Blood flow effects of percutaneous peripheral nerve stimulation. A blinded, randomized clinical trial.

BACKGROUND: The vasculature function is mainly regulated by the autonomic nervous system. Importantly, the sensory-motor nervous system also innervates peripheral vessels and has the capacity to modulate vascular tone. Here we investigated the effects of electrical stimulation of a mixed nerve trunk on blood flow in deep arteries and muscle perfusion. Our hypothesis is that stimulation of a mixed nerve can modify blood flow. METHODS: Twenty-nine healthy participants were included into a randomized-crossover and blinded clinical trial. Each subject received a placebo and two percutaneous peripheral nerve stimulation (pPNS) protocols on the median nerve: Pain Threshold continuous Low Frequency (PT-cLF) and Sensory Threshold burst High Frequency (ST-bHF). Blood flow was then assessed bilaterally using Power Doppler Ultrasonography at the main arteries of the arm, and blood perfusion at the forearm muscles. Afterwards, blood flow was quantified using a semi-automatized software, freely shared here. RESULTS: Placebo, consisting in needle insertion, produced an immediate and generalized reduction on peak systolic velocity in all arteries. Although nerve stimulation produced mainly no effects, some significant differences were found: both protocols increased the relative perfusion area of the forearm muscles, the ST-bHF protocol prevented the reduction in peak systolic velocity and TAMEAN of the radial artery produced by the control protocol and PT-cLF produced a TAMEAN reduction of the ulnar artery. CONCLUSIONS: Therefore, the arterial blood flow in the arm is mainly impervious to the electrical stimulation of the median nerve, composed by autonomic and sensory-motor axons, although it produces mild modifications in the forearm muscles perfusion.

Analysis of Healthcare Costs Incurred in Regional Hospitals in Andalusia (Spain) during the COVID-19 Pandemic.

(1) Background: The global health crisis caused by the coronavirus disease (COVID-19) pandemic has led to extreme overloading of different public healthcare systems worldwide. The Spanish Public Healthcare System is one of them. This study aimed to conduct a comparative cost analysis to assess the impact of the COVID-19 pandemic on small- and medium-sized regional hospitals in Andalusia (Spain). (2) Methods: This comparative, multicentre, observational, and retrospective study was designed to perform a comparative cost analysis between the Alto Guadalquivir Health Agency (AGHA) and Poniente University Hospital (PUH), both of which belong to the Spanish Public Health System (PHS). The data included in this study corresponds to the total costs by area and year incurred by the 61,335 patients from both healthcare institutions (AGHA = 36,110; PUH = 25,225) in the areas of hospital emergency service (HES), hospitalisation, and intensive care unit (ICU), during the 24 months of the study period (from 1 January 2019 to 31 December 2020). (3) Results: The analysis results showed a significant increase in costs incurred in 2020 for HES relative to those incurred in 2019 for both AGHA (+14%; p < 0.003) and PUH (+36%; p = 0.002). Additionally, costs incurred for ICU increased significantly in 2020 relative to those incurred in 2019 for both AGHA (+30%; p = 0.003) and PUH (+46%; p = 0.002). Hospitalisation costs for AGHA also increased significantly (+9%; p < 0.012) in 2020 versus those obtained in 2019; however, no significant differences were found for PUH (+6%; p = 1) in the same period analysed. However, the number of patients treated in the areas of HES, hospitalisation, and ICU was significantly reduced throughout 2020 compared to 2019. (4) Conclusions: Our findings show that the costs incurred during 2020 in the regional hospitals of Andalusia (Spain) increased significantly in most of the parameters analysed relative to those incurred in the year before the pandemic (i.e., 2019).

