, and tarry stools, although patients may also present with rectorrhagia and hypotension on admission. A high percentage of these symptoms have a spontaneous resolution, without requiring additional procedures. Angiography is the gold standard for the diagnosis of hemobilia, but advances in computed tomography angiography make it a less invasive and more widely available option. Endovascular embolization is the main treatment for these patients, but there are other alternatives such as vascular or bile duct stent placement.

Cuidado de enfermería, factor fundamental para la evolución de las personas con fístulas enterocutáneas / Nursing care, essencial factor for the evolution of people with enterocutaneous fistulas

Resumen Objetivo: Conocer los tipos de cuidados de enfermería y de otros profesionales de la salud para las personas hospitalizadas por fístulas enterocutáneas. Metodología: Se realizó una revisión integrativa de literatura siguiendo los pasos de Ganong (1987) y la guía PRISMA. Se utilizaron las bases de datos MEDLINE, LILACS, BDENF, CINAHL y SCIELO. Se consultaron artículos en inglés y español que estuvieran en texto completo y de acceso gratuito. Los descriptores y palabras claves utilizados fueron: fistula, atención de enfermería, adulto Enterocutaneous fistula, intestinal fistula, therapy, nursing care, adult, hospitalization. Se incluyeron artículos publicados entre los años 2014 a 2020. Resultados: Se encontraron 13 Artículos de los cuáles 8 fueron Guías Clínicas, 3 casos Clínicos y 2 Revisiones Integrativas, los cuales aportan información sobre los cuidados al paciente con fistula enterocutánea distribuidos en cinco pilares, los cuales orientan el manejo interdisciplinario que se da a este tipo de pacientes en el ámbito clínico. Conclusión: Los cuidados a las personas con fístulas enterocutáneas en el ámbito clínico, tiene un abordaje interdisciplinario basado en cinco pilares: prevención y control de sepsis, del desequilibrio hidroelectrolítico, prevención de la desnutrición, el control del efluente y el cuidado de la piel perilesional.Palabras Clave: Fistula, atención de enfermería, adulto.

Objetos proposicionales: una política organizacional mediada por documentos / Propositional objects: an organizational policy mediated by documents

Los documentos han formado parte importante de los procesos de formalización y transforma-ción organizacional. Esto ha sido particularmente evidente en el campo de la medicina. En este trabajo analizamos las acciones que promueven documentos como las guías de práctica clínica. Realizamos etnografías focalizadas, entrevistas y análisis documental en espacios de diseño, así como también en centros de atención. Para el análisis, adoptamos la perspectiva de la teoría del actor-red. Esta aproximación nos ha permitido señalar cómo las guías inscriben relaciones que son interpretadas localmente, entablan vínculos de co-afección en tanto modifican y son modificadas por los escenarios clínicos, y participan de arreglos pragmáticos para formular de-terminados efectos. Finalmente, y adoptando elementos de la filosofía procesual de Whi-tehead, consideramos que estas pueden ser concebidas como objetos proposicionales. Estos ob-jetos recogen las potencialidades normativas de un escenario, ofrecen ocasiones para ser in-troducidos en relaciones y, asimismo, orientar su curso. (AU)

Documents have been an important part of organisational formalization and transformation. This has been particularly evident in the medical field. In this work we analyze the actions promoted by documents such as clinical practice guidelines. We carried out focused ethnogra-phies, interviews, and documentary analysis in design spaces, as well as in care centres. For the analysis, we adopted actor-network theory perspective. This approach has allowed us to point out how the guides inscribe relationships that are interpreted locally, establish co-affection links as they modify and are modified by the clinical scenarios, and participate in pragmatic arrangements to formulate clinical effects. Finally, and adopting elements of Whitehead's process philosophy, we consider that these can be conceived as propositional ob-jects. These objects collect the normative potential of a scenario, offer opportunities to be introduced into relationships and, likewise, guide its course. (AU)

