«Nos trata por igual, nos guía¼: navegación de pares para la vinculación al cuidado del VIH en hombres que tienen sexo con hombres y mujeres transgénero en Lima, Perú / "They treat us as equals, they guide us": peer navigation for HIV care engagement with men who have sex with men and transgender women in Lima, Peru

Objetivo.Analizar los elementos de un programa de navegación en Lima que facilitaron la vinculación de hombres que tienen sexo con hombres (HSH) y mujeres transgénero (MT) a la atención del VIH. Materiales y métodos. Realizamos entrevistas a 20 usuarios recibiendo servicios de navegación y a 4 navegadores pares viviendo con VIH. Resultados. El trabajo de los navegadores contribuyó a cubrir una brecha en los servicios para el VIH, brindando acompañamiento personalizado para navegar el sistema de salud y facilitando el proceso de vinculación a la atención médica. Conclusiones. La navegación de pacientes basada en el desarrollo de fortalezas de los usuarios puede ser una estrategia útil y factible para mejorar la vinculación al cuidado médico de HSH y MT en Perú, incorporando navegadores pares a los equipos de salud, horizontalidad en el trato y estrategias de salud pública con mayor participación comunitaria

Protocolo para el tratamiento de la recesión gingival con membrana de fibrina rica en plaquetas / Protocol for the Treatment of Gingival Recession with Platelet-rich Fibrin Membrane

Introducción: Es necesario la aplicación de protocolos de actuación como herramientas que permiten homogeneizar los procedimientos plásticos periodontales regenerativos y establecer las pautas de actuación del Periodontólogo para el abordaje de las recesiones gingivales con esta modalidad terapéutica de avanzada. Objetivo: Diseñar un protocolo para el tratamiento de la recesión gingival mediante la utilización de la membrana de fibrina rica en plaquetas, asociada al colgajo de avance coronal. Métodos: Se realizó una investigación con enfoque cualitativo en la Facultad de Estomatología de Villa Clara, de julio de 2020 a diciembre de 2021. Para el diseño del protocolo se empleó una fase de preparación y una de elaboración; dentro de esta última se estructuraron tres momentos: revisión sistemática de la literatura, aplicación de técnicas grupales (grupo focal y nominal) y conclusión del documento. Se realizó una valoración por criterios de especialistas externos antes de concluir la estructura definitiva del protocolo. Resultados: Se consultaron cinco guías para la confección de protocolos, cinco protocolos de atención médica y enfermería y 10 estomatológicos. La estructura del documento quedó conformada por: portada, introducción, objetivos, profesionales a quienes va dirigido, población diana, proceso de elaboración, procedimiento, algoritmo, fecha de implementación y revisión, proceso de implantación, indicadores de evaluación, glosario y referencias bibliográficas. Conclusiones: Se diseñó un protocolo de actuación que establece las pautas para la realización del proceder terapéutico regenerativo, desde la selección de los pacientes hasta la evolución de la terapéutica. El documento se valoró por especialistas externos como positivo(AU)

Introduction: It is necessary to apply action protocols as tools to homogenize regenerative periodontal plastic procedures and to establish the guidelines for the periodontist to approach gingival recession with this advanced therapeutic modality. Objective: To design a protocol for the treatment of gingival recession using platelet-rich fibrin membrane associated with coronal advancement flap. Methods: A research with a qualitative approach was carried out in the School of Stomatology of Villa Clara, from July 2020 to December 2021. For the design of the protocol, a preparation phase and an elaboration phase were used; within the latter, three moments were structured: systematic review of the literature, application of group techniques (focal and nominal group) and conclusion of the document. An evaluation by external specialists was carried out before finalizing the definitive structure of the protocol. Results: Five guides for the preparation of protocols, five medical and nursing care protocols and 10 stomatological protocols were consulted. The structure of the document consisted of: cover page, introduction, objectives, target professionals, target population, elaboration process, procedure, algorithm, implementation and revision date, implementation process, evaluation indicators, glossary and bibliographic references. Conclusions: An action protocol was designed that establishes the guidelines for carrying out the regenerative therapeutic procedure, from the selection of patients to the evolution of the therapy. The document was positively evaluated by external specialists(AU)

Exploring the Global Landscape of Self-Medication Among Students: Trends, Risks, and Recommendations for Safe and Responsible Practices

Objective: This study aimed to provide a comprehensive overview of self-medication practices among students by conducting a bibliometric analysis of the available scientific literature. This research highlights the importance of promoting safe and responsible healthcare behaviors among students. Methods: A systematic search was conducted in the Scopus database to retrieve all peer-reviewed English articles and reviews published from 1968 onwards. The retrieved documents were analyzed to identify publication trends, citation counts, top journals, geographical distribution, and emerging research themes. Results: The findings indicate a significant increase in published literature about student self-medication over the past fifteen years. However, it was observed that the citation count for these documents was lower than expected, suggesting a need for increased attention toward this critical topic. The analysis also identified several hot topics in student self-medication, including the misuse of over-the-counter medications, dietary supplements, and psychoactive substances. The inappropriate use of antibiotics and the self-medication of mental health issues, such as anxiety and depression, were also identified as significant problems. Conclusions and recommendations: Self-medication among students is a complex and critical issue that requires immediate attention. This study highlights the urgent need for greater awareness and education regarding responsible self-medication practices among students. New policies, interventions, and strategies should be developed to address malpractices, misconceptions, and harmful practices related to self-medication. Educational institutions and health authorities should play a crucial role in providing students with mental health resources and support services... (AU)

Insuficiente aplicación de Medicina Natural y Tradicional en afecciones relacionadas con la ortopedia y la traumatología / Unsatisfactory Application of Natural and Traditional Medicine in Conditions Related with Orthopedics and Traumatology

