Assessing skills in psychiatry. Experience and implementation of OSCE for medical students.

INTRODUCTION: Medical education has been changing, and the evaluation strategies that make it possible to address not only theoretical knowledge but also clinical skills. In Mental Health, these skills play a central role. The Objective Structured Clinical Examination (OSCE) is one of the evaluations that could assess clinical skills. This article describes the implementation and performance for the evaluation of undergraduate students since the OSCE's introduction in 2015. METHODS: An explanation of the implementation is made, and a description of the OSCEs carried out to undergraduate medical students in the second semester of mental health, using the databases of the final practical examinations during those years. The perception of mental health teachers is also described. RESULTS: The mental health OSCE implemented in 2015-2, is developed in the Simulated Hospital of the University and has five stations (interview, mental examination, diagnosis, treatment and information to the family and ethics). Between 2016-2 and 2019-2, 486 students performed OSCE with an average score of 3.85 (scale 0-5). It was observed that the grade obtained when evaluating anxiety disorders was below average, that of affective disorders above average, while that of psychotic disorders was within the average. The professors highlight the versatility, the comprehensive objective evaluation of the practical and theoretical aspects, and the possibility of comparison between the different groups. CONCLUSIONS: The OSCE is an examination that provides the possibility to evaluate the competences in psychiatry of medical students and allows the identification of the aspects to be improved in the teaching learning process.

Genome-wide study of gene-by-sex interactions identifies risks for cleft palate.

Structural birth defects affect 3-4% of all live births and, depending on the type, tend to manifest in a sex-biased manner. Orofacial clefts (OFCs) are the most common craniofacial structural birth defects and are often divided into cleft lip with or without cleft palate (CL/P) and cleft palate only (CP). Previous studies have found sex-specific risks for CL/P, but these risks have yet to be evaluated in CP. CL/P is more common in males and CP is more frequently observed in females, so we hypothesized there would also be sex-specific differences for CP. Using a trio-based cohort, we performed sex-stratified genome-wide association studies (GWAS) based on proband sex followed by a genome-wide gene-by-sex (GxS) interaction testing. There were 13 loci significant for GxS interactions, with the top finding in LTBP1 (RR=3.37 [2.04 - 5.56], p=1.93x10 -6 ). LTBP1 plays a role in regulating TGF-B bioavailability, and knockdown in both mice and zebrafish lead to craniofacial anomalies. Further, there is evidence for differential expression of LTBP1 between males and females in both mice and humans. Therefore, we tested the association between the imputed genetically regulated gene expression of genes with significant GxS interactions and the CP phenotype. We found significant association for LTBP1 in cell cultured fibroblasts in female probands (p=0.0013) but not in males. Taken altogether, we show there are sex-specific risks for CP that are otherwise undetectable in a combined sex cohort, and LTBP1 is a candidate risk gene, particularly in females.

Predictors of Quality of Work Life in Health Care Workers at Adult Critical Care Units: A Cross-sectional Study.

Aim and background: Satisfaction with the quality of work life reflects the inadequate distribution of the workforce in critical care units and is not enough; on many occasions, they work in precarious conditions and with high levels of physical, emotional, spiritual, and social demands, impacting the quality of care. Aim: To identify predictors of the quality of work life of healthcare workers in adult critical care units (ACCU). Materials and methods: Quantitative study, cross-sectional analytical design with stratified two-stage sampling; three instruments were applied to 209 healthcare professionals in adult critical care units in different sites in a region of Colombia, concerning Quality of Life at Work-GOHISALO, Copenhagen Psychosocial Questionnaire-COPSOQ and Professional Quality of Life-ProQoL V. Multiple ordinal logistic regression was performed with exposure variables from the COPSOQ and ProQoL domains; the outcome variables were the dimensions of the Quality of Work Life instrument. Ethical standards for research involving human subjects were ensured. Results: According to the results of the multiple logistic models, quality of work life is predicted by job integration and predictability (OR = 6.93; 95% CI = 3.6-13.9), leisure time management and double presence (OR = 4.5; 95% CI = 1.22-8.79). Both job satisfaction and job security are related to leadership quality (OR=3.82; 95% CI = 2.27-6.55 and OR = 3.18; 95% CI = 1.22-8.79), respectively. Conclusions: The quality of work life of healthcare workers in adult intensive care units is predicted by quantitative demands, double presence, emotional demands, work pace, predictability, vertical trust, and quality of leadership. How to cite this article: Quinones-Rozo LP, Canaval-Erazo GE, Sandoval-Moreno LM. Predictors of Quality of Work Life in Health Care Workers at Adult Critical Care Units: A Cross-sectional Study. Indian J Crit Care Med 2024;28(4):355-363.

Incidence and risk factors for catheter-associated urinary tract infection in 623 intensive care units throughout 37 Asian, African, Eastern European, Latin American, and Middle Eastern nations: A multinational prospective research of INICC.

OBJECTIVE: To identify urinary catheter (UC)-associated urinary tract infection (CAUTI) incidence and risk factors. DESIGN: A prospective cohort study. SETTING: The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries. PARTICIPANTS: The study included 169,036 patients, hospitalized for 1,166,593 patient days. METHODS: Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression. RESULTS: Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower-middle-income countries (3.05); and with patients in public hospitals (5.89).The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001). CONCLUSIONS: CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.

Assessing the impact of a multidimensional approach and an 8-component bundle in reducing incidences of ventilator-associated pneumonia across 35 countries in Latin America, Asia, the Middle East, and Eastern Europe.

