La narratividad como perspectiva transdiscursiva para la formación ético-profesional del universitario

El artículo tiene como objetivo caracterizar las potencialidades formativas de la narratividad como criterio y práctica para la educación ético - profesional del estudiante universitario. Entre los resultados se destacó la propuesta de valores formativos transdisciplinares desde la narratividad y de acciones prácticas con una perspectiva transdisciplinar que permite pasar de los presupuestos de la narración a la narratividad como eje transdiscursivo en la formación ético-profesional de las diversas carreras.

The article aims to characterize the formative potential of narrativity as a criterion and practice for the ethical-professional education of the university student. Among the results, the proposal of transdisciplinary training values ​​from narrativity and practical actions with a transdisciplinary perspective that allows moving from the assumptions of narration to narrativity as a transdiscursive axis in the ethical-professional training of the various careers stood out.

[Design and implementation of a transdisciplinary care model for patients with hereditary angioedema, in a Colombian health institution]. / Diseño e implementación de un modelo de atención transdisciplinaria para pacientes con angioedema hereditario, en una institución de salud colombiana.

OBJECTIVE: Describe the design and implementation of a transdisciplinary care model for patients with hereditary angioedema in Colombia. METHODS: Descriptive longitudinal observational study. 140 patients with hereditary angioedema were included in a transdisciplinary care model for one year. Seizure rates, hospitalizations, emergency room visits, quality of life, and pharmacological adherence were measured. RESULTS: The model was associated with reductions of 76% in seizures, 66% in hospitalizations, and 87% in emergency room visits. Pharmacological adherence increased 19% and was complete after four months. The quality of life increased significantly. CONCLUSIONS: Hereditary angioedema is an orphan disease that requires a comprehensive approach for effective care.

OBJETIVO: Describir el diseño e implementación de un modelo transdisciplinario de atención para pacientes con angioedema hereditario en Colombia. MÉTODOS: Estudio observacional longitudinal descriptivo. 140 pacientes con angioedema hereditario fueron incluidos en un modelo de atención transdisciplinario por un año. Se midieron tasas de crisis, hospitalizaciones, visitas a urgencias, calidad de vida y adherencia farmacológica. RESULTADOS: El modelo se asoció con reducciones del 76% en crisis, 66% en hospitalizaciones y 87% en visitas a urgencias. La adherencia farmacológica aumentó 19% y fue completa después de cuatro meses. La calidad de vida aumentó significativamente. CONCLUSIÓN: El angioedema hereditario es una enfermedad solitaria que requiere un abordaje integral para la atención eficaz.

Transdisciplinary research before, during and after COVID-19 vaccination in Chile: a virtuoso collaboration with future perspectives.

The COVID-19 pandemic presented numerous challenges that required immediate attention to mitigate its devastating consequences on a local and global scale. In March 2020, the Chilean government, along with health and science authorities, implemented a strategy aimed at generating relevant evidence to inform effective public health decisions. One of the key strengths of this strategy was the active involvement of the scientific community, employing transdisciplinary approaches to address critical questions and support political decision-making. The strategy promoted collaborations between the government, public and private institutions, and transdisciplinary academic groups throughout each phase of the pandemic. By focusing on pressing problems and questions, this approach formed the foundation of this report which reflects the collaborative effort throughout the pandemic of individuals from the Instituto de Sistemas Complejos de Ingeniería (ISCI), the Faculty of Medicine of the University of Chile, government authorities and industry. Early in the pandemic, it became crucial to gather evidence on how to minimize the impact of infection and disease while awaiting the availability of vaccines. This included studying the dynamics of SARS-CoV-2 infection in children, assessing the impact of quarantines on people's mobility, implementing strategies for widespread SARS-CoV-2 polymerase chain reaction (PCR) testing, and exploring pool testing for large populations. The urgent need to reduce disease severity and transmission posed a significant challenge, as it was essential to prevent overwhelming healthcare systems. Studies were conducted to predict ICU bed requirements at the local level using mathematical models. Additionally, novel approaches, such as using cellphone mobility-based technology to actively identify infected individuals, and to optimize population sampling, were explored following the first wave of the pandemic. Chile took early action in addressing vaccination through a high-level scientific board, before vaccines became available. Studies conducted during this period included population-based immunologic evaluations of different vaccines, which helped build confidence in the population and supported the need for booster doses and potential vaccination of children. These studies and collaborations, which will be discussed here, have provided valuable insights and will inform future approaches in a post-pandemic world. Importantly, highly conservative estimates indicate that 3,000 lives and more than 300 million USD were saved by this academic-public-private collaborative effort.