Juicios metacognitivos en la educación médica / Metacognitive judgments in medical education

Resumen En la educación médica, la metacognición incide en diferentes aspectos: mejora el rendimiento académico, contribuye a la toma de decisiones, facilita el desarrollo de habilidades clínicas, permite combatir el exceso de confianza y disminuye errores diagnósticos. Por ello, se constituye en una habilidad necesaria en la formación del médico. En este sentido, el uso de estrategias que promuevan el desarrollo de juicios metacognitivos, es clave en los procesos de enseñanza y aprendizaje. Para profundizar en los aportes de los juicios metacognitivos en el campo de la educación médica, se construye el siguiente artículo producto de una revisión bibliográfica. En él se logra pasar de una dimensión macro de la metacognición (conocimiento o regulación), a una dimensión micro referida a los juicios metacognitivos, evidenciado cómo estos aportan al razonamiento clínico, a la toma de decisiones, a la disminución del error médico y a la seguridad del paciente. El artículo muestra una línea de trabajo denominada juicios metacognitivos, caracterizada por centrarse en la precisión entre las afirmaciones de desempeño en una tarea y el rendimiento real.

Abstract Metacognition contributes to medical education from different aspects: improve academic performance, contributes to decision making, facilitates the development of clinical skills, helps combat overconfidence and reduces diagnostic errors. This is why it becomes a necessary skill to develop in the training of the student medicine for which strategies such as metacognitive scaffolds are included, deliberate consideration of alternatives, and the reproduction of optimal actions. To understand these contributions for learning medicine, a bibliographic review article was developed, through a process that included searching databases through descriptors in Spanish and English, the selection of articles that will include the relationship of metacognition and the learning of medicine, to arrive at the construction of a text that would account for an understanding of the subject. The above allowed, not just delve into metacognition as a higher order skill in learning, but also guide a discussion that highlights a line of work called metacognitive judgments, which is characterized by focusing on the precision between performance claims on a task and actual performance.

Digital resources for transfusion education.

INTRODUCTION: Regular training in the blood transfusion process is crucial for transfusion safety. Hospital transfusion committees have an obligation to provide this education to hospital employees through training activities. E-learning is positioning itself as a valid alternative to physical-presence courses. MATERIALS AND METHODS: We describe a training course on blood transfusion to members of our hospital who are involved in the transfusion process, including technicians, nurses, and doctors. The course uses Moodle as the e-learning platform; it is evaluated using a satisfaction survey along with a knowledge-transfer and impact survey a year after taking the course. RESULTS: From 2015 to 2018, seven editions of the online transfusion course were developed. Six hundred and eighty students enrolled; of these, 124 did not take the final examination (18.2%); 60 never began the course (8.8%). Of the 556 students who completed the course, 546 passed (98.2%). The average score from the initial self-assessment was 7.3 while the average score from the final self-assessment was 9.2; the mean improvement was 1.9 (out of 10). The level of general course satisfaction was 9.27 (an average out of 10). More than 90% of the students stated that they were able to apply the acquired knowledge in the workplace after a year. CONCLUSIONS: E-learning has demonstrated itself as an affordable solution that could help in the training of all staff involved in the transfusion process at our hospital, with the advantage that it includes general knowledge and particular skills in local transfusion medical practice.

Neck Pain- and Unsteadiness-Inducing Activities and their Relationship to the Presence, Intensity, Frequency, and Disability of Headaches.

(1) Background: Headache is a significant public health problem. Despite the association between headache and neck pain, little is known about the relationships among specific activities that generate neck pain and headache. The aim of this study was to identify the specific activities that result in neck pain and unsteadiness, and determine how they are linked to headache in university students. (2) Methods: One hundred and six patients with physician-diagnosed headache and 92 healthy university students completed surveys assessing demographics; the presence, frequency, intensity, and disability of headaches; and activities generating neck pain and unsteadiness. (3) Results: The presence of headache was related to female gender (p = 0.001), neck pain when reading or watching television (p = 0.024), and unsteadiness when moving the head (p = 0.005). Headache-related disability was associated with intensity of neck pain (p < 0.001), neck pain when reading or watching television (p = 0.033), and stumbling (p < 0.001). Headache frequency was related to smoking (p = 0.004), the duration of neck pain-associated symptoms (p = 0.047), and neck pain when driving (p = 0.039). Intensity of headache was associated with female gender (p = 0.002), smoking (p = 0.013), and neck pain-related sleep alterations (p = 0.024). (4) Conclusions: Female gender, smoking, neck pain, and unsteadiness when moving the head are factors related to headache in university students.