BACKGROUND: Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal. METHODS: We implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods. RESULTS: 174,987 patients, during 1,201,592 patient-days, used 463,592 MV-days. VAP per 1000 MV-days rates decreased from 28.46 at baseline to 17.58 at the 2nd month (RR = 0.61; 95% CI = 0.58-0.65; P < 0.001); 13.97 at the 3rd month (RR = 0.49; 95% CI = 0.46-0.52; P < 0.001); 14.44 at the 4-15 month (RR = 0.51; 95% CI = 0.48-0.53; P < 0.001); 11.40 at the 16-27 month (RR = 0.41; 95% CI = 0.38-0.42; P < 0.001), and to 9.68 at the 28-39 month (RR = 0.34; 95% CI = 0.32-0.36; P < 0.001). The multilevel Poisson regression model showed a continuous significant decrease in incidence rate ratios, reaching 0.39 (p < 0.0001) during the 28th to 39th months after implementation of the intervention. CONCLUSIONS: This intervention resulted in a significant VAP rate reduction by 66% that was maintained throughout the 39-month period.

Mortalidad por lesiones de tránsito y desigualdades sociales en Colombia, 2019

[RESUMEN]. Objetivo. Evaluar la asociación entre las desigualdades sociales y la mortalidad por lesiones de tránsito en Colombia durante 2019. Métodos. En este estudio ecológico se evaluó la asociación entre las desigualdades sociales y la mortalidad por lesiones de tránsito de las personas usuarias del sistema de transporte terrestre carretero en Colombia durante 2019, con base en fuentes secundarias de información, a nivel de departamento como unidad admi- nistrativa y geográfica de estudio. Se hizo un análisis estadístico descriptivo tanto del indicador de salud como de los estratificadores de equidad y se utilizaron medidas absolutas y relativas para determinar las brechas de desigualdad social. Resultados. En 2019 murieron en Colombia 6 580 personas por lesiones de tránsito, la mayoría de las cuales (82%) eran hombres. La condición de usuario más crítica fue la de motociclista. El grupo etario con más víctimas tenía aproximadamente 30 años. Los departamentos con población entre 500 000 y 2 000 000 de habitantes tuvieron la más alta participación. El estratificador de equidad con la condición más crítica de des- igualdad fue el número de motocicletas registradas por cada 100 000 habitantes. Se evidenciaron brechas de desigualdad importantes entre los departamentos. Conclusiones. Se reconocieron desigualdades de la mortalidad por lesiones de tránsito en Colombia. Se deben orientar políticas y actuaciones que contribuyan a la disminución de las inequidades identificadas, lo que redunda en la calidad de vida, bienestar y salud de los ciudadanos.

[ABSTRACT]. Objective. To evaluate the association between social inequalities and deaths from traffic injuries in Colombia in 2019. Methods. This ecological study evaluated the association between social inequalities and deaths from traffic injuries among users of the road transport system in Colombia in 2019, based on secondary information sources, using the department level as the administrative and geographic unit of study. A descriptive statistical analysis of health indicators and equity stratifiers was performed. Absolute and relative measures were used to determine social inequality gaps. Results. In 2019, 6 580 people died from road traffic injuries in Colombia. The majority of them (82%) were men. The most critical user condition was being a motorcyclist. The age group with the most victims was approximately 30 years old. Departments with populations between 500 000 and 2 000 000 were the most represented. The most critical equity stratifier was the number of registered motorcycles per 100 000 popula- tion. Significant inequality gaps between departments were observed. Conclusions. Inequalities in deaths from road traffic injuries in Colombia were observed. Policies and actions should focus on helping to reduce identified inequities, resulting in better quality of life, well-being, and health for the population.

[RESUMO]. Objetivo. Avaliar a relação entre desigualdades sociais e mortalidade por acidentes de trânsito na Colômbia no ano de 2019. Métodos. Este estudo ecológico avaliou a relação entre desigualdades sociais e mortalidade por acidentes de trânsito entre usuários do sistema de transporte rodoviário na Colômbia em 2019, com base em fontes secundárias de informação e departamentos como unidades administrativas e geográficas do estudo. Foi feita uma análise estatística descritiva do indicador de saúde e dos estratificadores de equidade, e foram utilizadas medidas absolutas e relativas para determinar as lacunas de desigualdade social. Resultados. Em 2019, 6 580 pessoas morreram na Colômbia em decorrência de acidentes de trânsito, em sua maioria homens (82%). A categoria de usuário mais afetada foi a de motociclistas, e a faixa etária com o maior número de vítimas girava em torno dos 30 anos. Departamentos com população entre 500 mil e 2 milhões de habitantes tiveram a maior participação. O estratificador de equidade com a condição mais crítica de desigualdade foi o número de motocicletas registradas por 100 mil habitantes. Foram evidenciadas lacunas significativas de desigualdade entre os departamentos. Conclusões. Foram reconhecidas desigualdades na mortalidade por acidentes de trânsito na Colômbia. É preciso implementar políticas e ações que contribuam para a redução das desigualdades identificadas, o que resultará em qualidade de vida, bem-estar e saúde para os cidadãos.