Effect of non-pharmacological intervention on the nutritional status of patients with Prader Willi Syndrome.

INTRODUCTION: Obesity is highly prevalent in patients with Prader-Willi syndrome (PWS), particularly among adults. This condition, which can be morbid in many cases, is multifactorial and has a complex management. The purpose of our study was to describe the feasibility of achieving a better nutritional status, including normal weight in individuals diagnosed with PWS, through specific nutritional interventions within the framework of a transdisciplinary treatment and without resorting to pharmacological treatments or growth hormone (GH). METHODOLOGY: This observational study included patients with confirmed genetic diagnosis of PWS, receiving transdisciplinary treatment in a specialized rare diseases institution. Patients under treatment with GH and those under pharmacological treatment with nutritional objectives were excluded from the study. All patients attended our institution regularly on a weekly or fortnightly basis. Anthropometric records, including weight, height, and body mass index (BMI) were evaluated in each visit from treatment onset until the last check-up. RESULTS: We included 24 patients with confirmed genetic diagnosis of PWS. At baseline, 9 patients (38 %) had obesity grade III, 1 (4 %) of obesity grade II, 10 (42 %) of obesity grade I, 2 (8 %) of overweight, and 2 patients (8 %) with normal baseline weight. After a median duration of 52 months (interquartile range 23-116 months) of transdisciplinary nutritional treatment, we identified a significant reduction in BMI (baseline 40.2 ± 15.7 kg/m2 vs. follow-up 28.3 ± 6.7 kg/m2, p < 0.0001), without significant differences regarding height (baseline 1.45 ± 0.1 m vs. follow-up 1.48 ± 0.1 m, p = 0.09). CONCLUSION: In this study, we demonstrated that nutritional nonpharmacologic interventions immersed in a transdisciplinary treatment enabled a consistent and sustainable improvement in BMI and nutritional status among patients with PWS.

Aportes conceptuales al diagnóstico para el ordenamiento territorial periurbano desde un abordaje sistémico y transdisciplinar

Los procesos de desarrollo territorial han generado un crecimiento no planificado del periurbano que genera impactos negativos en su estructura y funcionamiento; por lo tanto, el trabajo está orientado a resaltar, desde la fase diagnóstica del ordenamiento territorial, la importancia del periurbano y sus diferentes componentes. El estudio se enmarca en una aproximación conceptual sistémica del territorio y de procesos que se llevan a cabo en Europa y Latinoamérica relacionados con el suelo periurbano, la cual corresponde a una revisión documental de carácter transdisciplinar, cuya estructura hermenéutica permitió hacer énfasis en la fase diagnóstica para reconocer la importancia del periurbano como espacio de transición y control de la expansión urbana. Los resultados pueden servir de base para la formulación de una regulación normativa que permita superar las contradicciones existentes en la interfaz urbano-rural desde una visión sostenible de largo plazo.

The processes of territorial development have generated an unplanned peri-urban growth that generates negative impacts on its structure and functioning; therefore, the work is aimed at highlighting, from the diagnostic phase of territorial planning, the importance of the peri-urban and its different components. The study is framed in a systemic conceptual approach to territory and processes that are carried out in Europe and Latin America related to peri-urban land, which corresponds to a documentary review of a transdisciplinary nature, whose hermeneutic structure allowed to emphasize the diagnostic phase to recognize the importance of the peri-urban as a space of transition and control of urban expansión. The results can serve as a basis for the formulation of a normative regulation that allows to overcome the existing contradictions in the urban-rural interface from a long-term sustainable vision.

Map silences and chronic humanitarian crises: Spatial patterns of migrant mortality in South Texas, 2009-2020.

Forensic and humanitarian interventions deployed to address migrant death in US southwestern border states have become increasingly prevalent over the past four decades. In this paper we address two persistent issues specific to the Texas-Mexico border context. First, we present the first comprehensive geospatial analysis of migrant deaths in South Texas, establishing a twelve-year (2009-2020) mortality profile. And second, we introduce the concept of necrosilences and its implications to both forensic and humanitarian work and usage of geospatial tools. We applied ANOVA, spatial statistics, and cluster analysis to test the relationships of migrant mortality point locations throughout South Texas, an area comprised of ten counties with some of the highest reported migrant deaths in the state. Our findings demonstrated that unidentified human remains that corresponded to migrants were found most consistently in jurisdictions inland from the Mexican border. Further, the map visualizations highlighted vast areas seemingly devoid of migrant deaths. These "empty" areas are emblematic of necrosilences. That is, instances where there is a lack of access or accounting rather than no death incidences. We conclude by discussing the importance of visualizing necrosilences.