La Medicina Natural y Tradicional aplica sus diferentes modalidades en la práctica médica moderna, segura, económica, inocua y simple; y con pocos efectos colaterales resuelve grandes problemas de salud en situaciones especiales o de desastres con recursos limitados. De ahí que el egresado de programas de especialización de las ciencias médicas cuenta con sólidos conocimientos para su aplicación, especialmente en las afecciones osteomioarticulares, donde la especialidad de ortopedia y traumatología tiene un papel primordial para identificar las causas y consecuencias de la insuficiencia de su aplicación en pacientes portadores de afecciones relacionadas con esta especialidad. A través de un estudio crítico reflexivo basado en el análisis y la síntesis, así como de la constatación de la validez de los puntos de vista asumidos como referentes en el proceso de superación del especialista de ortopedia y traumatología, se pudo mostrar cómo se ha concebido la superación profesional en el Hospital General Dr. Juan Bruno Zayas Alfonso, al integrar adecuadamente los conocimientos y las competencias. Esto se expresó en la elaboración e implementación de una estrategia de superación profesional, que permitió la actualización de relevantes conocimientos necesarios en el campo de la MNT para el desempeño de este profesional. Se concluyó que era insuficiente el nivel de conocimiento de los contenidos, como también los cursos ofertados para su desarrollo, lo que trajo como consecuencia una atención médica sin calidad(AU)

Natural and traditional medicine applies its different modalities in modern, safe, economical, innocuous and simple medical practice; with few collateral effects, it solves major health problems in special or disaster situations with limited resources. Hence, the graduate of specialization programs in medical sciences possesses solid knowledge for its application, especially in osteomyoarticular conditions, in which the specialty of orthopedics and traumatology has a key role in identifying the causes and consequences of its unsatisfactory application in patients with conditions related to this specialty. Through a reflexive and critical study based on analysis and synthesis, as well as the verification of the validity of the viewpoints assumed as referents in the process of improvement of the orthopedics and traumatology specialist, it was possible to show how professional improvement has been conceived at Hospital General Dr. Juan Bruno Zayas Alfonso, by adequately integrating knowledge and competences. This was expressed through the elaboration and implementation of a professional improvement strategy, which allowed updating relevant knowledge necessary in the field of natural and traditional medicine for the performance of this professional. The level of knowledge about the contents was concluded to be insufficient, while the courses offered for its development were so, which resulted in a medical care without quality(AU)

Compreendendo o termo gordofobia médica a partir da perspectiva de pessoas gordas / Understanding the term medical fatphobia from the perspective of fat people

Resumo O ativismo gordo tem como objetivo unir e mobilizar pessoas gordas, a fim de romper com a inviabilização de seus corpos e denunciar a gordofobia. Há algum tempo, o ativismo vem impulsionando a expressão "gordofobia médica" para denunciar a opressão vivenciada dentro dos serviços de saúde. Este artigo tem como objetivo compreender o termo, a partir da percepção de pessoas gordas. É uma pesquisa qualitativa, com dados coletados por meio de um questionário virtual direcionado a pessoas gordas ou ex-gordas, que alcançou 515 respondentes de todas as regiões do Brasil. Os dados foram analisados utilizando a análise temática, com a criação de seis categorias. Entre os principais resultados, pode-se compreender que a gordofobia médica envolve: despreparo, desrespeito e autoritarismo; reprodução de estereótipos, repulsa e preconceito, desumanização da pessoa gorda, diagnóstico superficial e generalizante, desprezo da queixa, foco no peso e negligência, e precarização do acesso e dos cuidados em saúde. Conclui-se que o estudo auxilia na compreensão do termo gordofobia médica, o que facilita o seu reconhecimento e prevenção na área da saúde.

Abstract Fat activism aims to unite and mobilize fat people to break with the impracticability of these bodies and denounce fatphobia. For some time now, activism has been pushing the expression "medical fatphobia" to denounce the oppression experienced by fat people within health services. This article aims to understand the term, from the perspective of fat people. This is a qualitative research, with data were collected via a virtual questionnaire aimed at fat or formerly fat people, which reached 515 respondents from all regions of Brazil. Data were analyzed using thematic analysis, with the creation of six categories. Among the main results, it can be understood that medical fatphobia involves: unpreparedness, disrespect and authoritarianism; reproduction of stereotypes, disgust and prejudice; dehumanization of the fat person; superficial and generalizing diagnosis; dismissal of the complaint, focus on weight and negligence; and precarious access to the health care. In conclusion, the work helps in understanding the term medical fatphobia, which facilitates its recognition and prevention in the health field.

Análisis de la atención sanitaria realizada en el buque escuela «Juan Sebastián de Elcano» durante diez años (2010-2020) / Analysis of health care performed on the Juan Sebastian de Elcano School Ship during ten years (2010-2020)