Mortalidad por lesiones de tránsito y desigualdades sociales en Colombia, 2019 / Deaths from traffic injuries and social inequality in Colombia, 2019 / Mortalidade por acidentes de trânsito e desigualdades sociais na Colômbia, 2019

RESUMEN Objetivo. Evaluar la asociación entre las desigualdades sociales y la mortalidad por lesiones de tránsito en Colombia durante 2019. Métodos. En este estudio ecológico se evaluó la asociación entre las desigualdades sociales y la mortalidad por lesiones de tránsito de las personas usuarias del sistema de transporte terrestre carretero en Colombia durante 2019, con base en fuentes secundarias de información, a nivel de departamento como unidad administrativa y geográfica de estudio. Se hizo un análisis estadístico descriptivo tanto del indicador de salud como de los estratificadores de equidad y se utilizaron medidas absolutas y relativas para determinar las brechas de desigualdad social. Resultados. En 2019 murieron en Colombia 6 580 personas por lesiones de tránsito, la mayoría de las cuales (82%) eran hombres. La condición de usuario más crítica fue la de motociclista. El grupo etario con más víctimas tenía aproximadamente 30 años. Los departamentos con población entre 500 000 y 2 000 000 de habitantes tuvieron la más alta participación. El estratificador de equidad con la condición más crítica de desigualdad fue el número de motocicletas registradas por cada 100 000 habitantes. Se evidenciaron brechas de desigualdad importantes entre los departamentos. Conclusiones. Se reconocieron desigualdades de la mortalidad por lesiones de tránsito en Colombia. Se deben orientar políticas y actuaciones que contribuyan a la disminución de las inequidades identificadas, lo que redunda en la calidad de vida, bienestar y salud de los ciudadanos.

ABSTRACT Objective. To evaluate the association between social inequalities and deaths from traffic injuries in Colombia in 2019. Methods. This ecological study evaluated the association between social inequalities and deaths from traffic injuries among users of the road transport system in Colombia in 2019, based on secondary information sources, using the department level as the administrative and geographic unit of study. A descriptive statistical analysis of health indicators and equity stratifiers was performed. Absolute and relative measures were used to determine social inequality gaps. Results. In 2019, 6 580 people died from road traffic injuries in Colombia. The majority of them (82%) were men. The most critical user condition was being a motorcyclist. The age group with the most victims was approximately 30 years old. Departments with populations between 500 000 and 2 000 000 were the most represented. The most critical equity stratifier was the number of registered motorcycles per 100 000 population. Significant inequality gaps between departments were observed. Conclusions. Inequalities in deaths from road traffic injuries in Colombia were observed. Policies and actions should focus on helping to reduce identified inequities, resulting in better quality of life, well-being, and health for the population.

RESUMO Objetivo. Avaliar a relação entre desigualdades sociais e mortalidade por acidentes de trânsito na Colômbia no ano de 2019. Métodos. Este estudo ecológico avaliou a relação entre desigualdades sociais e mortalidade por acidentes de trânsito entre usuários do sistema de transporte rodoviário na Colômbia em 2019, com base em fontes secundárias de informação e departamentos como unidades administrativas e geográficas do estudo. Foi feita uma análise estatística descritiva do indicador de saúde e dos estratificadores de equidade, e foram utilizadas medidas absolutas e relativas para determinar as lacunas de desigualdade social. Resultados. Em 2019, 6 580 pessoas morreram na Colômbia em decorrência de acidentes de trânsito, em sua maioria homens (82%). A categoria de usuário mais afetada foi a de motociclistas, e a faixa etária com o maior número de vítimas girava em torno dos 30 anos. Departamentos com população entre 500 mil e 2 milhões de habitantes tiveram a maior participação. O estratificador de equidade com a condição mais crítica de desigualdade foi o número de motocicletas registradas por 100 mil habitantes. Foram evidenciadas lacunas significativas de desigualdade entre os departamentos. Conclusões. Foram reconhecidas desigualdades na mortalidade por acidentes de trânsito na Colômbia. É preciso implementar políticas e ações que contribuam para a redução das desigualdades identificadas, o que resultará em qualidade de vida, bem-estar e saúde para os cidadãos.

Formación Interprofesional en salud mental: un reto posible / Interprofessional training in mental health: a possible challenge

RESUMEN: Introducción: El abordaje de la salud mental requiere acciones interprofesionales, sin embargo, su enseñanza es tradicionalmente uniprofesional y en escenarios especializados, reforzando la creencia que la salud mental es cuestión de especialistas. Es por esto que se diseña la primera rotación interprofesional en salud mental de la que se tenga conocimiento en Colombia, en la cual rotan estudiantes de medicina y psicología. El objetivo del presente artículo es describir este proceso y la rotación. Material y método: Se describe cuáles fueron los pasos para el diseño y la implementación de la rotación interprofesional en salud mental. Resultados: Se describe la rotación, la cual cuenta con elementos clínicos y simulados y diversas metodologías de aprendizaje y evaluación. Conclusiones: La rotación interprofesional es una estrategia útil en el proceso de aprendizaje de competencias en salud mental y habilidades para el trabajo interprofesional.

ABSTRACT Background: Mental health approaches require interprofessional actions. However, education on mental health is traditionally uniprofessional and is performed in specialized scenarios which reinforces the belief that mental health is only a concern for specialists. This is the reason why the first interprofessional mental health rotation in Colombia was designed and launched. The aim of this paper is to describe that process and the rotation itself. Material and method: This work describes the steps for the design and implementation of an interprofessional rotation on mental health. which involve medicine and psychology students. Results: The structure of the rotation is detailed. It contains both a clinical component and a simulated one, and diverse methodologies for learning and assessment. Conclusions: This interprofessional rotation is a useful strategy in the learning process of specific competences in mental health, and it facilitates acquisition of skills for teamwork.