Relationship among mental models, theories of change, and metacognition: structured clinical simulation / Relación entre modelos mentales, teorías del cambio y metacognición: Simulación clínica estructurada

Abstract Learning is a change in the way of thinking that lasts over time and allows for solving problems; on the other hand, education based on structured clinical simulation is a pedagogic mediation between the classroom and clinical practice, which allows experience, reflection, monitoring, control, and restructuring of thought, which can contribute to deep and lasting learning. It is desirable that students, both undergraduate and graduate, are given the opportunity to be trained under structured simulation.

Resumen El aprendizaje es el cambio en el pensamiento que perdura en el tiempo y permite la solución de problemas; por su parte, la educación basada en simulación clínica estructurada es una mediación pedagógica entre el aula de clase y la práctica clínica, que permite experiencia, reflexión, monitoreo, control y reestructuración del pensamiento, lo que puede aportar en aprendizajes profundos y duraderos. Es deseable que los estudiantes, tanto en pregrado como en posgrado, tengan la oportunidad de ser formados con simulación estructurada.

Cambio conceptual sobre infarto agudo del miocardio en estudiantes de ciencias de la salud / Conceptual change on acute myocardial infarction among health sciences students

Resumen Objetivo: caracterizar de los modelos explicativos sobre infarto agudo del miocardio (IAM) en estudiantes de ciencias de la salud e identificar los cambios que ocurren en éstos al implementar el aprendizaje basado en problemas (ABP). Marco de referencia: las nuevas tendencias de enseñanza- aprendizaje en ciencias privilegian la construcción de actividades participativas que propicien el razonamiento científico, la argumentación y la apropiación de los conceptos específicos, dirigidos a la comprensión de la racionalidad de la ciencia y su aplicación en el contexto cotidiano. Diseño: estudio descriptivo con análisis comprensivo cualitativo en estudiantes de tercer semestre de pregrado de la Facultad de Salud de la Universidad Tecnológica de Pereira. Intervenciones: inicialmente se caracterizaron los modelos explicativos de los estudiantes acerca del concepto IAM, clasificándolos según cuatro categorías: sentido común (SC), anatómico/tisular (AT), celular/ funcional (CF), biológico/metabólico (BM). En el segundo momento se implementó el ABP como estrategia didáctica de intervención de los modelos explicativos. Luego se conformó un grupo focal con el cual se llevó a cabo un análisis comprensivo y en profundidad del cambio en los modelos explicativos. Resultados: en la primera fase del análisis se encontró que la mayoría de estudiantes se encontraba en el modelo SC, posteriormente, se nota una progresión a los modelos superiores, siendo el AT el más frecuente; finalmente, se logra identificar que los estudiantes demuestran tener elementos de varios modelos. Conclusiones: se logró evidenciar un cambio sustancial en los modelos explicativos iniciales; lo que permite vincular al ABP como estrategia didáctica para promover el cambio conceptual.

Abstract Objective: to characterize the explanatory models of acute myocardial infarction (AMI) in health sciences students and to identify the changes that occur in them when implementing problem-based learning (PBL). Frame of reference: the new teaching-learning trends in science benefit the construction of participatory activities that propitiate scientific reasoning, argumentation and the appropriation of specific concepts, aimed at understanding the rationality of science and its application in the everyday context. Design: descriptive study with comprehensive qualitative analysis in undergraduate third-semester students of the Faculty of Health of the Technological University of Pereira. Interventions: the students' explanatory models about the IAM concept were initially characterized, classifying them according to four categories: common sense (CS), anatomical / tissue (AT), cellular / functional (CF), biological / metabolic (BM). In the second time, the PBL was implemented as a didactic strategy for the intervention of explanatory models. Then a focus group was formed with which a comprehensive and in-depth analysis of the change in the explanatory models was carried out. Results: in the first phase of the analysis it was found that the majority of students were in the CS model; later, a progression to the higher models was observed, being the AT the most frequent. Finally, it is possible to identify that the students demonstrate having elements of several models. Conclusions: a substantial change in the initial explanatory models was evidenced, thus allowing to link the PBL as a didactic strategy to promote conceptual change.