Frequency of depression and anxiety symptoms in mexican patients with rheumatic diseases determined by self-administered questionnaires adapted to the spanish language

Abstract Background The frequency of depression and anxiety symptoms in Spanish-speaking patients suffering from rheumatic conditions is unknown when using self-administered detection tools. Methods A single-center, cross-sectional survey including 413 patients (341 women) with well-defined rheumatic diseases was conducted. The patient health questionnaire-9 (PHQ-9) and generalized anxiety disorder (GAD)-7 questionnaires were used to detect depression and anxiety symptoms, respectively. Results A total of 193 patients (46.7%) reported depression symptoms, and increased PHQ-9 scores were more frequently observed in women than in men (23% vs. 13%; p = 0.038), particularly in association with osteoarthritis, fibromyalgia, Sjögren’s syndrome, and osteoporosis. From 88 patients (21.3%) with PHQ-9 scores ≥ 10 points (moderate-to-severe depression symptoms), 27 (30.6%) were previously diagnosed to have depression and only four were under antidepressant treatment. Anxiety symptoms were observed in 168 patients (40.6%) and classified as moderate-to-severe by elevated GAD-7 scores in 68 subjects (16.4%). Of them, 12 (17.6%) were previously diagnosed with GAD, but only 4 (5.8%) were under therapy. Conclusions An unexpected and unusually high frequency of undiagnosed depression and anxiety symptoms was found in rheumatic patients. Self-administered screening tools adapted to the Spanish language are useful and may help clinicians to suspect these conditions.

Autosabotaje en el amor: una trampa catastrófica. Análisis basado en los largometrajes Love y La vida de Adele / Self-sabotaje in love: a catastrophic trap. Analysis based on the films Love and Blue is in the warmest color

Este artículo presenta el resultado de las interpretaciones realizadas en el proyecto de investigación del curso de trabajo de grado cine y condición humana del programa de psicología de la Universidad Católica Luis Amigó, denominado Autosabotaje en el amor: una trampa catastrófica, análisis basado en los largometrajes Love y La vida de Adele, cuyo objetivo fue analizar los factores que inciden en el surgimiento del autosabotaje en el amor, por medio de los personajes de las películas La vida de Adele y Love. La investigación tuvo enfoque cualitativo de tipo hermenéutico - fenomenológico, donde se hizo un análisis de los personajes de los largometrajes mencionados, a la luz de teorías psicoanalíticas y filosóficas. Lo encontrado da cuenta de que el autosabotaje puede ser un mecanismo de defensa, que surge como vía de escape, ante una evidente desidealización del objeto amado, o un temor del sujeto autosaboteador de asumir la plenitud de su deseo.

This article presents the results of the interpretations made in the research project of the degree work, film and human condition of the psychology program of the Univer sidad Católica Luis Amigó, called: Self-sabotage in love: a catastrophic trap, analysis based on the feature films Love and Blue is the Warmest Colour, whose objective was to analyze the factors that affect the emergence of self-sabotage in love, through the characters in the movies Blue is the Warmest Colour and Love. The research had a qualitative hermeneutic-phenomenological approach, where characters were analyzed of the aforementioned films, in light of psychoanalytic and philosophical theories. The findings show that self-sabotage can be a defense mechanism, which emerges as a way of escape, in the face of evidence of deglamoring the beloved object, or a fear of the self-sabotage subject to assume the fullness of desire.

