[Quality of life of Medicine students of the National University of Córdoba, Argentina] / Calidad de vida de estudiantes de la Facultad de Medicina de la Universidad Nacional de Córdoba.

Background: Quality of life (QoL), according to the WHO, includes the perception that a person has about their physical health, level of independence, social relationships, system of values ​​and goals, expectations, standards and concerns. The medical student faces a high level of competitiveness in the course of his academic training with an increase in the workload as he progresses; this causes symptoms such as anxiety, stress, sadness, among others. If these aspects are not treated or are masked, they can turn into depression, generalized anxiety, burnout and even suicide (2). Aim: To describe the QoL of the students of medicina at the National University of Córdoba, considering the complete training cycle divided into two groups from 1 to 3° and from 4 to 5°. Methods: Cross-sectional study, through the Guarani System of the UNC. The WHOQoL-BREF online questionnaire, which uses the Likert scale, was applied to all students. This assesses the global QoL and satisfaction regarding the state of physical and psychological health, interpersonal relationships and environment. p was considered significant <0.05. This work was approved by the Adult CIEIS. Results: 854 responses were obtained, 72% were female, 43% were from another province/country and 63% corresponded to the 1-3° group. Of these, 37% rated their QoL as "fairly good", while 36% of the 4-5th grade group perceived their QoL as "normal" (p:0.0469). The most influential variables correspond to the supply of money for their needs (p:0.0005), sexual satisfaction (p:0.0056) and access to health services (p:0.0042) . Cronbach's alpha was 0.8899. Conclusion: QoL is better perceived in the 1-3 year group and economic supply, sexual satisfaction and access to health services were the main points to take care of in this medicine students.

Introducción: La calidad de vida (CV), según la OMS, comprende la percepción que tiene una persona sobre su salud física, nivel de independencia, relaciones sociales, sistema de valores y metas, expectativas, estándares y preocupaciones (1). El estudiante de medicina se enfrenta con un alto nivel de competitividad en el transcurso de su formación académica con aumento de la carga horaria a medida que avanza; esto origina síntomas como ansiedad, estrés, tristeza, entre otros.  Si tales aspectos no son tratados o son enmascarados pueden transformarse en depresión, ansiedad generalizada, burnout y hasta suicidio (2). Objetivo: Describir la CV de los estudiantes de medicina de la Universidad Nacional de Córdoba, considerando el ciclo completo de formación divididos en dos grupos de 1-3° y 4-5°. Métodos: Estudio transversal, mediante el Sistema Guaraní de la UNC se aplicó el cuestionario online WHOQOL-BREF, que utiliza escala de Likert a todos los alumnos. Este valora la CV global y satisfacción respecto al estado de salud física, psicológica, relaciones interpersonales y entorno. Se consideró significativo una p<0.05. Este trabajo fue aprobado por el CIEIS del Adulto. Resultados: Se obtuvieron 854 respuestas, el 72% fue de género femenino, el 43% es originario de otra provincia/país y el 63% correspondió al grupo de 1-3°. De estos, el 37% calificó su CV como "bastante buena", mientras que el 36% del grupo de 4-5° percibió su CV como "normal" (p:0,0469). Las variables más influyentes corresponden al abastecimiento de dinero para sus necesidades (p:0,0005), satisfacción sexual (p:0,0056) y el acceso a los servicios sanitarios (p:0,0042). El alfa de Cronbach fue 0.8899. Conclusión: La CV es mejor percibida en el grupo de 1-3° año y se destacan el suministro económico, la satisfacción sexual y el acceso a los servicios sanitarios.

El papel del padre en el cuidado del neonato en una unidad de cuidados intensivos durante la pandemia del COVID-19: una mirada desde las nuevas masculinidades / The role of the father in the care of the newborn in an intensive care unit during the COVID-19 pandemic: a perspective from the new masculinities / O papel do pai no cuidado do recém-nascido em uma unidade de terapia intensiva durante a pandemia da COVID-19: uma visão das novas masculinidades

Resumen: Objetivo: Analizar el papel del padre en el cuidado del neonato hospitalizado en una unidad de cuidados intensivos neonatal. Metodología: Se trata de un estudio de enfoque cualitativo con selección de muestreo abierto, saturación por conveniencia, entrevistas a 10 padres y 4 de ellas analizadas a través del programa Atlas Ti 8.0®, por medio de categorías y análisis de contenido. Resultados: Para hacer frente a la situación estresante de tener a su hijo en unidad de cuidados intensivos, los padres requieren capacitarse y aprender respecto de la condición de salud del niño, realizar constantemente introyección y autoanálisis reflexivo, profundizar en el componente espiritual y, como responsables económicos, enfocarse también en el trabajo. Conclusión: Se identificaron las habilidades del padre en el cuidado del neonato hospitalizado, tales como paciencia y pasión para realizar papel de padre. Se evidencia que el hombre tiene un papel fundamental en el cuidado del neonato.

Abstract: Goal. To analyze the role of the father in the care of the newborn hospitalized in a neonatal intensive care unit. Methodology. This is a qualitative approach study. The selection of open sampling, convenience saturation, interviewing 10 parents where at the end 4 were analyzed where the interviews were conducted in the Neonatal Intensive Care Units (NICU). The data was analyzed using the Atlas Ti 8.0® program through categories and content analysis. Results. Parents need to face the stressful situation of having their child in an intensive care unit, train and learn about the baby's health condition, constantly carry out introjection and reflective self-analysis, delve into the spiritual component and also focus on the I work as financial manager. Conclusion. The father's skills in the care of the hospitalized newborn were identified, such as patience and passion to perform the role of father. It is evident that man has a fundamental role in the care of the newborn.