Enseñando medicina en tiempos de pandemia: una experiencia desde el curso Salud Mental / Teaching medicine in pandemic times: An experience from mental health rotation

RESUMEN Introducción: la pandemia por la COVID-19 llevó a la implementación de medidas de protección en diversos ámbitos de la sociedad. Bajo esta premisa, en todos los niveles de la educación en Colombia se cancelaron las clases presenciales, ocasionando el cese asistencial de los estudiantes de medicina en los hospitales donde realizaban sus practices clínicas. Objetivos: describir las estrategias educativas aplicadas para continuar con las rotaciones clínicas, garantizando el desarrollo de las competencias necesarias en el programa de salud mental. Métodos: la rotación en salud mental del pregrado Medicina, posterior al aislamiento preventivo decretado por el gobierno colombiano, se empezó a realizar de manera virtual y remota con el uso de diversas herramientas tecnológicas. Con la apertura parcial se implementaron actividades semipresenciales y con pacientes reales. Se realizaron actividades sincrónicas y asincrónicas que incluyeron el aprendizaje de recursos tecnológicos, telesimulación, seminarios, talleres, Desarrollo de casos y clubes de revistas, entre otros. Resultados: la virtualidad permitió, además de brindar un aprendizaje de calidad, generar espacios de acompañamiento personalizado a los estudiantes por la situación relacionadacon la pandemia, así como el diseño de estrategias de enseñanza y mecanismos de evaluación novedosos. Conclusiones: la experiencia del cambio de la educación presencial a la virtual permitió múltiples aprendizajes personales y técnicos, y la implementación de nuevas metodologías y herramientas tecnológicas, obteniendo resultados favorables en la ejecución del curso y la evaluación de él mismo con una adecuada satisfacción, tanto en los docentes de psiquiatría como en los estudiantes.

SUMMARY Introduction: The COVID-19 pandemic led to the implementation of diverse safety measures in various aspects of society. Traditional in-person classes were canceled under this premise at all levels of education in Colombia, causing medical students to stop assisting to hospitals for their clinical practices. Objectives: Describe educational strategies applied to continue clinical rotations, securing the development of the necessary competences in the mental health program. Methods: The Medicine School's clinical rotation on mental health started being instructed virtually and remotely using diverse technological tools after the Colombian government decreed a preventive lockdown. Mixed modality activities with real patients restarted once lockdown was partially lifted. We performed synchronous and asynchronous activities that included learning using technological resources, telesimulation, seminaries, workshops, case developments, and journal clubs, among others. Results: Virtual instruction generated personalized tutorship spaces, the design of adapted teaching strategies and novel evaluation mechanisms while maintaining the quality of learning. Conclusion: The change from traditional in-person education to a virtual learning produced multiple personal and technical lessons with the implementation of new methodologies and technological tools, obtaining favorable results in execution, evaluation, and psychiatry teacher's and student's satisfaction.

Physiological changes associated with respiratory muscle training in patients on mechanical ventilation / Cambios fisiológicos relacionados con entrenamiento muscular respiratorio en pacientes con ventilación mecánica

Abstract Introduction: Respiratory muscle training is a technique that aims to increase the strength of the respiratory muscles. However, few studies have addressed physiological changes related to this intervention in patients on mechanical ventilation. Objective: To determine the physiological changes associated with respiratory muscle training in patients on mechanical ventilation. Materials and methods: A secondary data analysis was performed. The population was made up of the 62 patients in the experimental group of the main study, who received respiratory muscle training. Heart rate, respiratory rate, blood pressure, oxygen saturation, and tidal volume values were obtained. The difference between the means of each of the variables was analyzed through the paired t-test, while physiological changes between training sessions were analyzed using the Kruskal-Wallis test. Differences with a p<0.05 value were considered statistically significant. Results: Statistically significant differences were found between physiological variables before and after respiratory muscle training (p<0.05), except for tidal volume and mean blood pressure (p>0.05). In contrast, when the effect was evaluated according to the number of training sessions received by the patients, no significant differences were observed in any of the variables (p>0.05). Conclusions: Respiratory muscle training is a viable and tolerable therapeutic intervention in this population.

Resumen Introducción. El entrenamiento muscular respiratorio es una técnica fisioterapéutica usada para incrementar la fuerza de la musculatura respiratoria, sin embargo pocos estudios han abordado los cambios fisiológicos relacionados con esta intervención en pacientes con ventilación mecánica. Objetivo. Determinar los cambios fisiológicos relacionados con el entrenamiento muscular respiratorio en pacientes con ventilación mecánica. Materiales y métodos. Se realizó un análisis de datos secundarios. La población estuvo conformada por los 62 pacientes del grupo experimental del estudio principal, quienes recibieron entrenamiento muscular respiratorio. Los valores de frecuencia cardiaca, frecuencia respiratoria, presión arterial, saturación de oxígeno y volumen corriente fueron registrados. La diferencia entre el promedio de cada una de las variables fue analizada mediante la prueba de t pareada, mientras que para el análisis de los cambios fisiológicos entre sesiones de entrenamiento se empleó la prueba de Kruskal-Wallis. Las diferencias con un valor p<0.05 se consideraron como estadísticamente significativas. Resultados. Se observaron diferencias estadísticamente significativas entre las variables fisiológicas antes y después del entrenamiento muscular respiratorio (p<0.05), a excepción de volumen corriente y la presión arterial media (p>0.05). Por el contrario, cuando se evaluó el efecto según el número de sesiones de entrenamiento recibidas por los pacientes, no se observaron diferencias significativas en ninguna de las variables (p>0.05). Conclusiones. El entrenamiento muscular respiratorio es una intervención terapéutica viable y tolerable en esta población.