Bioética, biopolítica e interculturalidad en salud pública: estudio de caso del Hospital Mama Dominga

Propósito/Contexto. Este artículo da cuenta de los resultados de un proyecto de investigación, cuyo objetivo fue la propuesta de un aporte desde la Bioética y la Biopolítica para la reformulación de un modelo de salud pertinente con las necesidades del contexto sociocultural de la población atendida por el Hospital Mama Dominga en Silvia, Cauca, Colombia. Metodología/Enfoque. El estudio siguió un corte fundamentalmente cualitativo, se privilegiaron las fuentes documentales y de sondeo, así como las observaciones propias del investigador. Resultados/Hallazgos. Los resultados ofrecen un acercamiento a la apreciación del pueblo Misak sobre la salud y su sistema de atención y resaltan la necesidad de apertura de diálogos realmente horizontales en ámbitos de ciencia y cultura, en pro del mejoramiento del bienestar de las comunidades tradicionales en el país. Discusión/Conclusiones/Contribuciones. A partir de la lectura de referentes teóricos y su correlación contextual con el desarrollo histórico de la salud en el Cauca, especialmente en el resguardo de Guambía con la comunidad Misak, se estableció una línea de análisis sobre la pertinencia de los modelos de atención en salud en contextos rurales o tradicionales y las oportunidades de transformación desde experiencias, historia y conocimientos propios de la población.

Purpose/Background. This article presents the results of a research project which objective was to propose a contribution, from bioethics and biopolitics, for the reformulation of a health attention model according with the needs of the community attended by Mama Dominga Hospital in Silvia, Cauca (Colombia) in their own sociocultural context. Methodology/Approach. The study fundamentally followed a qualitative approach, favouring documentary sources, polls, interviews and observations from the researcher. Results/Findings. The results offer an approach to the Misak conception about health and its attention system, and highlight the importance of promoting truly horizontal dialogues in science and culture spaces, in favor of the wellbeing improvement of traditional communities across the country. Discussion/Conclusions/Contributions. Parting from theoretical references and their contextual correlation with the historical development of health policies in Cauca -specially the Guambía Reservation with Misak people-, it was possible to set an analysis line about health attention models and their pertinence in rural and/or traditional contexts, and their adjustment opportunities by listening to experiences, history and knowledge that come from the own community.

Objetivo/Contexto. Este artigo relata os resultados de um projeto de pesquisa cujo objetivo foi propor uma contribuição da Bioética e da Biopolítica para a reformulação de um modelo de saúde relevante para as necessidades do contexto sociocultural da população atendida pelo Hospital Mama Dominga em Silvia, Cauca, Colômbia. Metodologia/Abordagem. O estudo seguiu uma abordagem fundamentalmente qualitativa, dando prioridade a fontes documentais e de pesquisa, bem como às observações do próprio pesquisador. Resultados/Descobertas. Os resultados oferecem uma abordagem da apreciação do povo Misak sobre a saúde e seu sistema de saúde e destacam a necessidade de abrir diálogos verdadeiramente horizontais nos campos da ciência e da cultura, a fim de melhorar o bem-estar das comunidades tradicionais do país. Discussão/Conclusões/Contribuições. Com base na leitura de referências teóricas e sua correlação contextual com o desenvolvimento histórico da saúde no Cauca, especialmente na reserva de Guambía com a comunidade Misak, foi estabelecida uma linha de análise sobre a pertinência dos modelos de atenção à saúde em contextos rurais ou tradicionais e as oportunidades de transformação com base nas experiências, na história e no conhecimento da população.