Resumo: Objetivo: Analisar o papel do pai no cuidado do recém-nascido hospitalizado em uma unidade de terapia intensiva neonatal. Metodologia: Este é um estudo de abordagem qualitativa com seleção aberta de amostras, saturação por conveniência, entrevistas com 10 pais e 4 deles analisados através do programa Atlas Ti 8.0®, por meio de categorias e análise de conteúdo. Resultados: Para lidar com a situação estressante de ter seu filho na unidade de terapia intensiva, os pais precisam treinar e aprender sobre a condição de saúde da criança, realizar constantemente introjeção e auto-análise reflexiva, aprofundar o componente espiritual e também focar em seu trabalho como financeiramente responsável. Conclusão: As habilidades do pai no cuidado do recém-nascido hospitalizado foram identificadas, tais como a paciência e a paixão para desempenhar o papel de pai. É evidente que os homens têm um papel fundamental no cuidado do recém-nascido.

Structural Analysis of the Michael-Michael Ring Closure (MIMIRC) Reaction Products.

A representative number of decalin and hydrindane derivatives 2a-l were prepared in 11-91% yield by means of a cascade reaction of cyclohexanone/cyclopentanone enolates and methyl acrylate through a Michael-Michael ring closure (MIMIRC) process. The relative stereochemistry of the four stereogenic centers formed in all products was determined by analyzing the vicinal coupling constants from the 1H NMR and X-ray crystallography. Such a stereochemical outcome was corroborated by conformational analysis supported by DFT calculations and simulating the 1H NMR spectra of representative products. All products showed the same relative stereochemistry at C-1 and C-8a, while at C-3 and bridgehead carbon C-4a, configurational changes were observed. The present results provide some insights about the scope and limitations of the triple cascade reaction between cycloalkanone enolates with methyl acrylate. This synthetic protocol is still a simple and very practical alternative to generate decalin and hydrindane derivatives with great structural diversity.

Actividad científica estudiantil: su dinamismo en el proceso docente educativo en la universidad médica avileña / Student scientific activity: its dynamism in the educational teaching process at Ciego de Avila medical university

RESUMEN Fundamento: la actividad científica estudiantil es un elemento fundamental en la organización del proceso docente educativo. Objetivo: describir los resultados alcanzados en la actividad científica estudiantil en la Universidad de Ciencias Médicas de Ciego de Ávila, en el periodo 2016-2020. Métodos: se realizó un estudio observacional descriptivo y transversal en la Universidad de Ciencias Médicas de Ciego de Ávila durante el período 2016-2020. Se utilizaron métodos teóricos y empíricos. Se consultaron los documentos constitutivos del Grupo Científico Estudiantil y los programas científicos de los eventos estudiantiles (de carácter provincial y nacional) y los convocados por Sociedades Científicas de la Salud, donde se registraron trabajos realizados por estudiantes o con participación en estos. Se revisaron además las relatorías donde constaban los premiados. Resultados: en el periodo estudiado se inscribieron en eventos a nivel provincial 1165 trabajos. En eventos nacionales se obtuvieron un total de 100 premios, 23 de ellos en los fórums científico estudiantiles nacionales de ciencias médicas. Se otorgaron a instancias nacionales tres reconocimientos a tres estudiantes de la institución por la actividad científica desarrollada y se obtuvo un premio en el Concurso Nacional Premio Anual de Salud en la categoría estudiantil, recién incorporada. Se creó la revista científica estudiantil Ciencimed. Conclusiones: en la Universidad de Ciencias Médicas de Ciego de Ávila se han alcanzado importantes resultados en el trabajo conjunto entre los grupos científicos y la institución para el desarrollo de la actividad científica estudiantil. No obstante, se debe trabajar en función de ampliar la representatividad de cada carrera.

ABSTRACT Background: student scientific activity is a fundamental element in the organization of the teaching-learning process. Objective: to describe the results achieved in the student scientific activity at Ciego de Ávila University of Medical Sciences from 2016 to 2020. Methods: a descriptive and cross-sectional observational study was carried out at the University of Medical Sciences of Ciego de Ávila from 2016-2020. Theoretical and empirical methods were used. The constitutive documents of the Student Scientific Group and the scientific programs of the student´s events (provincial and national) and those convened by Scientific Health Societies were consulted, where work carried out by students or with their participation were recorded. The reports containing the winners were also reviewed. Results: in the period studied, 1,165 works were enrolled in events at the provincial level. In national events, a total of 100 awards were obtained, 23 of them in the national student scientific forum of medical sciences. Three recognitions were awarded by national authorities to three students of the institution for their scientific activity developed and a prize was obtained in the National Annual Health Prize Competition in the newly incorporated student category. The student scientific journal Ciencimed was created. Conclusions: at Ciego de Ávila University of Medical Sciences important results have been achieved in the joint work between scientific groups and the institution for the development of student scientific activity. However, work should be done to expand the representativeness of each degree.

Epidural analgesia in the obese obstetric patient: a retrospective and comparative study with non-obese patients at a tertiary hospital.