Introducción: El buque escuela Juan Sebastián de Elcano es un bergantín-goleta de la Armada. Debido a sus características y tipo de navegaciones, la asistencia sanitaria (prestada por un Role 1 embarcado y, puntualmente, por un equipo quirúrgico compuesto por un oficial médico cirujano general y un oficial médico anestesiólogo), está considerada un recurso esencial. Material y métodos: Estudio descriptivo retrospectivo sobre las atenciones médicas realizadas a bordo agrupadas por especialidad, pruebas médicas complementarias, consumo de hemoderivados, motivo de asistencia médica en puerto, número de evacuaciones hasta territorio nacional y tipo de consultas realizadas por telemedicina al Role 4 durante doce cruceros de navegación entre 2010 y 2020. Resultados: Las asistencias sanitarias más prevalentes han sido: traumatológicas (n=1.982, 22.04 %), seguidas de otorrinolaringológicas (n=1.234, 13,72 %) y finalmente la tercera especialidad con consultas más prevalentes fue medicina interna (n=1.125, 12,50 %). Se llevaron a cabo 112 interconsultas en puerto (primera causa odontología y segunda traumatología) y 24 evacuaciones a territorio nacional. Las pruebas complementarias más frecuentemente solicitadas fueron: control de estupefacientes y radiografías. Se realizaron 37 consultas de telemedicina y no se transfundió ninguna unidad de hemocomponentes durante el periodo analizado. Conclusiones: El estudio de la asistencia sanitaria en el buque escuela de la Armada ha revelado que la traumatología es la causa más prevalente de las consultas a bordo, seguida de las interconsultas en puerto, las consultas por telemedicina y evacuaciones en territorio nacional. Gracias a la labor de la Sanidad Militar a bordo es posible la función marinera, docente y embajadora en los mares. (AU)

Overview: Juan Sebastián de Elcano training ship is a brigantine-school of the Spanish Navy. Due to its characteristics and navigation type, health care (provided by a Role 1 on-board and occasionally enhanced by a surgical team that includes a general surgeon medical officer and an anesthesiologist medical officer), is considered an essential resource. Material and methods: Retrospective descriptive study of medical care provided on board, grouped by medical specialty, complementary tests, blood products consumption, reason of medical assistance in port, number of evacuations to national territory and type of consultations performed by telemedicine to Role 4 during twelve sailing cruises between 2010 and 2020. Results: The most prevalent healthcare services were traumatology (n=1.982, 22.04%), followed by otorhinolaryngology (n=1.234, 13.72%) and the third was internal medicine (n=1.125, 12.50%). 112 internal medicine consultations were conducted in port (dental first and traumatology second) and 24 evacuations to national territory. The most often requested complementary tests were drug control and X-rays. There were 37 telemedicine consultations and no unit of blood components were transfused during the analyzed period. Conclusions: The study of health care on the navy training ship has shown that traumatology is the most frequent cause of medical consultations on board, followed by internal medicine consultations in port, telemedicine consultations and evacuations to national territory. Thanks to the work of the Military Health on board, it is possible to sail, teach and be ambassador on the seas. (AU)

Análisis de la atención sanitaria realizada en el buque escuela «Juan Sebastián de Elcano» durante diez años (2010-2020) / Analysis of health care performed on the Juan Sebastian de Elcano School Ship during ten years (2010-2020)

Introducción: El buque escuela Juan Sebastián de Elcano es un bergantín-goleta de la Armada. Debido a sus características y tipo de navegaciones, la asistencia sanitaria (prestada por un Role 1 embarcado y, puntualmente, por un equipo quirúrgico compuesto por un oficial médico cirujano general y un oficial médico anestesiólogo), está considerada un recurso esencial. Material y métodos: Estudio descriptivo retrospectivo sobre las atenciones médicas realizadas a bordo agrupadas por especialidad, pruebas médicas complementarias, consumo de hemoderivados, motivo de asistencia médica en puerto, número de evacuaciones hasta territorio nacional y tipo de consultas realizadas por telemedicina al Role 4 durante doce cruceros de navegación entre 2010 y 2020. Resultados: Las asistencias sanitarias más prevalentes han sido: traumatológicas (n=1.982, 22.04 %), seguidas de otorrinolaringológicas (n=1.234, 13,72 %) y finalmente la tercera especialidad con consultas más prevalentes fue medicina interna (n=1.125, 12,50 %). Se llevaron a cabo 112 interconsultas en puerto (primera causa odontología y segunda traumatología) y 24 evacuaciones a territorio nacional. Las pruebas complementarias más frecuentemente solicitadas fueron: control de estupefacientes y radiografías. Se realizaron 37 consultas de telemedicina y no se transfundió ninguna unidad de hemocomponentes durante el periodo analizado. Conclusiones: El estudio de la asistencia sanitaria en el buque escuela de la Armada ha revelado que la traumatología es la causa más prevalente de las consultas a bordo, seguida de las interconsultas en puerto, las consultas por telemedicina y evacuaciones en territorio nacional. Gracias a la labor de la Sanidad Militar a bordo es posible la función marinera, docente y embajadora en los mares. (AU)

Overview: Juan Sebastián de Elcano training ship is a brigantine-school of the Spanish Navy. Due to its characteristics and navigation type, health care (provided by a Role 1 on-board and occasionally enhanced by a surgical team that includes a general surgeon medical officer and an anesthesiologist medical officer), is considered an essential resource. Material and methods: Retrospective descriptive study of medical care provided on board, grouped by medical specialty, complementary tests, blood products consumption, reason of medical assistance in port, number of evacuations to national territory and type of consultations performed by telemedicine to Role 4 during twelve sailing cruises between 2010 and 2020. Results: The most prevalent healthcare services were traumatology (n=1.982, 22.04%), followed by otorhinolaryngology (n=1.234, 13.72%) and the third was internal medicine (n=1.125, 12.50%). 112 internal medicine consultations were conducted in port (dental first and traumatology second) and 24 evacuations to national territory. The most often requested complementary tests were drug control and X-rays. There were 37 telemedicine consultations and no unit of blood components were transfused during the analyzed period. Conclusions: The study of health care on the navy training ship has shown that traumatology is the most frequent cause of medical consultations on board, followed by internal medicine consultations in port, telemedicine consultations and evacuations to national territory. Thanks to the work of the Military Health on board, it is possible to sail, teach and be ambassador on the seas. (AU)