De la bioética de protección a la medicina basada en la evidencia desde una perspectiva transdisciplinar

En el contexto de la bioética se debate con frecuencia el hecho de que, con el desarrollo de la ciencia y la técnica, de las tecnologías de la información y las comunicaciones, y los cambios relacionados con el ecosistema, se hace necesario garantizar el respeto de la vulnerabilidad humana y la integridad personal al aplicar y fomentar el conocimiento científico, la práctica médica y las tecnologías vinculadas (artículo 8 de la Declaración Universal sobre Bioética y Derechos Humanos). Esta vulnerabilidad se protege a través del respeto con equidad y justicia, de los derechos básicos de cada ser humano y al garantizar la integridad personal; esta es la esencia de la bioética de protección y constituye, también, la base principal de la medicina basada en la evidencia, caracterizada por el uso consciente, explícito y juicioso de la evidencia clínica en la práctica diaria para el cuidado del paciente, en aras de ofrecer la mejor atención. Existe una necesidad inmediata de proporcionar beneficios sostenibles a las personas vulnerables en situaciones de enfermedad, por ello es vital mantener un enfoque en la salud pública cubana desde la perspectiva de la bioética de protección y la transdisciplinariedad, sustentada en una medicina basada en la evidencia, en las 3 esferas, en el proceso asistencial, en el proceso pedagógico y en el investigativo; como máximo exponente de la salud global, que tiene como esencia una visión transdisciplinaria, ya que aborda la salud desde la perspectiva del derecho universal a esta y al bienestar social.

In the context of bioethics, the fact that with the development of science and technology, of information and communication technologies, and the changes related to the ecosystem, it is necessary to guarantee respect for vulnerability and personal integrity when applying and promoting scientific knowledge, medical practice and related technologies (article 8 of the Universal Declaration on Bioethics and Human Rights). This vulnerability is protected through respect, with equity and justice, for the basic rights of every human being and by guaranteeing personal integrity; this is the essence of protection bioethics and also constitutes the main basis of evidence-based medicine, characterized by the conscious, explicit and judicious use of clinical evidence in daily practice for patient care, for the sake of to offer the best care. There is an immediate need to provide sustainable benefits to vulnerable people in disease situations, for this reason it is vital to maintain a focus on Cuban public health from the perspective of protective bioethics and transdisciplinarity, supported by evident-based medicine, in the 3 spheres, in the care process, in the pedagogical process and in the investigative process; as the greatest exponent of Global Health, whose essence is a transdisciplinary vision, since it addresses health from the perspective of the universal right to it and to social well-being.

Transdisciplinary experiential learning in biomedical engineering education for healthcare systems improvement.

BACKGROUND: The growing demand for more efficient, timely, and safer health services, together with insufficient resources, put unprecedented pressure on health systems worldwide. This challenge has motivated the application of principles and tools of operations management and lean systems to healthcare processes to maximize value while reducing waste. Consequently, there is an increasing need for professionals with the appropriate clinical experience and skills in systems and process engineering. Given their multidisciplinary education and training, biomedical engineering professionals are likely among the most suitable to assume this role. In this context, biomedical engineering education must prepare students for a transdisciplinary professional role by including concepts, methods, and tools that commonly belong to industrial engineering. This work aims to create relevant learning experiences for biomedical engineering education to expand transdisciplinary knowledge and skills in students to improve and optimize hospital and healthcare care processes. METHODS: Healthcare processes were translated into specific learning experiences using the Analysis, Design, Development, Implementation, and Evaluation (ADDIE) model. This model allowed us to systematically identify the context where learning experiences were expected to occur, the new concepts and skills to be developed through these experiences, the stages of the student's learning journey, the resources required to implement the learning experiences, and the assessment and evaluation methods. The learning journey was structured around Kolb's experiential learning cycle, which considers four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. Data on the student's learning and experience were collected through formative and summative assessments and a student opinion survey. RESULTS: The proposed learning experiences were implemented in a 16-week elective course on hospital management for last-year biomedical engineering undergraduate students. Students engaged in analyzing and redesigning healthcare operations for improvement and optimization. Namely, students observed a relevant healthcare process, identified a problem, and defined an improvement and deployment plan. These activities were carried out using tools drawn from industrial engineering, which expanded their traditional professional role. The fieldwork occurred in two large hospitals and a university medical service in Mexico. A transdisciplinary teaching team designed and implemented these learning experiences. CONCLUSIONS: This teaching-learning experience benefited students and faculty concerning public participation, transdisciplinarity, and situated learning. However, the time devoted to the proposed learning experience represented a challenge.

Challenges for Plant Growth Promoting Microorganism Transfer from Science to Industry: A Case Study from Chile.

