Cervical cancer prevention: Feasibility of self-sampling and HPV testing in rural and urban areas of Bolivia: An observational study.

BACKGROUND: Cervical cancer is a major health problem in Latin America. In 2019, the Italian Agency for Development Cooperation (La Paz regional site) conducted a pilot study to estimate the prevalence of high-risk human papillomavirus (HPV) and the feasibility of HPV screening in Bolivia through self-sampling and portable and transportable laboratory instruments for HPV testing in urban and rural areas. METHODS: Women aged 20-65 years from La Paz (urban area), Toro Toro (rural area), and Acasio (rural area) were enrolled in local public health centers between Dec 1, 2019, and June 30, 2021. Self-sampling was carried out with the Viba-Brush system (Rovers, Oss, Netherlands) and samples were preserved in ThinPrep containers (Hologic Corporation, San Diego, CA, USA). The GeneXpert system (Cepheid, Sunnyvale, CA, USA) for high-risk HPV testing detects HPV E6 and E7 DNA via real-time PCR in a mobile system of easy execution requiring minimal manual intervention. The system provides results in about 1 h. The hr- HPV prevalence data, overall and partial genotyping, were analyzed considering the following age groups: 20-34, 35-44, and 45-65 years old. FINDINGS: 2168 women were enrolled: 614 (28.3%) in La Paz, 743 (34.3%) in Toro Toro, and 811 (37.4%) in Acasio. Only one sample was collected from each participant. 2043 (94.2%) of 2168 samples were adequate for HPV testing. 255 (12.5%) samples were positive for high-risk HPV. Comparing the urban area (La Paz) versus rural combined areas (Acasio+Toro Toro), using a logistic model, the HPV total rate was statistically significantly higher in the city of La Paz (15.0% vs 11.4%; OR:1.37;95% CI: 1.04-1.80). Furthermore, the HPV prevalence was declining by age, and the urban/rural odds ratio was 1.50; (95% IC 1.13-19). The overall HPV 16 positivity was 2.7% (55/2043) and for HPV 18/45 was 1.8% (37/2043) without any statistically significant differences between the three BHU enrolling centers. Only the prevalence of HPV group '39/56/66/68' was significantly higher in La Paz (p<0,001) in comparison to Acasio and Toro Toro. INTERPRETATION: The total and age-adjusted prevalence of high-risk HPV infection in rural and urban areas in Bolivia, as measured with a validated test for screening, is similar to that observed in Europe and the USA. Our study shows that a screening protocol for HPV testing with self-sampling would be feasible in urban and rural areas in Bolivia, and that the reported high occurrence of cervical cancer in Bolivia is not related to a higher rate of high-risk HPV infections. Carrying out HPV tests locally avoids the issues associated with transportation and storage of the collected material and allows the participant to wait in the clinic for the test result, overcoming the very long response time for screening test in Bolivia.

Antiviral therapy in shrimp through plant virus VLP containing VP28 dsRNA against WSSV.

The white spot syndrome virus (WSSV), currently affecting cultured shrimp, causes substantial economic losses to the worldwide shrimp industry. An antiviral therapy using double-stranded RNA interference (dsRNAi) by intramuscular injection (IM) has proven the most effective shrimp protection against WSSV. However, IM treatment is still not viable for shrimp farms. The challenge is to develop an efficient oral delivery system that manages to avoid the degradation of antiviral RNA molecules. The present work demonstrates that VLPs (virus-like particles) allow efficient delivery of dsRNAi as antiviral therapy in shrimp. In particular, VLPs derived from a virus that infects plants, such as cowpea chlorotic mottle virus (CCMV), in which the capsid protein (CP) encapsidates the dsRNA of 563 bp, are shown to silence the WSSV glycoprotein VP28 (dsRNAvp28). In experimental challenges in vivo, the VLPs- dsRNAvp28 protect shrimp against WSSV up to 40% by oral administration and 100% by IM. The novel research demonstrates that plant VLPs, which avoid zoonosis, can be applied to pathogen control in shrimp and also other organisms, widening the application window in nanomedicine.

Reduced Anterolateral Thigh Flap Donor-Site Morbidity Using Incisional Negative Pressure Therapy.

BACKGROUND: Primary closure of the donor-site after harvest of a large anterolateral thigh flap (ALT) is associated with significant morbidity. Incisional negative pressure therapy (INPT) may decrease complications in high-risk incisions. This study assessed if the incidence of complications after primary closure of the ALT flap donor-site decreases with INPT. METHODS: Retrospective cohort study of a prospectively maintained database including patients who underwent upper and lower limb reconstruction, using an ALT free flap with primary closure of the donor-site. Two groups were defined: primary closure and INPT (study group) and primary closure with traditional dressings (control group). Nonparametric statistics were employed to identify prognostic factors, p < 0,05. RESULTS: Fifty-eight free ALT flaps in 58 patients (study group n = 28; control group n = 30) were included. Median flap width and length were 9 cm (range: 5-14) and 25 cm (range: 10-48), respectively. Median follow-up was 19 months (range: 3-78 months). No significant differences in age or flap size were identified in both groups (p > 0.05). The global complication rate was 7.14% (n = 2) in the INPT group, and 37% (n = 11) in the control group (p = 0.007). The study group had a lower dehiscence and skin necrosis rate (p < 0.05). Multivariate logistic regression analysis showed IPNT was associated with a significant reduction of donor-site complications (p = 0.006), especially in patients with defects > 8 cm (p = 0.003). CONCLUSION: In this cohort study the use of INPT significantly reduced the donor-site morbidity after ALT flap harvest.