Efecto del tiempo y temperatura de almacenamiento a corto plazo sobre el contenido de las proteínas en leche humana / Effects of short term storage time and temperature on the protein content of human milk

La leche materna constituye el alimento ideal para el recién nacido y el lactante en forma exclusiva hasta los 6 meses de edad; y hasta los 2 años con alimentos complementarios. El destete precoz es de causa multifactorial: falta de control prenatal, desconocimiento de los beneficios de la leche materna, hipogalactia, prácticas hospitalarias inadecuadas, publicidad de alimentos infantiles, incorporación de la madre al trabajo y como desconocimiento sobre la extracción y preservación de la leche humana. El objetivo del presente trabajo es evaluar el efecto del tiempo y temperatura de almacenamiento a corto plazo, sobre el contenido de proteínas en la leche humana madura de madres que asistieron a la consulta del Hospital “Dr. Jorge Lizárraga”, Valencia, Estado Carabobo, Venezuela. Investigación experimental, correlacional, cuantitativa y aplicada. Fueron analizadas 20 muestras de leche, de mujeres sanas, con amamantamiento en forma exclusiva, obtenidas por extracción manual. Cada una de ellas se separó en 2 la alícuotas: 1. Para analizar en fresco, 2 tras almacenamiento a 15˚C durante 24 horas. La determinación de proteínas se realiz según las normas industriales Covenin. La concentración de proteínas fue de 1,53 gr/dl en leche recién extraída y 1,50 gr/dl en leche almacenada a 15 ˚C por 24 horas. No hubo diferencia significativa entre los valores de proteínas en leche materna recién extraída y almacenada. En la leche humana almacenada a 15 ˚C durante 24 horas, las concentraciones de las proteínas no se modifican comparándola con la leche recién extraída

Maternal milk is the ideal food for newborns and infants, on an exclusive basis, up to six months and together with complementary food, up to two years of age. The early weaning could have multifactorial causes: lack of prenatal control, unawareness of the benefits of breastfeeding, hypogalactia, inappropriate hospital practices, advertising of infant foods, return of the mother to work, unawareness regarding milk extraction and preservation. The objective of this investigation is to evaluate the effect of storage time and temperature within a short term on how it affects the protein content in mature milk of mothers who attended medical consulting at Hospital Dr. Jorge Lizarraga. This is an experimental, correlational, cuantitative and applied investigation. Twenty milk samples were analyzed from healthy women with exclusive breastfeeding, obtained through manual extraction. Each of these samples was separated in 2 aliquots: 1. To be analyzed at once. 2. To be analyzed after being stored at 15°C for 24 hours. Determination of proteins was performed according to the industrial norms of Covenin. The concentration of proteins was of 1,53 gr/dl in recently extracted milk and 1,50 gr/dl in milk stored at 15°C for 24 hours. There was no significant difference between the values of proteins found in the recently extracted maternal milk and the one that had been stored

Complejo esclerosis tuberosa: a propósito de un caso / Tuberous sclerosis complex: a case report

El complejo esclerosis tuberosa (CET) es una enfermedad, multisistémica, autosómica, dominante caracterizada por una diversidad de manifestaciones clínicas. El 85% de los niños con esta enfermedad presenta manifestaciones nuerológicas que por su gravedad, constituyen la principal causa de morbimortalidad. Los rabdomiomas cardiacos están presentes en 66% en recién nacidos y las lesiones mucocutáneas en un 100%. Se produce por mutaciones de los genes TSCI del cromosoma 9q34 y TSC2 del cromosoma 16q13.3. Se hereda con un rasgo autosómico dominante, pero el 60% -70% de los casos son esporádicos y representarían nuevas mutaciones. La prevalencia de esta enfermedad varía entre 1/10000 de los niños nacidos vivos. Presentar la evolución clínica de un lactante masculino de 3 meses de edad, con diagnóstico de esclerosis tuberosa y revisar los aspectos más relevantes de esta anomalía congénita. Lactante de 3 meses de edad, referido por presentar rabdomioma cardíaco diagnósticado por ecografía perinatal. En la resonancia magnética cerebral, se evidenciaron nódulos subependimarios adyacentes al cuerno frontal del ventrículo lateral. Evaluación dermalógica con lámpara de Wood: se observaron máculas en hojas de fresno, compatibles con una enfermedad neurocutánea. La esclerosis tuberosa puede originar manifestaciones clínicas muy diversas, por lo que requiere de un diagnóstico precóz para garantizar la calidad de vida de estos pacientes, a través de la intervención multidisciplinaria de todo el equipo de salud