Recomendaciones de no hacer en distintos ámbitos de la atención pediátrica / Do not do recommendations in different paediatric care settings

Introducción: Muchas son las iniciativas encaminadas a eliminar intervenciones clínicas de poco valor en la asistencia sanitaria. Desde el Comité de Calidad Asistencial y Seguridad del Paciente de la Asociación Española de Pediatría, se ha propuesto la elaboración de recomendaciones de «no hacer» (RNH) con el objetivo de señalar una serie de prácticas evitables en la atención del paciente pediátrico en atención primaria, urgencias, hospitalización y domicilio. Material y métodos: Este trabajo se desarrolló en 2fases: una primera en la que se propusieron posibles RNH y una segunda en la que se consensuaron las recomendaciones finales mediante el método Delphi. Tanto las propuestas como las evaluaciones partieron de miembros de los grupos y sociedades pediátricas a los que se les realizó la propuesta, coordinados por miembros del Comité de Calidad Asistencial y Seguridad del Paciente. Resultados: Fueron propuestas un total de 164 RNH por la Sociedad Española de Neonatología, la Asociación Española de Pediatría de Atención Primaria, la Sociedad Española de Urgencias de Pediatría, la Sociedad Española de Pediatría Interna Hospitalaria y el Comité de Medicamentos de la Asociación Española de Pediatría con el Grupo Español de Farmacia Pediátrica de la Sociedad Española de Farmacia Hospitalaria. Se logró reducir el conjunto inicial a 42 RNH y en sucesivas fases se llegó a la selección final de 25 RNH, 5 RNH por cada grupo o sociedad. Conclusiones: Este proyecto ha permitido seleccionar y consensuar una serie de recomendaciones para evitar prácticas inseguras, ineficientes o de escaso valor en distintos ámbitos de la atención pediátrica, lo que podría resultar útil para mejorar la seguridad y la calidad de nuestra actividad asistencial. (AU)

Introduction: There are many initiatives aimed at eliminating health care interventions of limited utility in clinical practice. The Committee on Care Quality and Patient Safety of the Spanish Association of Pediatrics has proposed the development of «do not do» recommendations (DNDRs) to establish a series of practices to be avoided in the care of paediatric patients in primary, emergency, inpatient and home-based care. Material and methods: The project was carried out in 2 phases: a first phase in which possible DNDRs were proposed, and a second in which the final recommendations were established by consensus using the Delphi method. Recommendations were proposed and evaluated by members of the professional groups and paediatrics societies invited to participate in the project under the coordination of members of the Committee on Care Quality and Patient Safety. Results: A total of 164 DNDRs were proposed by the Spanish Society of Neonatology, the Spanish Association of Primary Care Paediatrics, the Spanish Society of Paediatric Emergency Medicine, the Spanish Society of Internal Hospital Paediatrics and the Medicines Committee of the Spanish Association of Pediatrics and the Spanish Group of Paediatric Pharmacy of the Spanish Society of Hospital Pharmacy. The initial set was limited to 42 DNDRs, and the selection over successive rounds yielded a final set of 25 DNDRs, with 5 DNDRs for each paediatrics group or society. Conclusions: This project allowed the selection and establishment by consensus of a series of recommendations to avoid unsafe, inefficient or low-value practices in different areas of paediatric care, which may contribute to improving the safety and quality of paediatric clinical practice. (AU)

As receitas médicas de Hannah Woolley: prática cotidiana e autoridade feminina na Inglaterra do século XVII / The medicinal recipes of Hannah Woolley: everyday practice and female authority in seventeenth-century England

Resumo O artigo retrata os interesses de uma escritora inglesa do século XVII sobre cuidados médicos, e as razões que a levaram a publicar textos sobre essa matéria. Hannah Woolley tecia orientações sobre diversos assuntos do âmbito doméstico, entre os quais receitas para preservar a beleza e a saúde. O artigo investiga os princípios que regiam o preparo dessas receitas, as intenções de Woolley ao escrever sobre o tema, e a maneira como a medicina acadêmica era traduzida e praticada por mulheres no cotidiano da época. O delineamento dessas questões ajudará a elucidar o cenário de atuação das curadoras letradas e a natureza das relações que teceram com os médicos eruditos.

Abstract This article describes a seventeenth-century English woman writer's interests in medical care and the reasons that led her to publish texts on this topic. Hannah Woolley offered guidance on a wide variety of topics in the domestic sphere, including recipes for health and beauty. Here we investigate the principles that governed the preparation of these recipes, Woolley's intentions in writing on this topic, and the way in which academic medicine was translated and practiced by women routinely during this period. Defining these issues will help shed light on the scenario in which literate female healers worked and the nature of their relationships with learned physicians.

Estado, naturaleza: Instituciones de salud pública y atención médica en São Paulo entre los siglos XIX y XX / State, nature: Public health and medical care institutions in São Paulo between the 19th and 20th centuries

El artículo tiene como objetivo discutir la noción de naturaleza y salud pública durante la transición del Imperio a la República, específicamente en São Paulo, en la región sureste de Brasil. La calidad de la naturaleza de São Paulo fue repetidamente destacada, incluso después de la llegada de las grandes epidemias de fiebre amarilla y cólera a partir de 1850. Los principales cambios que tuvieron lugar en ese período fueron el aumento de la densidad democrática, la sustitución del trabajo esclavizado por trabajadores blancos y el cambio de régimen político. El objetivo aquí es discutir de manera panorámica el lugar de asistencia brindado por las Santas Casas de Misericordia en el cambio del siglo XIX al XX, en un período en que la atención a la salud todavía era la principal preocupación del gobierno. Veremos que, con la creación de los servicios sanitarios en el período republicano, las nociones de benignidad del clima y de las tierras de São Paulo se transformaron en la apreciación del avance sanitario y la calidad del marco civilizador de São Paulo.(AU)