Asociación de obesidad general y abdominal con hipertensión, dislipemia y presencia de prediabetes en el estudio PREDAPS / Association of general and abdominal obesity with hypertension, dyslipidemia and prediabetes in the PREDAPS study

Introducción y objetivos: Algunas medidas antropométricas muestran mayor capacidad que otras para discriminar la presencia de factores de riesgo cardiovascular. Este trabajo estima la magnitud de la asociación de diversos indicadores antropométricos de obesidad con hipertensión, dislipemia y prediabetes (glucemia basal o glucohemoglobina alteradas). Métodos: Análisis transversal de la información recogida en 2.022 sujetos del estudio PREDAPS (etapa basal). Se definió obesidad general como índice de masa corporal ≥ 30 kg/m2 y obesidad abdominal con 2 criterios: a) perímetro de cintura (PC) ≥ 102 cm en varones/PC ≥ 88 cm en mujeres, y b) índice cintura/estatura (ICE) ≥ 0,55. La magnitud de la asociación se estimó mediante regresión logística. Resultados: La hipertensión arterial mostró la asociación más alta con la obesidad general en mujeres (OR = 3,01; IC95%, 2,24-4,04) y con la obesidad abdominal según el criterio del ICE en varones (OR = 3,65; IC95%, 2,66-5,01). La hipertrigliceridemia y los valores bajos de colesterol unido a lipoproteínas de alta densidad mostraron la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,49; IC95%, 1,68-3,67 y OR = 2,70; IC95%, 1,89-3,86) y la obesidad general en varones (OR = 2,06; IC95%, 1,56-2,73 y OR = 1,68; IC95%, 1,21-2,33). La prediabetes mostró la asociación más alta con obesidad abdominal según el criterio del ICE en mujeres (OR = 2,48; IC95%, 1,85-3,33) y con obesidad abdominal según el criterio del PC en varones (OR = 2,33; IC95%, 1,75-3,08). Conclusiones: Los indicadores de obesidad abdominal mostraron la mayor asociación con la presencia de prediabetes. La relación de los indicadores antropométricos con hipertensión y con dislipemia mostró resultados heterogéneos (AU)

Introduction and objectives: Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin). Methods: Cross-sectional analysis of information collected from 2022 participants in the PREDAPS study (baseline phase). General obesity was defined as body mass index ≥ 30 kg/m2 and abdominal obesity was defined with 2 criteria: a) waist circumference (WC) ≥ 102 cm in men/WC ≥ 88 cm in women, and b) waist-height ratio (WHtR) ≥ 0.55. The magnitude of the association was estimated by logistic regression. Results: Hypertension showed the strongest association with general obesity in women (OR, 3.01; 95%CI, 2.24-4.04) and with abdominal obesity based on the WHtR criterion in men (OR, 3.65; 95%CI, 2.66-5.01). Hypertriglyceridemia and low levels of high-density lipoprotein cholesterol showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.49; 95%CI, 1.68-3.67 and OR, 2.70; 95%CI, 1.89-3.86) and with general obesity in men (OR, 2.06; 95%CI, 1.56-2.73 and OR, 1.68; 95%CI, 1.21-2.33). Prediabetes showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.48; 95%CI, 1.85-3.33) and with abdominal obesity based on the WC criterion in men (OR, 2.33; 95%CI, 1.75-3.08). Conclusions: Abdominal obesity indicators showed the strongest association with the presence of prediabetes. The association of anthropometric indicators with hypertension and dyslipidemia showed heterogeneous results (AU)

Association of General and Abdominal Obesity With Hypertension, Dyslipidemia and Prediabetes in the PREDAPS Study.