Lo psicosocial, una lectura que trascienda la unión de conceptos y relaciones / The psychosocial, a reading that transcends the union of concepts and relationships

El objetivo de la siguiente reflexión consiste en hacer una lectura acerca de la noción de lo psicosocial. Esta convoca a una revisión crítica para aportar elementos de reflexión en la realización de intervenciones psicosociales o caracterizar las formas de comprender procesos de transformación social que impliquen al sujeto y a la comunidad. En este sentido, se interroga ¿de qué manera los profesionales de las ciencias sociales y humanas hacen lectura de contexto e intervienen bajo este híbrido conceptual? Para ello se parte de la crítica hacia el uso indiscriminado del concepto en las múltiples formas en que este es utilizado por parte de los profesionales de las ciencias sociales y humanas; asimismo, de la lectura de este a la luz de la psicología social, gracias a la cual se trasciende el mero uso del concepto y se profundiza en lo que implicaría la unión de lo "psico" y lo "social" en la variedad de discursos y prácticas que existen hoy día en nuestros contextos sociales, posibilitando así una nueva comprensión del sujeto desde la interacción social y el relacionamiento en la construcción de la realidad. Desde esta perspectiva se pretende reflexionar sobre lo psicosocial para conocer la incidencia en las transformaciones sociales.

The aim of the next reflection is to make a reading about the notion of psychosocial. It calls for a critical review to provide elements of reflection in the realization of psychosocial interventions or to characterize ways of understanding processes of social transformation involving the subject and the community. In this sense, it is questioned how social and human science professionals make context reading and intervene under this conceptual hybrid? this is based on the criticism of the indiscriminate use of the concept in the many ways in which it is used by professionals of the social and human sciences, also the reading of it in view of social psychology, thanks to which the mere use of the concept is transcended and the deepening of what would involve the union of the "psycho" and the "social" in the variety of discourses and practices that exist today in our social contexts, this will enable a new understanding of the subject from social interaction and relationship in the construction of reality, from this perspective it is intended to reflect the psychosocial, to know the impact on social transformations.

Autolesiones no suicidas en adolescentes: prevención y detección en la atención primaria / Non-suicidal self-injuries in adolescents: prevention and detection in primary care

Las autolesiones no suicidas (ALNS) son conductas autolesivas sin objetivo suicida que afecta a los adolescentes con una prevalencia del 17-18%. Se caracterizan por ser lesiones autoinflingidas, principalmente en las extremidades y el abdomen. La psicopatología está sujeta a la presencia de una desregulación emocional, en la que se busca el enmascaramiento del dolor emocional con el físico. Se realizó una revisión bibliográfica con búsqueda en bases de datos, incluyendo palabras clave en inglés y español. Se encontró que la identificación de los factores de riesgo para ALNS en los adolescentes permite la prevención e identificación oportuna de las ALNS; por lo tanto, se propuso la clasificación de los factores de riesgo para ALNS y los instrumentos en atención primaria para su identificación. Se concluyó que el manejo de las ALNS corresponde al psiquiatra infantil y del adolescente, pero su detección y prevención es papel fundamental de los médicos de atención primaria

Non-suicidal self-injuries (NSSI) are self-harm behaviours without a suicidal objective, and have a prevalence of 17-18% in adolescents. It is characterised by self-inflicted injuries, mainly in the extremities and abdomen. The psychopathology is subject to the presence of emotional deregulation, in which it seeks the masking of emotional pain with physical pain. A literature review was conducted using research in databases, including key words in English and Spanish. It was found that the identification of NSSI risk factors in adolescents helps in its prevention and identification, and as such it was proposed to classify the NSSI risk factors, as well as the tools for their identification in primary care. It was concluded that the management of NSSI corresponds to the child and adolescent psychiatrist, but primary care physicians have a fundamental role in its detection and prevention

Presencia de duplicación 2p25.3 y síndrome de microdeleción 2q37.3 en un mismo individuo / Presence of 2p25.3 Duplication and 2q37.3 Microdeletion Syndrome in the Same Individual / Presença de duplicação 2p25.3 e síndrome da microdeleção 2p25.3 no mesmo indivíduo

Resumen: El estudio del cromosoma 2 en los seres humanos ha permitido reconocer que su alteración, basada en una localización específica, puede conducir a diversas enfermedades asociadas. Mediante la identificación fenotípica, sustentada en el estudio molecular de hibridación genómica comparativa y un estudio bioinformático posterior, se detectó la presencia de una duplicación patogénica en la región cromosómica 2p25.3p24.3, relacionada con la afección de 36 genes. Adicionalmente, se identificó una deleción patogénica en la citobanda 2q37.3, relacionada con la afección de 36 genes. El análisis bioinformático demostró interacciones entre genes que explican características sintomatológicas. Esta es la primera vez que se presentan estas dos variantes en un mismo individuo. Ambas alteraciones se han asociado con retraso psicomotor moderado, autismo, neurohipófisis ectópica, aracnodactilia, cardiopatía congénita y alteraciones cardiovasculares. Se ha propuesto que la mutación HDAC4 es la causante de la mayoría de las características del síndrome de microdeleción 2q37. El fenotipo clínico heterogéneo es el resultado del reordenamiento cromosómico encontrado, lo cual permite describir, interpretar y dar un tratamiento oportuno y dirigido a la paciente y la respectiva conserjería genética familiar. Finalmente, esta es la primera vez que se reporta este tipo específico de reordenamiento cromosómico.