Entrenamiento microquirúrgico a distancia / e-Learning microsurgical training

Introducción y Objetivo: Tradicionalmente el entrenamiento microquirúrgico se basa en la tutela presencial de un instructor. Esto presenta ciertas limitantes como la escasez de instructores y el número limitado de alumnos por instructor. El objetivo del presente trabajo es describir un método de entrenamiento y adquisición de destrezas microquirúrgicas basado en un currículum en línea y evaluación dirigida por un instructor a distancia. Material y método: Se entrenaron 6 alumnos de Medicina mediante un curso de dificultad progresiva basado en modelos inanimados y anastomosis arterial término-terminal en muslo y ala de pollo ex vivo. Los alumnos, mediante una plataforma en línea, recibieron vídeos instructivos antes de cada sesión, registraron su actividad y enviaron un vídeo de su entrenamiento al instructor. Las correcciones fueron entregadas a los alumnos por parte del instructor mediante la misma plataforma en línea. Comparamos la sesión inicial y final utilizando escalas de evaluación objetivas para investigar la adquisición de destrezas microquirúrgicas. Resultados: Fue factible implementar un sistema de evaluación a distancia. Todos los alumnos incrementaron sus puntajes al final del entrenamiento. Conclusiones: Mediante el uso de plataformas de formación en línea, es posible incrementar la destreza microquirúrgica sin la presencia física de un instructor, sobrellevando las limitaciones del modelo tradicional

Background and Objective: Traditionally, microsurgical training has been based on a face-to-face tuition. This presents certain limitations such as the shortage of instructors and the limited number of students per instructor. The aim of this study is to describe a method of training and acquisition of microsurgical skills based on an online curriculum and distance based evaluation. Methods: Six medical students were trained through a progressive difficulty program based on non biological models and artery to artery anastomosis using a non living chicken thigh and wing. Using an online platform, the students reviewed the instructional videos for each training lesson, registered their progress and sent a video to the instructor for assessment. Corrections were delivered through the same platform. The initial and final sessions were compared using objective evaluation scales in order to assess the microsurgical skill acquisition. Results: It is feasible to implement a remote evaluation system. All students increased their scores at the end of training. Conclusions: Using instructional on line platforms, it's possible to increase the microsurgical skill without the physical presence of an instructor, overcoming the limitations of the traditional model

Evaluación de la microcirculación con sidestream dark field (SDF) Microscan® como método de monitorización en microcirugía en modelo porcino / Microcirculation assessment with sidestream dark field (SDF) Microscan® as flap monitoring method in microsurgery in a porcine model

Objetivo: Determinar la factibilidad de la monitorización en microcirugía por medio de la evaluación no invasiva de la microcirculación con sidestream dark field (SDF) y compararla con otros métodos. Materiales y métodos: Estudio experimental. En 8 cerdos se elevó colgajo pectoral y se disecó pedículo. Se llevó a cabo una instalación sucesiva de dispositivos cutáneos para la evaluación de la microcirculación: SDF para evaluar flujo, y near infrared spectroscopy (NIRS) para evaluar saturación de O2 (SatO2). Posteriormente se evaluó la oclusión venosa, arterial y total con pinzamiento durante 180 s. Resultados: SDF en oclusión venosa: disminución del flujo: 51 s (59-62); SDF en oclusión arterial: disminución del flujo: 3 s (1-5); SDF en oclusión vascular total: disminución del flujo: 3,5 s (2-5). NIRS en oclusión venosa: disminución de la SatO2:15,2 ± 5,3%; NIRS en oclusión arterial: disminución de la SatO2 23,9 ± 13,8%; NIRS en oclusión vascular total: disminución de la SatO2 23,85 ± 13,9%. Doppler en oclusión venosa: no desapareció; Doppler en oclusión arterial y oclusión vascular total: desapareció a los 2 s. En cada una de las mediciones, los cambios clínicos fueron más tardíos que los observados con SDF. Conclusión: Es factible la monitorización en microcirugía por medio de la evaluación de la microcirculación con Microscan®. Este método permite realizar el diagnóstico de oclusión vascular más tempranamente que con NIRS y evaluación clínica.