INTRODUCTION AND OBJECTIVES: Some anthropometric measurements show a greater capacity than others to identify the presence of cardiovascular risk factors. This study estimated the magnitude of the association of different anthropometric indicators of obesity with hypertension, dyslipidemia, and prediabetes (altered fasting plasma glucose and/or glycosylated hemoglobin). METHODS: Cross-sectional analysis of information collected from 2022 participants in the PREDAPS study (baseline phase). General obesity was defined as body mass index ≥ 30kg/m2 and abdominal obesity was defined with 2 criteria: a) waist circumference (WC) ≥ 102cm in men/WC ≥ 88cm in women, and b) waist-height ratio (WHtR) ≥ 0.55. The magnitude of the association was estimated by logistic regression. RESULTS: Hypertension showed the strongest association with general obesity in women (OR, 3.01; 95%CI, 2.24-4.04) and with abdominal obesity based on the WHtR criterion in men (OR, 3.65; 95%CI, 2.66-5.01). Hypertriglyceridemia and low levels of high-density lipoprotein cholesterol showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.49; 95%CI, 1.68-3.67 and OR, 2.70; 95%CI, 1.89-3.86) and with general obesity in men (OR, 2.06; 95%CI, 1.56-2.73 and OR, 1.68; 95%CI, 1.21-2.33). Prediabetes showed the strongest association with abdominal obesity based on the WHtR criterion in women (OR, 2.48; 95%CI, 1.85-3.33) and with abdominal obesity based on the WC criterion in men (OR, 2.33; 95%CI, 1.75-3.08). CONCLUSIONS: Abdominal obesity indicators showed the strongest association with the presence of prediabetes. The association of anthropometric indicators with hypertension and dyslipidemia showed heterogeneous results.

Psiquiatria Biológica e Psicofarmacologia: a formação de uma rede tecnocientífica / Biological Psychiatry and Psychopharmacology: a techno-scientific network in debate

Resumo A Psiquiatria Biológica emerge nos anos de 1980, nos Estados Unidos, com a publicação do DSM-III (Diagnostic and Statistical Manual of Mental Disorders). Este manual tem a proposta de ser a-teórico e apresentar descrições objetivas dos, então, chamados "distúrbios mentais" a partir de um critério classificatório que não inclui discussões acerca da etiologia destes "distúrbios". Isto implica que, apesar da denominação biológica conferida a esta vertente psiquiátrica, não houve nenhuma descoberta acerca da etiologia biológica destes distúrbios que justificasse sua denominação e seu estrondoso sucesso mundial. Neste artigo, pretendemos analisar as modificações ocorridas na psiquiatria norte-americana a partir da introdução do DSM-III, dos primeiros medicamentos psicotrópicos e o subsequente papel desempenhado pela indústria farmacêutica neste processo. Desse modo, o que está em análise neste artigo é que, ao se apropriar dos medicamentos psicotrópicos como primeira opção terapêutica, a Psiquiatria Biológica cria uma aliança com a indústria farmacêutica que a insere numa rede tecnocientífica que dificulta saber os limites entre Psiquiatria Biológica, Psicofarmacologia e Indústria farmacêutica.

Abstract Biological Psychiatry emerged in the 1980s in the United States with the publication of DSM-III (Diagnostic and Statistical Manual of Mental Disorders). This manual intends to be a-theoretical and to provide objective descriptions of "mental disorders" by using diagnostic criteria that do not include discussions about the aetiology of these "disorders". Hence and despite the "biological" label conferred to this branch of psychiatry, there is no explicit concern to ascertain the possible biological origins of "mental disorders" in DSM-III. In this paper we intend to examine the modifications in North American Psychiatry following the introduction of the first psychotropic medications and the subsequent role played by the pharmaceutical industry in this process. Thus, what is under analysis in our article is that, by appropriating psychotropic drugs as the first therapeutic option, Biological Psychiatry creates an alliance with the pharmaceutical industry that inserts it into a technoscientific network that makes it difficult to know the limits between Biological Psychiatry, Psychopharmacology and the Pharmaceutical industry.

Controversias sobre ADHD y metilfenidato en discusiones sobre medicalización en Argentina y Brasil / Controvérsias sobre TDAH e metilfenidato nas discussões sobre medicalização na Argentina e no Brasil / Controversies about ADHD and methylphenidate in discussions on medicalization in Argentina and Brazil

Resumen El trabajo tiene como objetivo ofrecer un análisis sistemático de algunos resultados de investigaciones realizadas en Argentina y Brasil relacionadas con el uso del metilfenidato, su prescripción y la regulación de la venta. También examinamos las discusiones entre investigadores y profesionales que asisten a personas diagnosticadas con TDAH en ambos países. El artículo integra dos campos de investigación. En Argentina se analizaron artículos de prensa, datos numéricos de organizaciones oficiales y profesionales y entrevistas semiestructuradas de profesionales de salud individuales y grupales realizadas entre 2007 y 2011. En Brasil se analizaron las revistas científicas, la observación participante y los profesores de las escuelas y los profesionales de la salud. Las conclusiones incluyen que los movimientos sociales en ambos países se han organizado y articulado, en un intento de promover el debate sobre la medicalización de la infancia y su despliegue en la sociedad.