Abstract: The study of chromosome 2 in humans has allowed recognizing that its alteration, based on a specific location, can lead to various associated diseases. Through the phenotypic identification, supported by comparative genomic hybridization and subsequent bioinformatic analysis, the presence of a pathogenic duplication was detected in the chromosomal region 2p25.3p24.3 affecting 36 genes. Additionally, a pathogenic deletion was identified in cytoband 2q37.3 affecting 36 genes. The bioinformatic analysis showed interactions among genes that explain symptomatic characteristics. This is the first time that these two variants are present in the same individual. Both disorders have been associated with moderate psychomotor retardation, autism, ectopic neurohypophysis, arachnodactyly, congenital heart disease, and cardiovascular disorders. The hdac4 mutation has been suggested to cause most of the features of 2q37 microdeletion syndrome. The heterogeneous clinical phenotype derives from the chromosomal rearrangement found, which allows describing, interpreting, and providing the patient with timely targeted treatment and the respective family genetic counseling. Finally, this specific type of chromosomal rearrangement has been reported for the first time.

Resumo: O estudo do cromossomo 2 em seres humanos nos permitiu reconhecer que sua alteração, com base em uma localização específica, pode levar a diversas doenças associadas. Por meio da identificação fenotípica, apoiada no estudo molecular da hibridação genômica comparativa e em um estudo bioinformático posterior, foi detectada a presença de uma duplicação patogénica na região cromossômica 2p25.3p24.3, relacionada a 36 genes afetados. Além disso, uma deleção patogénica foi identificada na citobanda 2q37.3, relacionada a 36 genes afetados. A análise bioinformática mostrou interações entre genes que explicam características sintomáticas. É a primeira vez que essas duas variantes são apresentadas no mesmo indivíduo. Ambos os distúrbios tém sido associados a retardo psicomotor moderado, autismo, neuro-hipófise ectópica, aracnodactilia, doenças cardíacas congénitas e distúrbios cardiovasculares. Propõe-se que a mutação hdac4 é a causa da maioria das características da síndrome de microdeleção 2q37. O fenótipo clínico heterogéneo é o resultado do rearranjo cromossômico encontrado, que permite descrever, interpretar e oferecer um tratamento oportuno direcionado ao paciente e ao respectivo aconselhamento genético familiar. Finalmente, também é a primeira vez que esse tipo específico de rearranjo cromossômico é relatado.

Prácticas, actitudes y conocimientos en relación a la terapia electroconvulsiva / Knowledge, attitudes and practices related to electroconvulsive therapy

Resumen Introducción. A pesar de la utilidad de la terapia electroconvulsiva (TEC), existe prevención hacia su uso en varios grupos poblacionales. Objetivos. Explorar y describir, desde el punto de vista de psiquiatras, médicos no psiquiatras y comunidad en general, los conocimientos, prácticas y actitudes respecto a la TEC. Materiales y métodos. Este fue un estudio de grupos focales en el que se hizo un análisis temático de las entrevistas. Resultados. Se evidenció que en la población general hay opiniones diversas, la mayoría negativas, y poco conocimiento, el cual proviene de la industria cinematográfica. Aceptar un tratamiento de TEC es siempre la última opción, pero con mayor información al respecto podría ser más considerado. Aunque los médicos muestran interés por conocer estudios sobre TEC, refieren que no han recibido formación y entrenamiento al respecto, además desconocen los avances en el tema. En el grupo de psiquiatras, los conocimientos, prácticas y actitudes dependieron de la experiencia y contacto con la TEC, pues aunque conocen su existencia, la mayoría no la usa ni la recomienda. Conclusión. Las prácticas y actitudes respecto a TEC en las poblaciones estudiadas varían según las experiencias y conocimientos que se tengan de este procedimiento.

Abstract Introduction: Despite the usefulness of electroconvulsive therapy (ECT), its use is avoided by several population groups. Objectives: To explore and describe, from the point of view of psychiatrists, non-psychiatrists and the community in general, knowledge, practices and attitudes regarding ECT. Materials and methods: Focus group study in which a thematic analysis of the interviews was made. Results: The general population seems to have different opinions, mostly negative, and little knowledge on this regard mainly influenced by the film industry. ECT treatment is always the last option, but it could be more considered if more information is provided. Although physicians show interest in learning about ECT, they report that they have not received training in this topic and are unaware of the progress on the subject. Knowledge, practices and attitudes of psychiatrists depend on the level of experience and contact with ECT, because, even though they know about its existence, most do not use it or recommend it. Conclusion: Practices and attitudes regarding ECT in the studied populations vary according to the experiences and knowledge of this procedure.