BACKGROUND AND OBJECTIVES: Obesity is becoming a frequent condition among obstetric patients. A high body mass index (BMI) has been closely related to a higher difficulty to perform the neuraxial technique and to the failure of epidural analgesia. Our study is aimed at analyzing obese obstetric patients who received neuraxial analgesia for labor at a tertiary hospital and assessing aspects related to the technique and its success. METHODS: Retrospective observational descriptive study during one year. Women with a BMI higher than 30 were identified, and variables related to the difficulty and complications of performing the technique, and to analgesia failure rate were assessed. RESULTS AND CONCLUSIONS: Out of 3653 patients, 27.4% had their BMI ≥ 30 kg.m-². Neuraxial techniques are difficult to be performed in obese obstetric patients, as showed by the number of puncture attempts (≥ 3 in 9.1% obese versus 5.3% in non-obese being p < 0.001), but the incidence of complications, as hematic puncture (6.6%) and accidental dural puncture (0.7%) seems to be similar in both obese and non-obese patients. The incidence of cesarean section in obese patients was 23.4% (p <  0.001). Thus, an early performance of epidural analgesia turns out to be essential to control labor pain and to avoid a general anesthesia in such high-risk patients.

Doença inflamatória intestinal: percepções dos pacientes e dos profissionais de saúde sobre a tomada de decisão compartilhada / Enfermedad inflamatoria intestinal: percepciones de los pacientes y de los profesionales de la salud sobre la toma de decisiones compartida / Inflammatory bowel disease: patients' and professionals' perceptions of shared decision-making

Resumo Objetivo Descrever as percepções de implementação da lei 41/2002 sobre a autonomia do paciente com doença inflamatória intestinal e profissionais em relação à tomada de decisão compartilhada. Métodos Estudo qualitativo e descritivo, utilizando abordagem fenomenológica. Foram realizadas entrevistas semiestruturadas em dez pacientes pertencentes à Associação de Pacientes com Doença de Crohn e Colite Ulcerativa de Zamora (Espanha), e grupo focal com sete gastroenterologistas e enfermeiros da clínica de ostomia e unidade de gastroenterologia hospitalar do Hospital Virgen de la Concha de Zamora. Foi realizada análise do conteúdo temático dos dados. Resultados Surgiram duas categorias principais e sete subcategorias: Informação (com conhecimento dos profissionais e dos pacientes, confiança no profissional, tempo e atitude em relação à informação) e Tomada de decisão compartilhada (com atitude em relação à informação, enfrentamento/resignação e apoio às decisões). A tomada de decisão compartilhada é um processo complexo, onde não somente a informação é o principal benefício para os pacientes, mas outras questões como apoio, tempo de doença ou emergência são importantes para a decisão do paciente. Conclusão Descrever as percepções dos pacientes e dos profissionais sobre a tomada de decisões compartilhadas, que as viam como um processo complexo. Melhorar as informações fornecidas aos pacientes sobre sua doença e seus direitos pode influenciar a participação na tomada de decisão compartilhada e modificar atitudes. Os pacientes não adotaram permanentemente um papel ativo ou passivo em relação à tomada de decisão compartilhada, mas, por múltiplos fatores, oscilaram entre os papéis. Consequentemente, é importante que os profissionais de saúde se envolvam no processo de compreensão dos pacientes e de suas necessidades para facilitar a tomada de decisão compartilhada. Além disso, é necessário maior investimento por parte das autoridades para garantir continuidade dos cuidados e desenvolver unidades multidisciplinares para doenças inflamatórias intestinais como forma de melhorar a tomada de decisão compartilhada.

Resumen Objetivo Describir las percepciones de la implementación de la ley 41/2002 sobre la autonomía del paciente con enfermedad inflamatoria intestinal y profesionales con relación a la toma de decisiones compartida. Métodos Estudio cualitativo y descriptivo, que utiliza el enfoque fenomenológico. Se realizaron entrevistas semiestructuradas a diez pacientes pertenecientes a la Asociación de Pacientes con Enfermedad de Crohn y Colitis Ulcerosa de Zamora (España); y un grupo focal de siete gastroenterólogos y enfermeros de la clínica de ostomía y de la unidad de gastroenterología hospitalaria del Hospital Virgen de la Concha de Zamora. Se realizó un análisis del contenido temático de los datos. Resultados Surgieron dos categorías principales y siete subcategorías: Información (con conocimiento de los profesionales y de los pacientes, confianza en el profesional, tiempo y actitud con relación a la información) y Toma de decisiones compartida (con actitud respecto a la información, enfrentamiento/resignación y apoyo a las decisiones). La toma de decisiones compartida es un proceso complejo en el que no solamente la información es el principal beneficio para los pacientes, sino que también hay otras cuestiones importantes para la decisión del paciente, como el apoyo, el tiempo de enfermedad o la emergencia. Conclusión Describir las percepciones de los pacientes y de los profesionales sobre la toma de decisiones compartida, que era vista como un proceso complejo. Mejorar la información ofrecida a los pacientes sobre su enfermedad y sus derechos puede influir en la participación de la toma de decisiones compartida y modificar actitudes. Los pacientes no adoptaron un papel permanentemente activo o pasivo respecto a la toma de decisiones compartida, sino que oscilaban entre los dos papeles debido a múltiples factores. Por lo tanto, es importante que los profesionales de la salud se involucren en el proceso de comprensión de los pacientes y de sus necesidades para facilitar la toma de decisiones compartida. Además, son necesarias mayores inversiones por parte de las autoridades para garantizar una continuidad de los cuidados y desarrollar unidades multidisciplinarias para enfermedades inflamatorias intestinales como forma de mejorar la toma de decisiones compartida.