Research on the plant growth promoting microorganisms (PGPM) is increasing strongly due to the biotechnological potential for the agricultural, forestry, and food industry. The benefits of using PGPM in crop production are well proven; however, their incorporation in agricultural management is still limited. Therefore, we wanted to explore the gaps and challenges for the transfer of biotechnological innovations based on PGPM to the agricultural sector. Our systematic review of the state of the art of PGPM research and knowledge transfer takes Chile as an example. Several transfer limiting aspects are identified and discussed. Our two main conclusions are: neither academia nor industry can meet unfounded expectations during technology transfer, but mutually clarifying their needs, capabilities, and limitations is the starting point for successful collaborations; the generation of a collaborative innovation environment, where academia as well as public and private stakeholders (including the local community) take part, is crucial to enhance the acceptance and integration of PGPM on the way to sustainable agriculture.

Ontologias da adolescência e ato infracional: uma revisão integrativa da década (2011-2020) / Ontologies of Adolescence and Offending: an integrative review of the decade (2011-2020)

Resumo Este artigo, segmento do trabalho de doutorado do autor, apresenta uma revisão integrativa de literatura nas diversas áreas de conhecimento que abordam a temática adolescência e ato infracional. Segue o método sistemático e o formato narrativo, tomando a ciência como prática social e levantando aspectos qualitativos da literatura produzida entre 2011 e 2020, com enfoque no estado atual do conhecimento e no modo como se tem produzido os saberes científicos nesse campo. Os resultados apresentam recortes importantes acerca da problemática, porém, de modo geral, o panorama revela saberes fragmentados, com discursos disciplinares e pouco dialogados. Os modos de considerar o adolescente nas pesquisas tendem a se dar com práticas de silenciamento, priorizando o saber-fazer-poder-dizer de adultos, "especialistas" e instituições. Ressalta-se a importância do pensamento crítico, decolonial, complexo e transdisciplinar como orientadores de uma ciência capaz de integrar diferentes saberes, rompendo com lógicas estanques de separação, oposição, redução, hierarquização e silenciamento.

Abstract This article, segment of the author's doctoral work, presents an integrative literature review in the different areas of knowledge that address the issue of adolescence and infractions. It follows the systematic method and narrative format, taking science as a social practice and raising qualitative aspects of the literature produced between 2011 and 2020, focusing on the current state of knowledge and the way scientific knowledge in this field has been produced. The results show important insights into this issue, however, in general, the panorama reveals fragmented knowledge, with disciplinary scientific discourses and little dialogue. The ways of considering adolescents in research tend to be based on silencing practices, prioritizing know-can-do-say from adults, "experts" and institutions. The importance of critical, decolonial, complex and transdisciplinary thinking is highlighted as guiding a science capable of integrating different knowledge, breaking with stagnant logics of separation, opposition, reduction, hierarchization and silencing.

Making thirsty cities sustainable: A nexus approach for water provisioning in Quito, Ecuador.

In view of accelerated climate change and urban demographics, balancing human and ecosystem needs for water resources is a critical environmental challenge of global significance. Since water, agriculture, health, and energy are inextricably linked, sustainable development goals (SDGs) actions in one policy area commonly have impacts on the others, as well as on the ecosystems that natural resources and human activities ultimately depend upon. Managing urban water supply systems therefore requires a nexus approach that integrates goals across sectors, reduces the risk that SDG actions will undermine one another, and ensures sustainable resource use. We developed a transdisciplinary methodological framework based on a Pareto frontier analysis to define the sustainable solutions of a multi-objective optimization among four competing criteria, water provision, water quality, energy cost, and biodiversity conservation. The study was applied to three mountainous headwater basins in the Ecuadorian Andes, which provide around 30% of Quito's total water supply. We found that an optimized management of water intake structures would meet current consumption needs while reducing the probability of emergence of water pathogens and limiting the impact on aquatic biodiversity by 30% and 9% respectively, without any increase in energy costs for pumping water from other sources. Nonetheless, under future scenarios of climate change and water demand, higher energy consumption, and therefore an increase in operating costs, would be needed to meet urban demand and preserve environmental conditions. Overall, the range of Pareto optimal water supply strategies across the water-health-energy-biodiversity nexus provides valuable information for decision makers and offers support for achieving sustainable management of water resources.

A systematic review of social participation in ecosystem services studies in Latin America from a transdisciplinary perspective, 1996-2020.