The tuberous sclerosis complex (TSC) is a multisystemic disease, autosomic dominant, characterized by a variety of clinical manifestations. Eighty five percent of children with this disease present neurological manifestations which, due to their sever ity, are the main cause of mortality. Cardiac rhabdomyomas occur in 66% of newborns and mucocutaneous lesions in 100%. This disease is caused by mutations in the TSC1 gene of chromosome 9q34 and TSC2 of chromosome 16p13.3. It is inherited as an autosomic dominant trait, but 60% -70% of cases are sporadic and represent new mutations. The prevalence of this disease varies from 1/6000 to 1/10000 live births. To report the clinical course of a 3 month old infant male, diagnosed with tuberous sclerosis and to review the mostrelevant aspects of this congenital disease. This is a 3 month old infant, referred because of a cardiac rhabdomyoma disgnosed in a perinatal ultrasound. The brain MRI showed subependymal nodules adjacent to the frontal horn of the lateral ventricle. Dermatological evaluation with Wood’s lamp revealed ash-leaf macules consistent with neurocutaneous disease. Tuberous sclerosis may cause a variety of clinical manifestations, and therefore requires early diagnosis to ensure the quality of life of these patients through multidisciplinary intervention by the entire health team

Casos clinicos: angioplastia pulmonar percutánea en atresia pilmonar neonatal / Clinical cases: percutaneous pulmonary angioplasty neonatal pulmonary atresia

Se presenta el caso clínico de un recien nacido masculino con el diagnóstico de atresia pulmonar por fusión valvar y perfusión pulmonar ductus dependiente; a quién se realizó una valvuloplastía pulmonar percutánea con guía fluoroscópica para restablecer un flujo anterógrado efectivo desde el ventrículo derecho al árbol vascular pulmonar.

Experiencias y retos del análisis sociológico en salud / Experiences and challenges and the health sociaologycal analysis

En un breve análisis del uso de los métodos cuantitativos y cualitativos a partir de la evolución de las ciencias sociales, se resalta la influencia instrumental del quehacer investigativo actual, que aun cuando reconoce la necesidad del pluralismo metodológico y la articulación de diferentes niveles de análisis, se adecua a fines teóricos o hipotéticos y a objetivos de dirección muy generales. A través de experiencias de investigaciones espacio-territoriales del Centro de Salud y Bienestar Humanos de la Universidad de La Habana, se resalta el enfoque epistemológico del espacio geográfico como vía para lograr análisis más integrados que identifiquen la heterogeneidad de la sociedad y contribuyan al desarrollo de políticas o acciones diferenciadas en salud. A partir de estrategias teóricas integradas y flexibles, se plantean algunos retos prácticos y éticos para los investigadores sociales de la salud(AU)

Relaciones verticales entre la lengua y el hueso hioides en el niño. Parte II / Vertical relationship between the tongue and the hyoid bone in the child. Part II

Sobre una muestra de 35 niños, de 6 años 10 meses como promedio de edad, se realizaron trazados cefalométricos a partir de telerradiografías de perfil tomadas en reposo mandibular. Se determinó la posición del hioides siguiendo el protocolo descrito por Bibby y se obtuvo una posición promedio de 0,37 mm. por debajo de un plano dado por C3 y SB y para la lengua una posición promedio de 44,18 mm. por sobre este mismo plano. Se realizó un estudio de correlación para ambas variables, la que indicó una débil relación cuantitativa entre las variables estudiadas (r = -0,32). Utilizando los mismos trazados, se describió la posición del dorso lingual y su relación con la bóveda palatina utilizando el método descrito en Rakosi, la que se correlacionó con las observaciones clínicas de postura lingual en reposo. Dichos resultados se presentan como estudio preliminar