Abstract Objective To describe perceptions of implementing law 41/2002 on patient autonomy in inflammatory bowel disease patients and professionals in relation to shared decision-making. Methods Qualitative descriptive study using a phenomenological approach. We conduced semi-structured interviews to 10 patients belonging to the Association of Patients with Crohn's Disease and Ulcerative Colitis in Zamora (Spain) as well as focus group to 7 gastroenterologists and nurses from the ostomy clinic and inpatient gastroenterology unit at the Virgen de la Concha Hospital in Zamora. Data thematic content analysis was performed. Results Two main categories and seven sub-categories emerged: Information (with professionals' and patients' knowledge, trust in the professional, time and attitude to information) and Shared decision-making (with attitude to information, coping-resignation and support for decisions). Shared decision-making is a complex process where not only the information is the main value for the patients, but other issues like support, time of illness or emergency are important for patient decision. Conclusion To describe patients' and professionals' perceptions of shared decision-making, who saw it as a complex process. To improve the information provided to patients about their illness and their rights can influence participation in shared decision-making and change attitudes. Patients did not permanently adopt an active or passive role in relation to shared decision-making, but instead oscillated between roles depending on multiple factors. Consequently, it is important for health professionals to engage in the process of understanding patients and their needs to facilitate shared decision-making. In addition, greater investment by the authorities is needed to ensure continuity of care and create multidisciplinary inflammatory bowel disease units as measures to improve shared decision-making.

Using Photovoice to stimulate critical thinking: An exploratory study with Nursing students.

OBJECTIVE: to explore the potentialities of the Photovoice methodology to stimulate critical thinking on Social Determinants of Health. METHOD: an exploratory and descriptive study with a qualitative approach, using different steps of the Photovoice methodology. Nursing students obtained photographs in their community, showing Social Determinants of Health, analyzed and classified the photographs, and exposed the results in the Nursing school. The students answered a questionnaire writing their perceptions. The data collected from the questionnaires were qualitatively analyzed. RESULTS: 91 students participated in the study. Two main categories emerged from the data: Photovoice is a good methodology to stimulate critical thinking on Social Determinants of Health, and Photovoice is a good methodology to stimulate other skills (expressing beliefs and perceptions, stimulating creativity, developing research skills, strengthening ties with colleagues, and attracting attention). CONCLUSION: we explore the potentialities of the Photovoice methodology. It can be an original, simple and economical tool to stimulate critical thinking on Social Determinants of Health, and to stimulate other skills. Photovoice can be considered in teaching about aspects related to health/care in Nursing students, in order to promote critical thinking of future agents for a change in health.

Plataforma digital para la satisfacción de las necesidades informacionales sobre la actividad científica estudiantil en Ciencias Médicas / A digital platform to meet information needs of students scientific activity in medical sciences schools

La actividad científica estudiantil, a pesar de constituir uno de los pilares en la formación universitaria en las Ciencias Médicas, todavía no logra alcanzar las potencialidades reales que posee. El objetivo de la presente investigación fue confeccionar y validar una plataforma digital para la satisfacción de las necesidades informacionales sobre la actividad científica estudiantil en la Universidad de Ciencias Médicas de Ciego de Ávila, Cuba, en el período comprendido desde el mes de marzo del año 2018 a febrero de 2019. La investigación se delimitó en tres etapas de trabajo: caracterización, diseño y evaluación. Se trabajó con estudiantes de tercer año que se encontraban cursando las carreras de Medicina, Estomatología, Enfermería y Tecnologías de la Salud. La plataforma se diseñó utilizando plantillas de Wordpress. Los estudiantes encuestados valoraron de regular la información recibida sobre la actividad científica y existió un número considerable que no poseía información al respecto, a pesar de considerar en su mayoría que era necesario poseer este conocimiento. La frecuencia de este grupo de estudiantes en jornadas científicas estudiantiles y eventos nacionales e internacionales, así como la publicación de sus resultados científicos, resultó alarmantemente baja. El diseño y la implementación de la plataforma digital logra satisfacer necesidades informacionales en relación con la actividad científica estudiantil, si bien es necesario evaluar dichas necesidades en todos los años de las diferentes carreras. La generalización de la plataforma a otros centros de Educación Superior puede contribuir a la formación en investigación científica en el pregrado en Cuba(AU)

Much as it is one of the cornerstones of undergraduate medical studies, students' scientific activity is yet to realize its full potential. The purpose of the study was to develop and validate a digital platform to meet the information needs of students' scientific activity at the University of Medical Sciences of Ciego de Avila, Cuba, from March 2018 to February 2019. The research was structured into three work stages: characterization, design and evaluation. The participants were third-year students majoring in medicine, dentistry, nursing and health technologies. The platform was designed on WordPress templates. Respondents ranked the information received about scientific activity as fair, and a considerable number of them did not have any information about the subject, though most thought such knowledge was necessary. Attendance by respondents to students' scientific meetings and national and international conferences was alarmingly low, as was the publication of their scientific results. The design and implementation of the digital platform make it possible to meet information needs concerning students' scientific activity, though such needs should be evaluated in all the years of the various majors. Generalization of the platform to other higher education institutions may contribute to undergraduate scientific research training in Cuba(AU)

Real-time RT-PCR assay to detect Granada virus and the related Massilia and Arrabida phleboviruses.