Abstract The paper aims to offer a systematic analysis of some results from investigations conducted in Argentina and Brazil relating on the use of methylphenidate, its prescription and sale's regulation. We also examined the discussions among researchers and professionals assisting individuals diagnosed with ADHD in both countries. The article integrates two research fields. In Argentina, newspaper articles, official and professional organizations' numeric data, and individual and group health professionals semi structured interviews conducted between 2007 and 2011 were analyzed. In Brazil scientific journals, participant observation and school teachers and health professionals were analyzed. Conclusions include that social movements in both countries have been organized and articulated, in an attempt to promote discussion on the medicalization of childhood and its deployment in society.

Resumo O artigo pretende oferecer uma análise sistemática de alguns resultados das investigações realizadas na Argentina e no Brasil sobre o uso de metilfenidato, sua prescrição e regulamento de venda. Também examinamos as discussões entre pesquisadores e profissionais que atendem indivíduos com diagnóstico de TDAH em ambos os países. O artigo integra dois campos de pesquisa. Na Argentina, foram analisados artigos de jornal, dados numéricos das organizações oficiais e profissionais e entrevistas semiestruturadas individuais e grupais de profissionais de saúde realizadas entre 2007 e 2011. No Brasil, foram analisadas as revistas científicas, a observação participante e professores e profissionais de saúde. Conclui-se que os movimentos sociais nos dois países foram organizados e articulados, na tentativa de promover a discussão sobre a medicalização da infância e sua implantação na sociedade.

Clinical Decision Support using a Terminology Server to improve Patient Safety.

Clinical Decision Support Systems (CDSS) are software applications that support clinicians in making healthcare decisions providing relevant information for individual patients about their specific conditions. The lack of integration between CDSS and Electronic Health Record (EHR) has been identified as a significant barrier to CDSS development and adoption. Andalusia Healthcare Public System (AHPS) provides an interoperable health information infrastructure based on a Service Oriented Architecture (SOA) that eases CDSS implementation. This paper details the deployment of a CDSS jointly with the deployment of a Terminology Server (TS) within the AHPS infrastructure. It also explains a case study about the application of decision support to thromboembolism patients and its potential impact on improving patient safety. We will apply the inSPECt tool proposal to evaluate the appropriateness of alerts in this scenario.

Astroglia-Microglia Cross Talk during Neurodegeneration in the Rat Hippocampus.

Brain injury triggers a progressive inflammatory response supported by a dynamic astroglia-microglia interplay. We investigated the progressive chronic features of the astroglia-microglia cross talk in the perspective of neuronal effects in a rat model of hippocampal excitotoxic injury. N-Methyl-D-aspartate (NMDA) injection triggered a process characterized within 38 days by atrophy, neuronal loss, and fast astroglia-mediated S100B increase. Microglia reaction varied with the lesion progression. It presented a peak of tumor necrosis factor-α (TNF-α) secretion at one day after the lesion, and a transient YM1 secretion within the first three days. Microglial glucocorticoid receptor expression increased up to day 5, before returning progressively to sham values. To further investigate the astroglia role in the microglia reaction, we performed concomitant transient astroglia ablation with L-α-aminoadipate and NMDA-induced lesion. We observed a striking maintenance of neuronal death associated with enhanced microglial reaction and proliferation, increased YM1 concentration, and decreased TNF-α secretion and glucocorticoid receptor expression. S100B reactivity only increased after astroglia recovery. Our results argue for an initial neuroprotective microglial reaction, with a direct astroglial control of the microglial cytotoxic response. We propose the recovery of the astroglia-microglia cross talk as a tissue priority conducted to ensure a proper cellular coordination that retails brain damage.