The article aims to discuss the notion of nature and public health during the transition from Empire to Republic, specifically in São Paulo, in the southeastern region of Brazil. The quality of nature in São Paulo was repeatedly highlighted, even after the arrival of the great epidemics of yellow fever and cholera from 1850 onwards. The main changes that took place in that period were the increase in democratic density, the replacement of slave labour by white workers and the change of political regime. The aim here is to discuss in a panoramic way the place of assistance provided by the Santas Casas de Misericordia at the turn of the nineteenth to the twentieth century, in a period when health care was still the main concern of the government. We will see that, with the creation of health services in the republican period, notions of the benignity of the climate and lands of São Paulo were transformed in the appreciation of the sanitary progress and the quality of the civilising framework of São Paulo.(AU)

The Influence of the Development and Management of Sports Tourism Resources on the Emotional Experience of Human Settlements / La influencia del desarrollo y gestión de los recursos del turismo deportivo en la experiencia emocional de los asentamientos humanos

This study aims to determine how sports tourism resources' development and administration affect human settlements' emotional experience. To analyze the new influencing factors of the population change rate since the beginning of the 21st century, the first decade of the 21st century in each province and city served as the research object. Excel and SPSS statistical software were used for one-way ANOVA, multiple comparative analysis, correlation analysis, and linear regression analysis. Society, the economy, medical care, education, and the natural environment were identified as the most influential factors in human settlements by the study. The population growth factor is still dominated by the economy, but people are paying increasing attention to the environmental factor. It has been discovered that people's requirements for human settlements vary over time. Despite its considerable efforts to improve the economy, China should give more attention to non-economic factors.(AU)

Evaluation of Metagenomics Next-Generation Sequencing as a Diagnostic Tool for Influenza Virus-Positive Respiratory Samples in Retired Fitness Players

The use of Metagenomics Next-Generation Sequencing (mNGS) as a diagnostic tool for respiratory infections, particularly in the context of retired fitness players, presents a novel avenue for optimizing healthcare and wellness in this unique population. Respiratory illnesses, including influenza, can have profound effects on the health and performance of retired athletes, making accurate and timely diagnosis paramount. In this study, we aimed to assess the applicability of mNGS in diagnosing influenza virus infections in retired fitness players. We collected and analyzed respiratory samples from this specific cohort, leveraging mNGS technology. Our research focused on evaluating mNGS's potential as a diagnostic tool compared to conventional methods. Our findings underscored the remarkable capabilities of mNGS. When compared to traditional diagnostic techniques, mNGS demonstrated superior sensitivity in detecting influenza virus-positive respiratory samples in retired fitness players. Additionally, mNGS facilitated the identification of not only known influenza strains but also previously undetected viral variants, offering a comprehensive view of the viral landscape. The utilization of mNGS as a diagnostic tool in the care of retired fitness players holds great promise in enhancing their health monitoring and overall well-being. This technology can aid in the early detection and precise characterization of respiratory infections, contributing to the timely implementation of targeted interventions and improving the quality of healthcare for this unique and health-conscious population. (AU)

Sumisión química en los Servicios de Urgencias de la Red Hospitalaria / Chemical submission in the Emergency Services of the Hospital Network

Antecedentes y objetivos: la escopolamina se emplea de forma subrepticia para cometer actos ilícitos. El número de casos de sospecha de consumo de esta sustancia en los servicios sanitarios de urgencias parece haber aumentado en los últimos años. No existe una clara y rigurosa relación con el número de casos descritos en la literatura científica, debido a la dificultad que supone su detección en los sujetos que se encuentran bajo sus efectos. Se plantea la profundización sobre la sumisión química, al describirse un caso clínico registrado en el Servicio de Urgencias del Hospital Central de la Defensa Gómez Ulla y una mejora del abordaje de este tipo de casos desde el triaje. Material y método: el estudio del caso registrado se ha basado en la descripción del método de detección analítico de la escopolamina y se ha apoyado en una revisión bibliográfica empleando distintas bases especializadas en referencia a intoxicación por escopolamina y su empleo en actos delictivos. Resultados: se identificó escopolamina. Al ser una sustancia cuya detección es tiempo-dependiente, el Hospital Central de la Defensa Gómez Ulla estableció un protocolo junto con el Instituto de Toxicología de la Defensa en 2018, a fin de realizar analíticas de identificación de sustancias empleadas en los casos de sospecha de sumisión química. Conclusiones: se plantea la necesidad de establecer protocolos de tipo multidisciplinar adecuados en los servicios de urgencias, estableciendo un diagnóstico diferencial en casos con alteraciones en el nivel de consciencia, al existir la posibilidad de intoxicación por escopolamina y sospecha de sumisión química, ya que la detección de la sustancia es tiempo-dependiente. (AU)

Antecedents and objectives: Scopolamine is used to commit illegal acts. The number of suspected cases of this substance in the Emergency Services seems to have increased in recent years. There is no clear and rigorous relationship with the number of cases described in the scientific literature, due to the difficulty of its detection in subjects who are under its effects. A further study on Chemical Submission is proposed, by describing a clinical case registered in the Emergency Service of the Gómez Ulla Central Defense Hospital and an improvement in the approach to this type of cases from triage. Material and methods: The study of the registered case has been based on the description of the analytical method and supported by a bibliographic review using different specialized bases in reference to Escopolamine poisoning and its use in criminal acts. Results: Being a substance whose detection is time-dependent, the Gómez Ulla Central Defense Hospital established a protocol together with the Defense Toxicology Institute in 2018 in order to carry out identification analyzes of substances used in cases of Suspected Submission Chemistry. Conclusions: The need to establish appropriate multidisciplinary protocols in the Emergency Services arises. Propose a differential diagnosis in cases with alterations in the level of consciousness, as there is the possibility of scopolamine intoxication and suspicion of Chemical Submission, since the detection of the substance is time-dependent. (AU)