In this article, we propose that ecosystem services (ES) should be studied integrating social participation and the narrative of social actors. We analyzed the ES literature (1996-2020) in Latin America (LA), basing our review on the concept that the study of this topic should be transdisciplinary and post-normal (i.e., extended peer communities). We prepared the review using the Scopus® and Web of Science™ (WoS) databases. We found 1069 articles related to social participation in ES studies in 20 LA countries, identifying 310 articles for further analysis using screening and eligibility protocols. We also used a random sample (n = 50) of the 310 articles for a detailed analysis of social participation and extended peer communities. Results showed that articles increased from seven in 2010 to 39 per year from 2015 to 2019. English is the primary language used (91% of the articles), with only one journal accepting publications in Spanish. The most common collaboration combination has been one LA author and one or more non-LA authors (41% of the articles). The semantic network analysis showed 35 thematic clusters, with the most common corresponding to ES protection and provision issues. Direct social participation was included in 62% of the articles, mainly through interviews; however, consultancy processes have dominated the participatory perspective of the authors without transformative involvement. We discuss article language and low inter-countries collaboration, both influencing the lack of social participation required for the transdisciplinary analysis of ES.

Aprendizaje automático aplicado en área de la salud: parte 2 / Machine Learning In Healthcare: part 2

En el artículo anterior se introdujo el tema y se desarrolló cómo es la recolección y análisis de datos, la selección y entrenamiento de modelos de aprendizaje automático supervisados y los métodos de validación interna que permiten corroborar si el modelo arroja resultados similares a los de otros conjuntos de entrenamiento y de prueba. En este artículo continuaremos con la descripción de la evaluación del rendimiento, la selección del modelo más adecuado para identificar la característica que se va a evaluar y la validación externa del modelo. Además, el artículo resume los desafíos existentes en la implementación del Machine Learning desde la investigación al uso clínico. (AU)

In the previous article, we introduced topics such as data collection and analysis, selection and training of supervised machine learning models and methods of internal validation that allow to corroborate whether the model yields similar results to other training and test sets.In this article, we will continue with the description of the performance evaluation, selecting the most appropriate model to identify the characteristic to evaluate and the external validation of the model. In addition, the article summarizes the actual challenges in the implementation of machine learning from research to clinical use. (AU)

La enseñanza de las metodologías cualitativas en carreras de las ciencias de la salud: desafíos y reflexiones a partir de experiencias de docencia en fonoaudiología / Training students of health sciences in qualitative method: challenges and reflections from the teaching experience in speech and language therapy

Explicar los alcances del enfoque cualitativo de investigación social en salud a estudiantes de carreras de Ciencias de la Salud resulta un desafío en la entrega de la perspectiva antropológica y social en la formación profesional. Lo anterior debido a que estos estudiantes están acostumbrados a operar en las dicotomías naturaleza/cultura y ciencia/creencia. Como docentes,implica enseñarles a observar más allá de dichas dicotomías. También exige superar la limitada comprensión que puede haber sobre lo que es la aproximación cualitativa en investigación y lo que les puede ofrecer. Por ello, el propósito del estudio es reflexionar sobre los alcances que tienen estos desafíos en el aula, recurriendo a casos de ejercicios de diseños de investigación cualitativa en la carrera de Fonoaudiología de la Facultad de Medicina de la Universidad de Chile. Concluimos que un acercamiento temprano a metodologías cualitativas permite a estudiantes de pregrado desarrollar una visión crítica hacia las dicotomías reduccionistas respecto de la producción y validación de conocimientos. Además, promueve entender la dimensión social de la salud como un fenómeno individual y colectivo. También favorece concebir a la Medicina como un campo de trabajo transdisciplinar.

To explain the scope of the qualitative approach to undergraduate students of healthcare sciences is a challenge for those of us who must translate the anthropological and social perspectives to students used to operate within nature/culture and science/belief dichotomies. This challenge involves teaching to look beyond these dichotomies and forces us, as lecturers, to overcome the barriers or limited understanding that often characterize health professionals' relation to what qualitative approach can offer to them. Based upon the teaching experience of the authors, this article aims to reflect about the emergence of these challenges, turning, therefore, to examples of qualitative research design in the speech and hearing program at the faculty of medicine of the University of Chile. We believe that an early approach to qualitative methodologies would allow undergraduate students to develop a critical vision in relation to reductive dichotomies, in addition to promoting an understanding of health as an individual and collective phenomenon, and of medicine as a trans disciplinary field of work.