Factors associated with failed weaning from mechanical ventilation in adults on ventilatory support during 48 hours or more / Factores asociados a destete fallido de la ventilación mecánica en adultos con soporte ventilatorio igual y mayor a 48 horas

Abstract Introduction: Failed weaning from mechanical ventilation (MV) has been reported in a proportion ranging from 10% to 20% of patients requiring ventilation support; this population has a longer duration of MV and risk of mortality. Objective: To evaluate factors associated with failed weaning from MV. Methodology: Descriptive study of a cohort of 139 patients, who participated in the clinical trial. Efficacy of respiratory muscle training (RMT) for weaning from MV in patients on MV during 48 hours or more. Clinical and sociodemographic exposure variables were measured. The outcome variable evaluated was failed weaning from MV. A descriptive analysis was carried out, and relative risks (RRs) were estimated using the Poisson regression. Single and multiple models were built. Results: The incidence of failed weaning was 24.09%, 95% confidence interval (CI) 16.83 to 31.33. Independent associated factors were the respiratory system as the main compromised system upon admission to the intensive care unit (RR: 3.89; 95% CI 1.33-11.37; P = 0.01) and the Apache score (RR 0.96; 95% CI 0.920.98; P = 0.02). Modifiable factors such as pulmonary rehabilitation interventions, physical rehabilitation, RMT, and specific ventilatory strategies showed no association (P >0.05). Conclusion: There are non-modifiable factors related to failed weaning from MV in adults. Patients admitted to the intensive care unit with the respiratory system as the main system compromised have a higher risk of failed weaning; modifiable factors were not found to be associated with failed weaning in the population studied.

Resumen Introducción: El destete fallido de la ventilación mecánica se ha reportado en una proporción que va del 10 al 20% de los pacientes que requieren soporte ventilatorio; esta población presenta mayor duración de la ventilación mecánica y riesgo de mortalidad. Objetivo: Evaluar factores asociados a destete fallido de la ventilación mecánica en pacientes adultos con soporte ventila-torio igual y mayor a 48 horas Metodología: Estudio observacional de una cohorte de 139 pacientes, quienes participaron en el ensayo clínico. Eficacia del entrenamiento muscular respiratorio en el destete de la ventilación mecánica en pacientes con ventilación mecánica por 48 horas o más; variables de exposición clínicas y sociodemográficas fueron medidas. La variable resultado evaluada fue destete fallido de la ventilación mecánica. Se realizó análisis descriptivo, y se estimaron riesgos relativos a través de la regresión Poisson. Se construyeron modelos simples y un modelo múltiple. Resultados: La incidencia de destete fallido fue 24.09% [C95%:16.83-31.33.Los factores independientemente asociados fueron sistema respiratorio como principal comprometido al ingreso a UCI (RR:3.89 IC95%:1.33-11.37 p = 0.01) y apache (RR:0.96 IC95%:0.92-0.98 p = 0.02).Factores modificables como intervenciones de rehabilitación pulmonar, rehabilitación física, entrenamiento muscular respiratorio, y estrategias ventilatorias especificas no mostraron asociación (p>0.05). Conclusiones: Factores no modificables están relacionados con el destete fallido de la ventilación mecánica en la población estudiada. El sistema respiratorio como principal comprometido al ingreso a la unidad de cuidado intensivo fue el factor de riesgo asociado a falla en el destete de la ventilación mecánica, los factores no modificables no se encontraron asociados con el evento estudiado.

La crisis del sistema de salud colombiano: una aproximación desde la legitimidad y la regulación / The Crisis of the Colombian Health System: An Approach from Legitimacy and Regulation / A crise do sistema de saúde colombiano: aproximação desde a legitimidade e a regulamentação

Resumen El objetivo fue determinar cuáles son las percepciones de distintos actores del sistema de salud colombiano sobre los problemas del sistema que están detrás de la crisis. Se realizó un estudio cualitativo a partir de entrevistas semiestructuradas y en profundidad con cuarenta agentes del sector salud, en Bogotá, Cali, Ibagué, Espinal y Calima-Darién. Los resultados mostraron que la corrupción, el incumplimiento de normas y los conflictos entre los intereses de diversos actores del sistema debilitan la legitimidad de este último, atomizan la cooperación y cohesión de los actores y fortalecen el interés particular. La polución normativa, la inconsistencia temporal de las normas y la información incompleta generan incertidumbre, confusión y desintegración en el interior del sistema, con lo cual contribuyen al desenvolvimiento de una crisis regulatoria con respecto a la cual se hace urgente recuperar espacios de toma de decisiones colectivas y concertadas que promuevan el diálogo y la superación de los intereses rentistas individualistas.

Abstract The objective was to determine the perceptions of different actors of the Colombian health system regarding the problems of the system behind the crisis. A qualitative study was carried out on the basis of semi-structured and in-depth interviews with forty health sector agents in Bogotá, Cali, Ibagué, Espinal, and Calima-Darién. The results showed that corruption, breach of regulations, and conflicts of interests between various actors in the system weaken the legitimacy of the system, shatter the cooperation and cohesion of the actors, and strengthen private interests. Regulatory pollution, a temporary inconsistency of regulations, and incomplete information generate uncertainty, confusion, and disintegration within the system. This, in turn, contributes to the development of a regulatory crisis regarding which it is urgent to recover collective and concerted decision-making spaces to promote dialogue and the overcoming of rentier individualistic interests.