BACKGROUND: Granada virus belongs to the genus Phlebovirus within the Naples serocomplex and was detected for the first time in sand flies from Spain in 2003. Seroprevalence studies have revealed that Granada virus may infect humans with most cases being asymptomatic. Moreover, recent studies in vector samples revealed that the related Massilia and Arrabida phleboviruses could be also circulating in Spain. The objective of this study was to develop and assess a new sensitive real-time RT-PCR assay for Granada virus diagnosis able to detect the related phleboviruses Massilia and Arrabida. METHODS: Two specific primers and one unique probe to detect Granada, Massilia and Arrabida viruses, without differentiating between them, were designed targeting the conserved L-segment of their genome. Sensitivity was assessed using 10-fold serial dilutions of quantified in vitro DNA samples. Specificity was evaluated by testing different genomic RNA extracted from other representative phleboviruses. The new assay was used for virus detection in sand flies collected in 2012 from the Balearic Archipelago, a touristic hotspot in the Mediterranean. RESULTS: The real-time RT-PCR assay exhibited a sensitivity per reaction of 19 copies for Granada and Arrabida, and 16 copies for Massilia. No other related phleboviruses were detected. From the 37 pools of sand fly samples studied from four different Balearic Islands, we detected one positive in the island of Cabrera. CONCLUSIONS: To our knowledge, the method described here is the first real-time RT-PCR designed to detect Granada virus and the related Massilia and Arrabida phleboviruses. The study demonstrated that this is a rapid, robust and reliable assay for the accurate diagnosis of human infections as well as for virus surveillance in vectors.

Using Photovoice to stimulate critical thinking: An exploratory study with Nursing students / Uso do Photovoice para estimular o pensamento crítico: um estudo exploratório com estudantes de Enfermagem / Cómo usar Photovoice para estimular el pensamiento crítico: un estudio exploratorio con estudiantes de enfermería

Objective: to explore the potentialities of the Photovoice methodology to stimulate critical thinking on Social Determinants of Health. Method: an exploratory and descriptive study with a qualitative approach, using different steps of the Photovoice methodology. Nursing students obtained photographs in their community, showing Social Determinants of Health, analyzed and classified the photographs, and exposed the results in the Nursing school. The students answered a questionnaire writing their perceptions. The data collected from the questionnaires were qualitatively analyzed. Results: 91 students participated in the study. Two main categories emerged from the data: Photovoice is a good methodology to stimulate critical thinking on Social Determinants of Health, and Photovoice is a good methodology to stimulate other skills (expressing beliefs and perceptions, stimulating creativity, developing research skills, strengthening ties with colleagues, and attracting attention). Conclusion: we explore the potentialities of the Photovoice methodology. It can be an original, simple and economical tool to stimulate critical thinking on Social Determinants of Health, and to stimulate other skills. Photovoice can be considered in teaching about aspects related to health/care in Nursing students, in order to promote critical thinking of future agents for a change in health.

Objetivo: explorar as potencialidades da metodologia Photovoice para estimular o pensamento crítico sobre os Determinantes Sociais da Saúde. Método: estudo exploratório e descritivo, com abordagem qualitativa, utilizando diferentes etapas da metodologia Photovoice. Os estudantes de enfermagem obtiveram fotografias em sua comunidade, mostrando Determinantes Sociais da Saúde, analisaram e classificaram as fotografias e expuseram os resultados na faculdade. Os alunos preencheram um questionário escrevendo suas percepções. Os dados coletados dos questionários foram analisados qualitativamente. Resultados: 91 estudantes participaram do estudo. Duas categorias principais emergiram dos dados: A Photovoice é uma boa metodologia para estimular o pensamento crítico sobre os determinantes sociais da saúde e estimular outras habilidades (expressar crenças e percepções, estimular a criatividade, desenvolver habilidades de pesquisa, fortalecer laços com colegas e atrair atenção). Conclusão: exploramos as potencialidades da metodologia Photovoice. Esta pode ser uma ferramenta original, simples e barata para estimular o pensamento crítico sobre os Determinantes Sociais da Saúde e estimular outras habilidades. A Photovoice pode considerar o ensino de aspectos relacionados à saúde/assistência em estudantes de enfermagem, a fim de promover o pensamento crítico de futuros agentes de mudança na saúde.

Objetivo: explorar las potencialidades de la metodología del Photovoice para estimular el pensamiento crítico sobre los Determinantes Sociales de la Salud. Método: estudio exploratorio y descriptivo con enfoque cualitativo, en el que se utilizaron diferentes pasos de la metodología del Photovoice. Los estudiantes de enfermería tomaron fotografías en su comunidad, en las que se mostraban los Determinantes Sociales de la Salud, las analizaron y clasificaron y expusieron los resultados en la facultad. A continuación, completaron un cuestionario escribiendo sus percepciones sobre las mismas. Los datos recopilados de los cuestionarios se analizaron cualitativamente. Resultados: en el estudio participaron 91 estudiantes. Surgieron dos categorías principales de los datos: Photovoice es una buena metodología para estimular el pensamiento crítico sobre los Determinantes Sociales de la Salud, y Photovoice es una buena metodología para estimular otras habilidades (expresar creencias y percepciones, estimular la creatividad, desarrollar habilidades de investigación, fortalecer los lazos con los compañeros y atraer la atención). Conclusión: exploramos las potencialidades de la metodología Photovoice. Puede ser una herramienta original, simple y económica para estimular el pensamiento crítico sobre los Determinantes Sociales de la Salud, y también para estimular otras habilidades. Photovoice se puede considerar para la enseñanza de aspectos relacionados con la salud y/o el cuidado con estudiantes de enfermería, para promover el pensamiento crítico de futuros agentes de cambio en la salud.