Aprendizaje automático aplicado en área de la salud: parte 1 / Machine learning in healthcare: part 1

Este será el primero de dos artículos donde se tratarán los pasos necesarios para desarrollar un proyecto de aplicación de técnicas de Machine Learning en Salud, que introduce nociones sobre la recolección y análisis de datos, la selección y entrenamiento de modelos de aprendizaje auto-mático de tipo supervisado y los métodos de validación interna para cada modelo. (AU)

This will be the first of two articles where the steps needed to apply machine learning methods in healthcare will be discussed. It will introduce fundamental notions about data collection, selection and training of supervised ML models as well as the methods of internal validation. In a second article, we will discuss about the performance evaluation to select the most appropriate model and its external validation. (AU)

Gender Dysphoria in the Pediatric Population: Initial Experience of a Transdisciplinary Group / Disforia de género en la población pediátrica: experiencia inicial de un grupo transdisciplinario

Introduction Although there is an increasing experience in the management of transgender individuals, this has not been thoroughly explored in children. The need to establish a comprehensive and transdisciplinary management is of critical importance. In order to solve this issue, we want to report the results of a cohort of individuals with gender dysphoria (GD) seen by our transdisciplinary group from a social and clinical and health access perspective. Methods A 10-year retrospective case series of all patients that had been seen by our transdisciplinary team was reviewed. The main demographic characteristics were described, as well as impact variables in terms of diagnosis and treatment of these individuals. A social description of each individual was described. Frequency, distribution, and central tendency measures were evaluated for data presentation. IBM SPSS Statistics for Windows, version 24.0 (IBM Corp, Armonk, NY) software was used. Results Four cases of GD were included. Three had male to female dysphoria and one female to male. The median reported age of GD awareness was 6 years old (between 4 and 8 years old), and the median time between GD awareness and the 1st medical evaluation was 7 years for all individuals. The median age at gender role expression was 12 years old (between 10 and 14 years old). All patients had already assumed their experienced gender role before the 1st evaluation by our group. The median age at the 1st evaluation by our group was 13 years old (between 10 and 16 years old); three of the patients were evaluated after initiation of puberty. In the present study, individuals with GD demonstrated having health care access barriers for their transition process. Referral times are high, and individuals with GD are cared after pubertal development, which is related to suboptimal outcomes. The spectrum of GD is broad, and management must be individualized according to expectations. Conclusion Individuals with GD face multiple access barriers that limit their possibility of being seen by a transdisciplinary team. This reflects in longer waiting times that negatively impact medical management. Gender dysphoria is a wide spectrum, and individuals should be evaluated individually by a transdisciplinary team.

Introducción En las ultimas décadas se ha ganado más experiencia en el manejo de individuos con disforia de genero (DG). Sin embargo, en la población pediátrica esto aun no se ha explorado completamente. La necesidad de ofrecer un manejo cuidadoso y transdisciplinario es de gran importancia. El objetivo de este estudio es presentar la experiencia de nuestro grupo transdisciplinario (GT) en el abordaje de pacientes con DG desde el punto de vista medico y social. Materiales y métodos Se realizó un análisis descriptivo de los casos de DG en menores de 18 años tratados en los últimos 10 años por el GT de Desórdenes del Desarrollo e Identidad Sexual. Se usaron medidas de frecuencia y tendencia central para la presentación de datos mediante el programa SPSS, versión 24.0. Se realizó un análisis descriptivo de las variables: familia y dinámica social; evaluación psiquiátrica; expectativas; barreras de acceso; y abordaje del GT. Resultados Se presentan cuatro casos de DG, tres hombre-mujer y uno mujer-hombre. La edad a la primera sensación de disforia (PSD) fue en promedio 5,7 años, y el tiempo medio entre la PSD y la primera evaluación médica (PEM) fue de 6,25 años. La edad promedio a la primera evaluación por el grupo (PEG) fue de 13,25 años; 3 individuos tenían pubertad avanzada y 1, incipiente. Dos individuos habían recibido atención médica antes de la PEG. Se identificó que, al momento de la valoración por el grupo, los individuos contaban con el apoyo de sus familiares, y el entorno escolar era cada vez más incluyente; en ninguno se identificó enfermedad psiquiátrica, y a todos se indicó acompañamiento por psicoterapia. La expectativa con el proceso fue heterogénea con respecto a procedimientos quirúrgicos, manejos hormonales y rol de género, dependiendo de las características físicas que generaban disforia (caracteres sexuales secundarios, genitales). Las barreras de acceso fueron el desconocimiento de los especialistas en primeras valoraciones y las administrativas. La decisión del grupo con respecto al manejo hormonal y quirúrgico, así como acompañamiento psicológico se individualizó para cada paciente. Conclusiones Los individuos con DG presentan barreras de acceso a soporte médico para su proceso de transición. Los tiempos de atención son prolongados; por ende, son atendidos después de desarrollar la pubertad, lo cual se relaciona con desenlaces subóptimos. El espectro de la DG es amplio y se debe individualizar el manejo según las expectativas.