A epigenética como nova hipótese etiológica no campo psiquiátrico contemporâneo / Epigenetics as new etiological hypothesis in the contemporary psychiatric field

Nas últimas décadas, as teorias neurocientíficas passaram a ser adotadas como explicação primordial para a etiologia dos transtornos mentais. Com o objetivo de encontrar os fundamentos dos transtornos, as investigações priorizaram a carga genética e o funcionamento cerebral. A partir da valorização da determinação biológica das doenças e do surgimento de variadas tecnologias de pesquisa médica, aventou-se a possibilidade de que as causas dos transtornos fossem, finalmente, compreendidas. No entanto, diversas dificuldades e desafios marcam o projeto neurocientífico de fundamentação biológica da etiologia das doenças. A introdução recente da noção de epigenética no campo psiquiátrico vem sendo considerada fundamental para renovar a esperança de compreensão da etiologia dos transtornos. A partir da análise de artigos de revisão, o presente trabalho tem como objetivos examinar a apropriação da noção de epigenética pelo campo psiquiátrico contemporâneo, identificando suas origens e descrevendo suas principais características, e refletir sobre as consequências de sua adoção. Além de contribuir para a redefinição das teses etiológicas no campo psiquiátrico, a noção de epigenética impõe uma reconfiguração do conhecimento genético e, em certa medida, do próprio projeto determinista e reducionista de fundamentação biológica dos transtornos mentais, permitindo interpretações mais nuançadas sobre as neurociências e a psiquiatria contemporânea...

In recent decades, neuroscientific theories began to be adopted as central to the etiology of mental disorders explanation. Aiming to find the foundations of disorders, investigations took prioritized genetic load and brain functioning. From the valuation of biological determination of diseases and the emergence of various technologies of medical research, one has suggested the possibility that the causes of disorders were finally understood. However, several difficulties and challenges mark the neuroscientific project biological foundation of disease etiology. The recent introduction of the notion of epigenetics in the psychiatric field has been considered essential to renew the hope of understanding the etiology of disorders. From the analysis of review articles, this article aims to examine the appropriation of the concept of epigenetics by contemporary psychiatric field, identifying their origins and describing their main characteristics, and reflect on the consequences of their adoption. Besides contributing to the redefinition of etiological theories in the psychiatric field, the notion of epigenetics imposes a reconfiguration of genetic knowledge and, to some extent, the deterministic and reductionist design of biological foundation of mental disorders itself, allowing for more nuanced interpretations of neuroscience and contemporary psychiatry...

Guía de práctica clínica sobre terapia intravenosa con dispositivos no permanentes en adultos / Clinical practice guideline on intravenous therapy with temporary devices in adults

El objetivo principal de la guía es proporcionar a los profesionales sanitarios una herramienta que les permita tomar decisiones basadas en evidencia sobre aspectos de la atención al paciente adulto con indicación de terapia intravenosa con dispositivos no permanentes. Además, se señalan los objetivos secundarios siguientes: aumentar la calidad de las intervenciones, evitar complicaciones relacionadas con la terapia intravenosa y reducir la variabilidad existente entre los profesionales sanitarios.

The guideline includes recommendations for taking care of adult patients with intravenous therapy who are at primary care centres, hospitals and homes.

Marcas no corpo, cansaço e experiência: nuances do envelhecer como professor de Educação Física / Marks on the body, fatigue and experience: nuances of aging as a physical education teacher / Marcas en el cuerpo, cansancio y experiencia: matices del envejecer cómo profesor de Educación Física

Este trabalho objetivou compreender e interpretar os significados que os professores de Educação Física atribuem ao corpo e envelhecimento, e investigar como tais representações influenciariam sua prática profissional. Participaram da investigação, de natureza qualitativa, 43 professores de escolas e academias de ginástica com cerca de trinta anos de formação. Os dados foram tratados mediante análise de conteúdo. O envelhecimento do professor propicia maturidade, experiência e confiança no trabalho, mas o corpo físico parece desprender-se do sujeito, repercutindo em sentimentos contraditórios relacionados ao envelhecimento. Nas academias, há certo ajuste ao contexto da visibilidade, pois são valorizadas as potencialidades e as marcas de saúde impressas no corpo. Já o desgaste e o cansaço são particularmente sentidos pelos professores atuantes em escola.