Resumo O objetivo foi determinar quais as percepções de diferentes atores do sistema de saúde colombiano sobre os problemas do sistema por trás da crise. Estudo qualitativo a partir de entrevistas semiestruturadas e em profundidade a quarenta agentes do setor saúde, em Bogotá, Cali, Ibagué, Espinal e Calima-Darién foi realizado. Os resultados mostraram que a corrupção, o descumpri- mento de regras e os conflitos entre os interesses de diversos atores do sistema enfraquecem a legitimidade deste último, atomizam a cooperação e coesão dos atores e fortalecem o interesse particular. A poluição normativa, a inconsistência temporal das regras e a informação incompleta criam incerteza, confusão e desintegração no interior do sistema, com o qual contribuem para o desenvolvimento de uma crise regulatória com respeito à qual resulta urgente recuperar espaços de tomada de decisões coletivas e concertadas a promover o diálogo e a superação dos interesses rentistas individualistas.

Intervención educativa en trabajadores de la salud sobre la captación de sintomáticos respiratorios de tuberculosis / Educative intervention aimed at health workers about the case-finding of individuals with tuberculosis respiratory symptoms

Objetivos: identificar el nivel de conocimientos relacionados con las acciones de búsqueda y detección de casos sintomáticos respiratorios de tuberculosis en trabajadores de la salud. Métodos: estudio descriptivo de corte transversal en 471 trabajadores de la salud de instituciones públicas y privadas en dos localidades de Bogotá, en el periodo septiembre 2012 a enero 2013. Se midieron los conocimientos antes y después de realizar la intervención educativa sobre la temática. Se consideraron los aspectos éticos. Resultados: antes de la intervención, se detectaron problemas de conocimientos en la identificación del sintomático respiratorio como paciente sospechoso de tuberculosis, en los exámenes a realizar para confirmar o descartar el diagnóstico de la enfermedad y en las recomendaciones para la toma de la baciloscopía de esputo. Después de la intervención, el nivel de los conocimientos en estos temas se incrementó entre el 8 y el 25 por ciento. Conclusiones: hay fallas en los conocimientos básicos y en las acciones de búsqueda activa y detección de casos sospechosos de tuberculosis, de ahí la importancia de realizar intervenciones educativas y de sensibilización en los trabajadores de la salud que se encuentran a cargo de la atención de los pacientes, elevar su nivel de conocimientos, mejorar la captación de sintomáticos respiratorios y con ello contribuir al diagnóstico más oportuno de personas con tuberculosis pulmonar(AU)

Objective: to establish the level of knowledge about the case-finding actions for detection of patients with tuberculosis respiratory symptoms in health workers. Methods: cross-sectional descriptive study of 471 health workers based in public and private institutions of two Bogota neighborhoods in the period of September 2012 through January 2013. Before and after the educative intervention, the participants' knowledge was evaluated. The ethical aspects were taken into account. Results: before the intervention, lack of knowledge was detected in answers about the detection of people with respiratory symptoms as suspected of tuberculosis, about the tests that should be performed to confirm or rule out the diagnosis and the recommendations for sputum-taking for bacilloscopy. After the intervention, the level of knowledge on these topics rose from 8 percent to 25 percent. Conclusions: poor basic knowledge about the active case-finding of suspected tuberculosis patients exists, hence the importance of carrying out educative interventions aimed at health workers in charge of taking care of patients, in order to raise their levels of knowledge and to improve respiratory symptom case-finding strategies, thus contributing to timely diagnosis of people with pulmonary tuberculosis(AU)

Creencias y actitudes del personal de salud frente a la tuberculosis en una localidad, Bogotá / Beliefs and attitudes of health workers about tuberculosis in a locality, Bogotá

Introducción: La tuberculosis (TB) persiste como un problema de salud pública, dada su asociación con numerosos aspectos, entre ellos la infección por el Virus de Inmunodeficiencia Humana (VIH), las precarias condiciones de vida, la multirresistencia a los fármacos, que afectan el control de la cadena de trasmisión. Objetivo: El objetivo del estudio fue identificar las creencias y actitudes en relación a la TB en trabajadores de la salud de una localidad de Bogotá. Metodología: Estudio de tipo descriptivo-transversal, a partir de la aplicación de un instrumento a 202 trabajadores de la salud durante el periodo de Marzo a Agosto de 2010. Resultados: Se encontró que el 32,0% de trabajadores considera la enfermedad transmisible hasta 2 a 3 semanas de iniciado el tratamiento. El 25,0% de los participantes refirieron que la enfermedad continúa siendo transmisible a pesar del tratamiento. El 48,5% de los trabajadores respondieron que se sentirían bien al atender a un paciente con TB y el 51,5% estarían indecisos y/o no se sentirían bien. Los datos preliminares verifican que persisten creencias y actitudes erróneas en relación a la TB, lo cual puede afectar la detección precoz y la adherencia al tratamiento.

Introduction: Tuberculosis (TB) persists as a public health problem, cause it association with many aspects, including infection with the Human Immunodeficiency Virus (HIV), the precarious living conditions, the multidrug resistance that affects the control of the chains transmission. Objetive: The aim of this study is identify the beliefs and attitudes about TB in health workers from a town of Bogotá. Methodology: Cross-sectional study, based on the application of an instrument to 202 health workers during the period from March to August 2010. Results: It was found that 32% of health workers consider the transmission of the disease until 2-3 weeks of starting treatment. 25% of participants reported that the disease continues to be transmitted with treatment. 48.5% of health workers answered that they were comfortable with the care of a patient with TB and 51.5% are undecided and / or would not feel right. Preliminary data showed that erroneous beliefs and attitudes persist in relation to TB, which can affect the early detection and treatment adherence.