Covid-19 e ciência pós-normal: reflexões epistemológicas e políticas / Covid-19 and post-normal science: epistemological and political reflections / Covid-19 y la ciencia posnormal: reflexiones epistemológicas y políticas

Diante do inusitado da pandemia de Covid-19 nos deparamos com um intenso entrecruzamento entre aspectos estritamente científicos e aspectos sociais e políticos. Nesse sentido, este ensaio teórico pretende refletir sobre os limites do conceito de ciência normal, apresentar a ideia de ciência pós-normal e, assim, defender a articulação intrínseca entre ciência, política e comunidade como possibilidade de posicionamento diante dos desafios da Covid-19. Na primeira parte do texto focamos o ideal controverso de ciência e de sua continuidade com a técnica e na segunda parte fazemos algumas referências a suas implicações políticas a partir da suposição de que as ideias de ciência pós-normal e de transdisciplinaridade contribuem para a superação da separação entre decisão e participação política e argumentação racional e científica.

With the unusual Covid-19 pandemic, we are facing an intense intersection between strictly scientific, social and political aspects. In this sense, this theoretical essay aims to reflect on the limits of the concept of normal science, to present the idea of post-normal science and, thus, to defend the intrinsic articulation between science, politics and the community as a possibility of positioning in the face of the challenges of Covid-19. In the first part of the text we focus on the controversial ideal of science and its continuity with technique and in the second part we make some references to its political implications based on the assumption that the ideas of post-normal science and transdisciplinary knowledge contribute to overcome the separation between political decision and participation and rational and scientific argumentation.

Frente a lo inusual de la pandemia de Covid-19, nos enfrentamos a una intensa intersección entre aspectos estrictamente científicos, sociales y políticos. En este sentido, este ensayo teórico tiene como objetivo reflexionar sobre los límites del concepto de ciencia normal, presentar la idea de la ciencia posnormal y, por lo tanto, defender la articulación intrínseca entre la ciencia, la política y la comunidad como una posibilidad de posicionamiento frente a los desafíos de Covid-19. En la primera parte del texto nos enfocamos en el controvertido ideal de la ciencia y su continuidad con la técnica y en la segunda parte hacemos algunas referencias a sus implicaciones políticas basadas en el supuesto de que las ideas de la ciencia y la transdisciplinariedad posnormal contribuyen a superar el separación entre decisión política y participación y argumentación racional y científica.

The concept of alimentation and transdisciplinary research.

Although the term 'alimentation' has existed in the English language since the late 16th century, its use is infrequent. In Latin languages, particularly French, 'alimentation' conveys a holistic notion of the process by which humans produce, procure, prepare, share, indulge in, and digest their foods. Thus, the concept of alimentation encompasses and integrates human, technological, sociocultural, and environmental domains. This article delves into the origins of the term 'alimentation' and its use in the foreign scientific literature, and particularly in the social sciences. Unlike 'food and nutrition', alimentation provides a broader frame for the grand challenges of what, how, and with whom we eat. This approach should lead to transdisciplinary research (TDR) interfacing several knowledge domains (e.g., environmental, technological, socio-cultural, nutritional, etc.) and involving key stakeholders. Possible outcomes of TDR in alimentation are inspiring and meaningful collaborations, innovative methodologies for integrating knowledge, transformative learning of researchers, enriched educational experiences for students, focused community action, and improved public policy. The term 'alimentation' is appropriately used in French and other Latin languages. Alimentation embraces human, technological, sociocultural, and environmental issues This holistic concept views agriculture, food, and nutrition as parts of a broader process Transdisciplinary research interfaces several dimensions of food and eating. © 2020 Society of Chemical Industry.