Dra. Norma Pérez Calleja: la más natural de los educadores sociales / Dr. Norma Pérez Calleja: the most natural of social educators

Fundamento: como parte del proyecto de investigación «Educadores Destacados del Siglo XX¼, se seleccionó para su estudio la personalidad de la Dra. Norma Ciríaca Pérez Calleja, pediatra y profesora ilustre de la provincia Ciego de Ávila. Objetivo: divulgar la vida y obra de la mencionada doctora como paradigma en el campo de la Pediatría y la educación médica. Métodos: se realizó una investigación descriptiva con enfoque cualitativo en la Universidad de Ciencias Médicas de Ciego de Ávila, en el periodo 2016-2017. Se utilizó el método biográfico o historia de vida para reconstruir el desarrollo vital como expresión singular de la realidad social vivida por la doctora, a través de distintas fuentes: revisión documental de su expediente docente y otros materiales que avalan sus reconocimientos sociales, crónicas sobre su vida, trabajos científicos, entrevistas, testimonios de colegas y pacientes, y fotos. Resultados: se caracterizó la vida de la doctora y profesora y su aporte a la formación de los profesionales de las ciencias médicas en Ciego de Ávila. Los documentos consultados permitieron avalar su conducta social como ejemplo vivo, sus firmes convicciones y fuerte voluntad, todo lo cual la hacen portadora de elevados principios y valores espirituales, los que constituyen guía de muchos y devienen significativas enseñanzas para la mayoría de los que la conocen. Conclusiones: la influencia movilizadora, profesionalidad y labor educativa de la doctora Norma Ciriaca Pérez Calleja permitieron considerarla como una educadora social y ejemplo a seguir por las nuevas generaciones.

Background: as part of the research project «Outstanding Educators of the 20th Century¼, the personality of Dr. Norma Ciriaca Pérez Calleja, pediatrician and outstanding professor from Ciego de Ávila province was selected for this study. Objective: to let know the life and work of the aforementioned doctor as a paradigm in the field of Pediatrics and medical education. Methods: a descriptive research work within the qualitative approach was carried out at Ciego de Ávila University of Medical Sciences, in the academic year 2016-2017. The biographical or life history method was used to reconstruct the vital development as a singular expression of the social reality lived by the doctor, through different sources: documentary review of her teaching file and other materials that endorse her social recognitions, chronicles about her life, scientific works, interviews, testimonies of colleagues and patients, and photos. Results: the life of the doctor and professor was characterized and her contribution to the training of professionals of the medical sciences in Ciego de Ávila. The documents consulted allowed to endorse her social behavior as a living example, her firm convictions and strong will, all of which make her a bearer of high spiritual principles and values, which are the guide for many others and become significant teachings for the majority of those who know her. Conclusions: the mobilizing influence, professionalism and educational work of Dr. Norma Ciriaca Pérez Calleja allowed considering her as a social educator and an example to follow for the new generations.

APUNTUSOFT: herramienta para el aprendizaje de la medicina tradicional integrada a la Morfofisiología / APUNTUSOFT: tool for the learning of folk medicine integrated to Morphology

Fundamento: el uso de las Tecnologías de la Información y las Comunicaciones permite una mejor implementación de la estrategia curricular de Medicina Natural y Tradicional en las ciencias médicas. Objetivo: elaborar un software educativo para el aprendizaje de los puntos de acupuntura integrados al sistema osteomioarticular en la disciplina Morfofisiología. Métodos: se desarrolló una investigación de desarrollo en el período enero-abril de 2016, en la Facultad de Ciencias Médicas "Dr. José Assef Yara" de la Universidad de Ciencias Médicas de Ciego de Ávila. Se utilizaron métodos teóricos: histórico-lógico, tránsito de lo concreto a lo abstracto, inductivo-deductivo, analítico-sintético y el sistémico-estructural; y empíricos: la revisión documental y la encuesta en forma de cuestionario a estudiantes y expertos en función de evaluadores externos del producto. Resultados: se constató que existen insuficiencias en la disponibilidad de literatura relacionada con los 18 puntos de acupuntura del sistema de Atan Dale Ralph, necesaria para facilitar el proceso de aprendizaje; por lo que se creó el software APUNTUSOFT, utilizando Chreasoft 3.2, Adobe Photoshop 8.0, Format Factory 2.7 y Microsoft Office 2010, el cual fue valorado por criterios de expertos y usuarios. Conclusiones: durante la valoración el producto informático se consideró Muy adecuado en la mayoría de los indicadores, por lo que resulta válido y de utilidad en la docencia, con capacidad para satisfacer las necesidades de aprendizaje en estas temáticas.

Background: the use of Information and Communication Technologies allows a better implementation of the curricular strategy of herbal and folk Medicine in the medical sciences. Objective: to develop an educational software for the learning of acupuncture points integrated to the musculoskeletal system in the Morphology discipline. Methods: a developmental research was developed in the period January-April 2016, in "Dr. José Assef Yara "Faculty of Medical Sciences at Ciego de Ávila University of Medical Sciences. Theoretical methods were used: historical-logical, from concrete to abstract, inductive-deductive, analytical-synthetic and systemic-structural; and empirical ones: the documentary review and the survey in questionnaire form was applied to students and experts based on external evaluators of the product. Results: it was verified that there are insufficiencies in the availability of literature related to the 18 points of acupuncture of the Atan Dale Ralph system, necessary to facilitate the learning process; so APUNTUSOFT software was created, using Chreasoft 3.2, Adobe Photoshop 8.0, Format Factory 2.7 and Microsoft Office 2010, which was evaluated by experts and users criteria. Conclusions: during the assessment the computing product was considered very adequate in most of the indicators, so it is valid and useful in teaching, with capacity to meet learning needs in these issues.

The domestic participation in birth assistance in the mid-twentieth century.