Enfoque hacia el uso de energías alternativas en establecimientos de atención médica / Approach to the use of alternative energies in medical care facilities

Introducción: El tema del cambio climático y sus efectos, en la salud, educación y transporte, es un tema emergente, que pretende la optimización del consumo y la eficiencia energética. Esta investigación se plantea como objetivo,la caracterización del uso y aprovechamiento de energías, en establecimientos de atención médica de la región capital durante el año 2022, considerando la distribución energética, eficiencia y fuentes primarias de energía utilizadas en este país. Métodos: Se trata de una investigación descriptiva, transversal y prospectiva,a través del análisis cuali-cuantitativo, con el uso de informantes clave quienes consideran importante la iluminación natural en los espacios y el mayor aprovechamiento energético en áreas como la quirúrgica y consulta externa. Resultados: Surge el uso de la energía solar, eólica e hidráulica como recursos energéticos aprovechables, así como la sostenibilidad y la mantenibilidad en el diseño y rediseño de infraestructuras hospitalarias. Los tipos de energías utilizados en Venezuela, siguen correspondiendo ala hidráulica y combustibles fósiles, se conoce la tecnología e implementación de paneles solares para la mejoría del cambio climático, la huella del carbono, el uso de energías verdes y reducción de combustibles fósiles. Su aceptación depende de regulaciones y la concientización energética como elementos fundamentales para el cambio.

Introduction: The issue of climate change and itseffects, in health, education and transportation, is an emergingissue, which aims at the optimization of energy consumption andefficiency. e objective of this research is to characterize the useand exploitation of energy in health care facilities in the capitalregion during the year 2022, considering the energy distribution,efficiency and primary energy sources used in this country.Methods: This is a descriptive, cross-sectional and prospectiveresearch, through qualitative-quantitative analysis, with the useof key informants who consider important the natural lightingin the spaces and the greater use of energy in areas such assurgery and outpatient care. Results: The use of solar, windand hydraulic energy emerged as usable energy resources, aswell as sustainability and maintainability in the design andredesign of hospital infrastructures. The types of energy used inVenezuela continue to correspond to hydraulics and fossil fuels; the technology and implementation of solar panels is known forthe improvement of climate change, the carbon footprint, theuse of green energy and reduction of fossil fuels. Their acceptancedepends on regulations and energy awareness as fundamental elements for change.

Racionamiento, inflación e inequidad sanitaria en Venezuela: caso de las enfermedades cardiovasculares / Rationing, inflation and health inequity in Venezuela: case of cardiovascular diseases

los modelos público-sanitarios de caráctermonopólico como el venezolano, suelen asociarse a tendencias al racionamiento de los bienes y servicios que proveen a sus usuarios, así como a la merma de la calidad de estos. Por otro lado, la provisión de dichos bienes y servicios por la vía de mecanismos de mercado, tiene ante sí, el inconveniente que supone el ambiente inflacionario de su economía, cuyo impacto en los precios limita el acceso del paciente a su consumo. El caso de la enfermedad cardiovascular ofrece algunas claves para la comprensión de este fenómeno en el medio venezolano.

Public-health models of a monopolistic nature, suchas the Venezuelan, bring with them trends in the rationing ofthe goods and services they provide to their users, as well as inthe reduction of their quality. On the other hand, the provisionof these goods and services by means of market mechanisms hasbefore it, in our environment, the enormous impediment posedby the inflationary environment of its economy, whose impacton prices limits the patient's access to consumption. The case of cardiovascular disease offers some keys to understanding thisphenomenon in the Venezuelan environment.

Breast, Cervical, and Lung Cancer: A comparison of Real Healthcare Costs and INA-CBGs Rates in the Era of National Health Insurance

Background: In Indonesia, the cost of cancer treatment has been determined by the Indonesian Case Base Groups (INA-CBGs) based on a code called the INA-CBG’s rates. However, a fair claim should be based on the severity of the disease and the class of treatment in the hospital, not on the rates of code. In fact, the real cost of therapy for cancer is influenced by several factors including stage, comorbidity, and severity (INA-CBGs coding, type of hospital, hospital class, treatment grade, side effects, and length of stay), so in many cases, there are reported differences between the real costs and the INA-CBGs rates charged to patients. Objective: This study aims to investigate the difference between real treatment costs and INA-CBG’s rates for cases of lung cancer, cervical cancer, and breast cancer at a cancer center hospital in Indonesia. Methods: This work uses an observational study, and the data were taken retrospectively from hospital financial data and patient medical records. The data were then analyzed using a one-sample t-test to determine the difference between real costs and INA-CBGs costs. Results: The results showed that there was no significant difference between real costs and INA-CBG’s cost on stage II lung cancer treatment in grade 2 with a sig. value of 0.683; code C-4-13-II in grade 3 with a sig. value of 0.151; and code C-4-13-III in grade 3 with a sig. value of 0.650; where the significance level (t alpha) is more than 0.05. Furthermore, the treatment costs for cervical cancer with codes C-4- 13-I and C-4-13-II in grade 1 had sig. values of 0.155 and 0.720 respectively. Lastly, the treatment cost for breast cancer patients with codes C-4-12-II in grade 3 had a sig. value of 0.145 and code C-4-13-II in grade 3 showed a sig. value of 0.091. (AU)