This study aimed to gain comprehension of and interpret the meanings that physical education teachers attribute to body and aging, and to investigate how these representations could influence their professional practice. This qualitative study was conducted among 43 teachers at schools and gyms with around 30 years of experience since graduating. The data were evaluated using content analysis. The teachers' aging gave them maturity, experience and confidence in their work. However, the physical body seemed to be separated from the subject, which led to contradictory feelings about aging. In the gyms, there was a certain adjustment to the context of visibility, since the potential of the body and the marks of health imprinted on it are highly valued. Wear and fatigue were particularly felt by the teachers working in schools.

Los objetivos de la investigación fueron comprender e interpretar los significados que los profesores de Educación Física atribuyen al cuerpo y al envejecimiento e investigar en que medida esas representaciones podrían influenciar su práctica profesional. Esta investigación, de naturaleza cualitativa, fue realizada con 43 profesores de escuelas y gimnasios que tenían más o menos 30 años de profesión. Los datos fueron interpretados por el análisis de contenido. El proceso de envejecimiento del profesor propicia madurez, experiencia y confianza en el trabajo, pero el cuerpo físico parece desprenderse del sujeto, repercutiendo en sentimientos contradictorios relacionados al envejecimiento. En los gimnasios, hay un ajuste al contexto de visibilidad, pues son valorizadas las potencialidades del cuerpo y las marcas de salud impresas en el cuerpo. Ya el desgaste y cansancio son sentidos por los ofesores que actúan en la escuela.

El Proceso Terapéutico "Momento a Momento" desde una Perspectiva Analítico-Funcional / A "Moment-to-Moment" Analysis of the Therapeutic Process Using a Functional-Analytic Approach

Este trabajo describe cómo se desarrolla el proceso terapéutico en un caso concreto mediante el estudio de las posibles funciones de la conducta verbal del terapeuta durante la interacción con su cliente. Para ello, se procedió a la observación de las grabaciones de las 10 sesiones que constituyeron la totalidad de la intervención terapéutica del caso estudiado. La categorización del comportamiento verbal del psicólogo en sesión fue realizada mediante el software The Observer® XT y la aplicación del Sistema de Categorización de la Conducta Verbal del Terapeuta (SISC-CVT) desarrollado por las autoras y asociado a altos niveles de concordancia inter e intra observadores. El análisis de los registros permitió una primera aproximación a la formulación de una "radiografía funcional" del proceso terapéutico que puede tener importantes implicaciones para el estudio y comprensión del fenómeno clínico así como para el diseño, entrenamiento y aplicación de formas más efectivas de intervención psicológica (AU)

This study analyzes the potential functions of the therapist's verbal behavior during actual in-session therapist-client interactions. The complete therapeutic process of a clinical case was recorded (10 sessions). The therapist's verbal behavior was coded by means of The Observer® XT software and the Therapists' Verbal Behavior Category System (SISC-CVT), which has shown high levels of inter and intra-rater agreement. Results showed a descriptive analysis of the therapeutic process. Our results help to understand the functional relations and learning mechanisms that may be involved during in-session verbal interaction. The approach illustrated in the present study could serve a first step to designing, training and putting into practice more effective psychological interventions (AU)

Popliteal pseudoaneurysm after total knee arthroplasty secondary to intraoperative arterial injury with a surgical pin: review of the literature.

Pseudoaneurysms of the popliteal artery after total knee arthroplasty are rare. Although many possible explanations are proposed in the literature, no intimate mechanism of injury to the artery is previously described. We report on a case of popliteal pseudoaneurysm after a total knee arthroplasty that presented clinically on the second postoperative day. Open vascular surgery with resection of the pseudoaneurysm and end-to-end bypass of contralateral saphena vein graft was successfully performed. At the time of the surgery, a hole was clearly identified on the anterior wall of the popliteal artery due to a perforation with a pin used during the knee arthroplasty. The patient had no further complications.