OBJECTIVE: to describe how the progressive creation of the Social Security (providing widespread health care) affected the birth assistance in Spain from the 1940s to the 1970s in a rural area. METHOD: historical ethnography. Twenty-seven people who lived at that time were selected and interviewed guided by a semistructured script. Based on their testimonies, a chart was built with the functional elements involved in birth assistance in this region. RESULTS: three agents performed such care: traditional midwives, women of the family/neighbors and health workers. CONCLUSION: although birth assistance had been transferred to the hands of the health workers from the forties in this region, women in labor continued to count on the domestic resources until the early seventies, when births were compulsorily transferred to hospitals. This research brings to light the names and recognizes the work performed by these female characters of the popular sphere, who helped women in labor of that community to give birth, for at least three decades.

Aproximación a la Medicina Natural y Tradicional desde la óptica de la extensión universitaria / An approximation to the Natural and Traditional Medicine from the university extension point of view

Introducción: como parte de la política de integración de la Medicina Natural y Tradicional en la docencia médica, y mediante estrategias curriculares nacionales, se imparten contenidos de Medicina Natural y Tradicional en las carreras de las ciencias médicas. En la Universidad de Ciencias Médicas de Ciego de Ávila este trabajo de integración se lleva a cabo, con carácter extensionista, desde la Cátedra Honorífica "Juan Tomás Roig". Objetivo: describir los resultados de la labor extensionista para la integración de la Medicina Natural y Tradicional en la docencia médica y en la interacción con la comunidad desarrollada por la Cátedra Honorífica "Juan Tomás Roig" en la Universidad de Ciencias Médicas de Ciego de Ávila. Método: se consultaron los documentos constitutivos y registros que recogen la actividad de la Cátedra Honorífica "Juan Tomás Roig" desde su creación y literatura sobre el tema, en formatos impreso y digital. Conclusiones: la actividad extensionista desarrollada por la Cátedra Honorífica "Juan Tomás Roig" contribuye a la difusión de los resultados de los proyectos de investigación y la información científico-técnica generada en el ámbito de la Medicina Natural y Tradicional para favorecer tanto su introducción o sistematización como conocimiento como la inclusión de sus diversas modalidades terapéuticas dentro de la estructura curricular de la Universidad de Ciencias Médicas de Ciego de Ávila; promueve estilos de vida saludables a través de acciones de prevención y posibilita la interacción de la Universidad con la sociedad a través de la cooperación y el trabajo coordinado con distintas instituciones de la provincia.

Introduction: as part of the integration policy of the Natural and Traditional Medicine in medical education, and through national curricular strategies, contents of Natural and Traditional Medicine are taught in medical science careers. In the University of Medical Sciences of Ciego de Ávila this integration work is carried out, with extension character, from the Honorary Chair "Juan Tomás Roig". Objective: to describe the results of extension work for the integration of Natural and Traditional Medicine in medical teaching and the interaction with the community developed by the Honorary Chair "Juan Tomás Roig" at the University of Medical Sciences of Ciego de Ávila. Method: were consulted the constituent documents and records that reflect the activity of the Honorary Chair "Juan Tomás Roig" since its inception and literature on the subject, in print and digital formats. Conclusions: the extension activity developed by the Honorary Chair "Juan Tomás Roig" contributes to the dissemination of the results of research projects and scientific and technical information generated in the field of Natural and Traditional Medicine to promote both their introduction or knowledge systematization as the inclusion of its various therapeutic modalities within the curricular structure at the University of Medical Sciences of Ciego de Ávila; promotes healthy lifestyles through prevention and enables interaction of the University with society through cooperation and coordinated work with various institutions in the province.

The domestic participation in birth assistance in the mid-twentieth century / A participação doméstica na assistência ao parto em meados do século XX / La participación de lo doméstico en la atención del parto a mediados del siglo XX

Abstract Objective: to describe how the progressive creation of the Social Security (providing widespread health care) affected the birth assistance in Spain from the 1940s to the 1970s in a rural area. Method: historical ethnography. Twenty-seven people who lived at that time were selected and interviewed guided by a semistructured script. Based on their testimonies, a chart was built with the functional elements involved in birth assistance in this region. Results: three agents performed such care: traditional midwives, women of the family/neighbors and health workers. Conclusion: although birth assistance had been transferred to the hands of the health workers from the forties in this region, women in labor continued to count on the domestic resources until the early seventies, when births were compulsorily transferred to hospitals. This research brings to light the names and recognizes the work performed by these female characters of the popular sphere, who helped women in labor of that community to give birth, for at least three decades.

Resumo Objetivo: descrever como a criação progressiva da Seguridade Social (oferecendo assistência médica ampla) afetou a assistência ao parto na Espanha durante as décadas de 1940 a 1970, em uma região rural. Método: etnografia histórica. Foram selecionadas 27 pessoas que viveram nessa época, as quais foram entrevistadas com o auxílio de um roteiro semiestruturado. Através dos seus depoimentos, construiu-se um quadro com os elementos funcionais envolvidos na assistência ao nascimento nessa região. Resultado: três agentes desempenhavam tal assistência: parteiras tradicionais, mulheres da família/vizinhas e profissionais da saúde. Conclusão: apesar da assistência durante o parto ter sido transferida para a responsabilidade dos profissionais da saúde a partir dos anos quarenta, nesta região as parturientes continuaram utilizando os recursos domésticos até o início dos anos setenta, quando os partos foram obrigatoriamente transferidos para os hospitais. Esta pesquisa traz à tona os nomes e reconhece o trabalho de personagens femininas da classe popular, que ajudaram mulheres em trabalho de parto dessa comunidade a dar à luz, durante pelo menos três décadas.