Atención a la paciente obstétrica en el contexto de la pandemia de COVID-19 / Obstetric patient care in the context of COVID-19 pandemic

La infección causada por el SARS-CoV-2, tuvo una repercusión negativa en la evolución clínica de un número importante de gestantes y puérperas en todo el mundo. Este trabajo tiene como objetivo, exponer los principales resultados de la organización del proceso de atención a la paciente obstétrica en el contexto de la pandemia por la COVID-19. Está basado en la organización y elementos fundamentales seguidos con las pacientes que ingresaron, por afecciones relacionadas con el aborto, embarazo o puerperio, con sospecha de COVID-19 o con RT-PCR para SARS-CoV-2 positivo, en el año 2020, y las positivas al SARS-CoV-2 en 2021, de las provincias La Habana, Mayabeque y Artemisa, que fueron atendidas en el Hospital Militar Central Dr. Luis Díaz Soto. Se tuvo en cuenta el total de casos ingresados, pacientes confirmadas, ingresos en unidad de cuidados intensivos obstétricos, en servicio de vigilancia intensiva obstétrica, y la evolución clínica Con la organización de la atención médica a las pacientes obstétricas con la COVID-19, se logró el cumplimiento de los protocolos establecidos y la integración multidisciplinaria en el seguimiento de los casos, lo cual contribuyó a la evolución favorable de la mayoría de las pacientes(AU)

The infection caused by SARS-CoV-2 had a negative impact on the clinical evolution of a significant number of pregnant and puerperal women worldwide. The aim of this work is to present the main results of the organization of the obstetric patient care process in the context of the COVID-19 pandemic. It is based on the organization and fundamental elements followed with the patients who were admitted, for conditions related to abortion, pregnancy or puerperium, with suspicion of COVID-19 or with positive RT-PCR for SARS-CoV-2, in the year 2020, and those positive to SARS-CoV-2 in 2021, from Havana, Mayabeque and Artemisa provinces, who were attended at the Central Military Hospital Dr. Luis Díaz Soto. The total number of cases admitted, confirmed patients, admissions to the obstetric intensive care unit, obstetric intensive surveillance service, and clinical evolution were taken into account. With the organization of medical care for obstetric patients with COVID-19, compliance with established protocols and multidisciplinary integration in the follow-up of cases was achieved, which contributed to the favorable evolution of most patients(AU)

Perspectiva dos profissionais de saúde sobre o uso da telessaúde no contexto da pandemia da covid-19 / Perspective of healthcare professionals on the use of telehealth in the context of the covid-19 pandemic / Perspectiva de los profesionales de la salud sobre el uso de telesalud en el contexto de la pandemia del covid-19

O objetivo deste estudo foi analisar o uso e os impactos da telessaúde em um Centro Especializado em Reabilitação (CER), sob a perspectiva dos profissionais de saúde, durante a pandemia da covid-19. Trata-se de um estudo transversal analítico realizado com profissionais da saúde de um CER. Utilizou-se questionário desenvolvido pelos pesquisadores sobre o perfil sociodemográfico e a percepção do profissional em relação aos atendimentos realizados à distância. Os dados foram analisados com pacote estatístico SPSS (26,0). Foi adotado nível de significância de 5% (p < 0,05).Amostra composta por 79 profissionais, a maioria formados há mais de dez anos, sem experiências com telessaúde. Houve relação significativa entre quantidade de ferramentas utilizadas com grau de dificuldade, e presença de treinamento com a autossatisfação sobre o atendimento. A escolha da ferramenta está intrinsecamente ligada à disponibilidade, à habilidade e à tarefa a ser realizada. O treinamento prévio demonstrou redução de barreiras e satisfação profissional

The objective of this study was to analyze the use and impacts of telehealth in a Specialized Rehabilitation Center (SRC), from the perspective of health professionals, during the covid-19 pandemic. This is an analytical cross-sectional study carried out with health professionals from a SRC. A questionnaire developed by the researchers was used on the sociodemographic profile and perception of the professional in relation to the consultations performed at a distance. Data were analyzed using the SPSS statistical package (26.0). A significance level of 5% (p < 0.05) was adopted. Sample composed of 79 professionals, most of them graduated for more than ten years, with no experience with telehealth. There was a significant relationship between the number of tools used and the degree of difficulty, and the presence of training, with self-satisfaction with the service. The choice of tool is intrinsically linked to availability, skill and task to be performed. Previous training demonstrated a reduction in barriers and job satisfaction.

El objetivo de este estudio fue analizar el uso y los impactos de la telesalud en un Centro Especializado de Rehabilitación (CER), desde la perspectiva de los profesionales de la salud, durante la pandemia del covid-19. Se trata de un estudio transversal analítico realizado con profesionales de la salud de un CER. Se utilizó un cuestionario elaborado por los investigadores sobre el perfil sociodemográfico y de percepción del profesional en relación a las consultas realizadas a distancia. Los datos se analizaron utilizando el paquete estadístico SPSS (26,0). Se adoptó un nivel de significancia del 5% (p < 0,05). Muestra compuesta por 79 profesionales, la mayoría graduados hace más de diez años, sin experiencia en telesalud. Hubo una relación significativa entre el número de herramientas utilizadas y el grado de dificultad, y la presencia de formación, con la autosatisfacción con el servicio. La elección de la herramienta está intrínsecamente ligada a la disponibilidad, habilidad y tarea a realizar. La formación previa demostró una reducción de las barreras y la satisfacción laboral.

Apropriação dos espaços urbanos na infância e na velhice em Brasília (DF) / Occupation of urban spaces in childhood and old age in Brasilia, Brazil / Apropiación de espacios urbanos en la infancia y en la vejez en Brasília, Brasil

Os estudos sobre as relações mútuas entre as pessoas e o ambiente buscam subsidiar melhorias no contexto urbano a partir de métodos e técnicas pautados na compreensão do uso de espaços públicos e privados. A crescente demanda pela promoção de ambientes amigáveis para idosos e crianças nos cenários urbanos direcionou esta pesquisa e elencou dois componentes: o panorama relativo à população local e o arcabouço teórico da psicologia ambiental. Para tanto, buscou-se identificar as principais atividades realizadas por crianças e idosos em seus respectivos locais de moradia. Foram avaliados os principais usos e atividades desses dois grupos, em duas vizinhanças, diferenciando-os de acordo com suas especificidades em termos de demandas individuais e ambientais. As observações sistemáticas a partir da técnica de mapeamento comportamental centrado no lugar (MCCL) ocorreram na cidade de Brasília, Distrito Federal (DF) e permitiram compreender o processo de apropriação dos espaços na infância e na velhice e suas repercussões em termos da congruência pessoa-ambiente. Cada um destes setores organizados a partir de elementos específicos direciona as ações dos participantes para determinados tipos de comportamentos, observados de maneira a compor um roteiro em que a brincadeira (lazer ativo) surge como central na infância e a caminhada (circulação) como mais potente para a população idosa. Os resultados demonstram que o diálogo entre a psicologia ambiental e a ciência do desenvolvimento humano tem sido bastante profícuo e tem contribuído para a compreensão de aspectos da relação pessoa-ambiente em diferentes momentos do ciclo de vida.(AU)

Studies on the mutual relations between people and the environment seek to support improvements in the urban context from methods and techniques based on understanding the use of public and private spaces. The growing demand for the promotion of friendly urban environments for older people and children guided this research, with two notable components: the panorama related to the local population and the theoretical framework of Environmental Psychology. Therefore, we sought to identify the main activities carried out by children and older people in their respective dwellings. The main uses and activities of these two groups were evaluated in two neighborhoods, differentiating them according to their specificities in terms of individual and environmental demands. Systematic observations using the place-centered behavioral mapping technique took place in the city of Brasília, Federal District, and allowed us to understand the process of appropriation of spaces in childhood and old age and its repercussions in terms of person-environment congruence. Each of these sectors, organized from specific elements, directs the participants' actions towards certain types of behavior, observed in order to compose a script in which playing (active leisure) emerges as central in childhood and walking (circulation) as more potent for the older people. The results demonstrated that the dialogue between environmental psychology and the science of human development has been very fruitful and has contributed to the understanding of aspects of the person-environment relationship at different times in the life cycle.(AU)

Los estudios sobre las relaciones mutuas entre las personas y el medio ambiente buscan aportar mejoras en el contexto urbano mediante métodos y técnicas basados en la comprensión del uso de los espacios públicos y privados. La creciente demanda de la promoción de ambientes amigables para las personas mayores y los niños en entornos urbanos guio esta investigación y enumeró dos componentes: el panorama relacionado con la población local y el marco teórico de la Psicología Ambiental. En este contexto, buscamos identificar las principales actividades que realizan los niños y las personas mayores en sus respectivas viviendas. Se evaluaron los principales usos y actividades de estos dos grupos en dos barrios, diferenciándolos según sus especificidades en cuanto a las demandas individuales y ambientales. Las observaciones sistemáticas utilizando la técnica de mapeo conductual centrado en el lugar (MCCL) ocurrieron en la ciudad de Brasília, Distrito Federal (Brasil) y nos permitieron comprender el proceso de apropiación de espacios en la infancia y la vejez y sus repercusiones en la congruencia persona-ambiente. Cada uno de estos sectores, organizados a partir de elementos específicos, orienta las acciones de los participantes hacia determinados comportamientos, observados para componer un guion en el que el juego (ocio activo) emerge como central en la infancia y el caminar (circulación) como el más potente para las personas mayores. Los resultados demuestran que el diálogo entre la Psicología Ambiental y la ciencia del desarrollo humano ha sido muy fructífero y ha contribuido a la comprensión de aspectos de la relación persona-entorno en diferentes momentos del ciclo de vida.(AU)

Max Goodwin: ética médica y el ideal de hacer el bien / Max Goodwin: Medical Ethics and the Ideal of Doing Good

El mundo de las ficciones, nos otorga la libertad de tomar prestados algunos de sus elementos para pensar en las vicisitudes que trae el ejercicio de nuestra práctica, en tanto agentes de la atención de la salud mental de las personas. La serie televisiva "New Amsterdam" propone un modelo de atención médica que nos resulta interesante para situar un campo de reflexión ético con el cual analizar algunas posiciones libidinales puestas en marcha en los roles profesionales que asumimos. Para ello, el siguiente trabajo parte del concepto de la ética que forjara Lacan en su seminario 7 y en el escrito "Kant con Sade", para establecer cuáles son los entramados libidinales que actúan en la configuración de la subjetividad heroica acuñada por Elena de la Aldea e Ignacio Lewkowicz

The fictional world give us several elements to think about in our profesional issues as mental health agents. The TV series "New Amsterdam gives an interesting model of medical care for bringing a field of ethical reflection. This work intends to analyze the subjective positions within our profesional roles. We'll take the concept of ethics on Lacan's seminar VII and "Kant with Sade", to establish which are the libidinal structures of heroic subjectivity in the work of Elena de la Aldea and Ignacio Lewkowicz