Resumen Objetivo: describir cómo incidió la creación progresiva de la Seguridad Social (ofreciendo asistencia sanitaria generalizada) en la atención al parto en España durante las décadas de 1940 a 1970, en una zona rural. Método: etnografía histórica. Se seleccionaron 27 personas que habían vivido en esos años, y se las entrevistó apoyadas por un guión semiestructurado. A través de sus testimonios se construyó un mapa con los elementos funcionales implicados en los cuidados en el nacimiento en ese territorio. Resultado: tres actores desempeñaban dicha atención: parteras tradicionales, mujeres familiares/vecinas y personal sanitario. Conclusión: a pesar de que la asistencia en el momento del parto pasó a estar en manos de los sanitarios a partir de los años cuarenta, en esta zona las parturientas siguieron haciendo uso de los recursos domésticos hasta bien entradas los setenta, cuando los partos obligatoriamente fueron desplazados a los hospitales. Esta investigación saca a la luz el nombre y reconoce la labor de personajes femeninos que, desde la esfera popular, ayudaron a dar a luz a parturientas de esa comunidad durante, al menos, tres décadas.

Enfermedad de Lyme en pediatría: distintas caras, una misma enfermedad. Serie de casos / Lyme disease in Pediatrics: different faces, the same disease. Cases series

La enfermedad de Lyme es producida por la espiroqueta Borrelia burgdorferi, que se transmite mediante la picadura de las garrapatas del género Ixodes ricinus. Se caracteriza por la aparición de un eritema migratorio en la zona de la picadura en las fases iniciales. Su diagnóstico se retrasa en gran parte de los casos y se presenta con formas diseminadas o tardías. El diagnóstico es fundamentalmente clínico; la serología suele ser negativa en las fases precoces, pero sirve de apoyo en el caso de las formas más avanzadas. El tratamiento se realiza con antibiótico oral durante 14-28 días, salvo en formas recurrentes o con afectación del sistema nervioso central. Presentamos cuatro casos de borreliosis de Lyme en niños con el fin de dar a conocer distintas formas de presentación de esta entidad y su manejo en la población pediátrica.

Lyme disease is caused by Borrelia burgdorferi infection which is transmittedby Ixodes ricinus. Erythema migrans, a rash spreading from the site of a tick bite, is the earliest and most common manifestation of the disease. If untreated, late manifestations of disseminated disease, mainly neurological and musculoskeletal, may occur. Serologic studies are usually negative in early stages and are not necessary to confirm the diagnosis in cases of erythema migrans. Laboratory confirmation is needed for disseminated disease. Most presentations, including facial nerve palsy, can be treated with oral antibiotics. Ceftriaxone is recommended in other cases of neuroborreliosis. Four cases of Lyme disease in children are reported to illustrate the different presentations of this disease and its management in children.

Enfermedad de Lyme en pediatría: distintas caras, una misma enfermedad. Serie de casos / Lyme disease in Pediatrics: different faces, the same disease. Cases series

La enfermedad de Lyme es producida por la espiroqueta Borrelia burgdorferi, que se transmite mediante la picadura de las garrapatas del género Ixodes ricinus. Se caracteriza por la aparición de un eritema migratorio en la zona de la picadura en las fases iniciales. Su diagnóstico se retrasa en gran parte de los casos y se presenta con formas diseminadas o tardías. El diagnóstico es fundamentalmente clínico; la serología suele ser negativa en las fases precoces, pero sirve de apoyo en el caso de las formas más avanzadas. El tratamiento se realiza con antibiótico oral durante 14-28 días, salvo en formas recurrentes o con afectación del sistema nervioso central. Presentamos cuatro casos de borreliosis de Lyme en niños con el fin de dar a conocer distintas formas de presentación de esta entidad y su manejo en la población pediátrica.(AU)

Lyme disease is caused by Borrelia burgdorferi infection which is transmittedby Ixodes ricinus. Erythema migrans, a rash spreading from the site of a tick bite, is the earliest and most common manifestation of the disease. If untreated, late manifestations of disseminated disease, mainly neurological and musculoskeletal, may occur. Serologic studies are usually negative in early stages and are not necessary to confirm the diagnosis in cases of erythema migrans. Laboratory confirmation is needed for disseminated disease. Most presentations, including facial nerve palsy, can be treated with oral antibiotics. Ceftriaxone is recommended in other cases of neuroborreliosis. Four cases of Lyme disease in children are reported to illustrate the different presentations of this disease and its management in children.(AU)

[Lyme disease in Pediatrics: different faces, the same disease. Cases series]. / Enfermedad de Lyme en pediatría: distintas caras, una misma enfermedad. Serie de casos.

Lyme disease is caused by Borrelia burgdorferi infection which is transmitted by Ixodes ricinus. Erythema migrans, a rash spreading from the site of a tick bite, is the earliest and most common manifestation of the disease. If untreated, late manifestations of disseminated disease, mainly neurological and musculoskeletal, may occur. Serologic studies are usually negative in early stages and are not necessary to confirm the diagnosis in cases of erythema migrans. Laboratory confirmation is needed for disseminated disease. Most presentations, including facial nerve palsy, can be treated with oral antibiotics. Ceftriaxone is recommended in other cases of neuroborreliosis. Four cases of Lyme disease in children are reported to illustrate the different presentations of this disease and its management in children.

Efficient preparation of α-ketoacetals.

The Weinreb amides 2a,b were prepared from the α,α-dimethoxyacetic acids 1c,d. A number of representative nucleophilic additions (RMgX and RLi) on 2 afforded α-ketoacetals 3a-j in 70-99% yield. These compounds represent a versatile arrangement of functional groups of significant synthetic value, as demonstrated in the synthesis of (±)-salbutamol.