Aim: Determine the feasibility of using SDF Microscan® as a non-invasive method for monitoring free flap microcirculation, and compare it to other methods. Materials and methods: Experimental study. In 8 pigs a pectoral myocutaneous flap was raised. Microcirculation was evaluated using: SDF Microscan®, near infrared spectroscopy (NIRS), clinical examination and Doppler. Venous, arterial and total occlusion was performed by clamping the vascular pedicle. Mean time to blood flow impairment diagnosis was measured. Results: SDF in venous occlusion: reduced microcirculatory flow index at: 51 s (59-62). SDF in arterial occlusion: reduced microcirculatory flow index at: 3 s (1-5). SDF in total vascular occlusion: reduced microcirculatory flow index at: 3.5 s (2-5). NIRS in venous occlusion: SatO2 decrease was 15.2 ± 5.3%. NIRS in arterial occlusion: SatO2 decrease was 23.9 ± 13.8%. NIRS in total vascular occlusion: SatO2 decrease was 23.85 ± 13.9%. Doppler in venous occlusion: The signal did not disappear. Doppler arterial and total vascular occlusion disappears at 2 s. The clinical changes were later than SDF. Conclusion: Microcirculation monitoring is feasible using SDF Microscan® in a pig model. This method allows to detect blood flow disruption earlier than NIRS and clinical evaluation.

A Novel Perforator Flap Training Model Using a Chicken Leg.

INTRODUCTION: Living animal models are frequently used for perforator flap dissection training, but no ex vivo models have been described. The aim of this study is to present a novel nonliving model for perforator flap training based on a constant perforator in the chicken leg. METHODS: A total of 15 chicken legs were used in this study. Anatomical dissection of the perforator was performed after its identification using ink injection, and in four of these specimens a perforator-based flap was raised. RESULTS: The anatomical dissection revealed a constant intramuscular perforator with a median length of 5.7 cm. Median proximal and distal vessel diameters were 0.93 and 0.4 mm, respectively. The median dissection time was 77.5 minutes. CONCLUSION: This study introduces a novel, affordable, and reproducible model for the intramuscular dissection of a perforator-based flap using an ex vivo animal model. Its consistent perforator and appropriate-sized vessels make it useful for training.

Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models.

BACKGROUND: Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model. METHODS: Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant. RESULTS: Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50 percent for artery and vein, respectively. CONCLUSIONS: Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.

A Novel Ex Vivo Training Model for Acquiring Supermicrosurgical Skills Using a Chicken Leg.

Background Supermicrosurgery is a technique used for dissection and anastomosis of submillimeter diameter vessels. This technique requires precise hand movements and superb eye-hand coordination, making continuous training necessary. Biological in vivo and ex vivo models have been described for this purpose, the latter being more accessible and cost-effective. The aim of this study is to present a new ex vivo training model using a chicken leg. Methods In 28 chicken legs, an anatomical study was performed. An intramuscular perforator vessel was identified and dissected. Arterial diameters of 0.7, 0.5, and 0.3 mm were identified and consistency of the perforator was assessed. In additional 10 chicken legs, 25 submillimeter arteries were anastomosed using this perforator vessel. Five arteries of 0.3 and 10 of 0.5 mm were anastomosed with nylon 11-0 and 12-0 sutures. Intravascular stent (IVaS) technique and open guide (OG) technique were used in 0.5-mm arteries. A total of 10 arteries of 0.7 mm were anastomosed using 10-0 sutures in a conventional fashion. Dissection and anastomosis time were recorded and patency was tested. Results We were able to identify 0.7 to 0.3 mm diameter arteries in all the specimens and confirm the consistency of the perforator. The median time for dissection was 13.4 minutes. The median time for anastomosis was 32.3 minutes for 0.3-mm arteries, 24.3 minutes for 0.5-mm arteries using IVaS, 29.5 minutes for the OG technique, and 20.9 minutes for the 0.7 mm diameter arteries. All the anastomoses were permeable. Conclusion Due to its consistent and adequate diameter vessels, this model is adequate for training supermicrosurgical skills.

Evaluación de zona dadora en reconstrucción auricular de microtia con técnica suprapericóndrica en la obtención de cartílago costal / Evaluation of donor site in auricular reconstruction of microtia with supraperichondrial costal cartilage harvest technique

Aim: To assess the presence of donor site sequel of patients undergoing ear reconstruction with costal cartilage harvest, using supraperichondrial technique. methods: Cross-sectional study; patients under 15 years. The cartilages were harvested with perichondrium. Three observers performed donor site assessment; they were independent to this study (validated Strasser score: deformity, asymmetry, contour and scar). Children and their mothers were applied satisfaction survey. Analysis of the association between variables: nonparametric tests. Results: 19 reconstructions, 18 patients, age 8 (6-15) years, follow-up 50 (14-96) months; number of rib cartilage harvested 3 (2-4) units. Expert assessment: excellent in 2 (10.5%) cases, good in 10 (52.6%), regular in 7 (36.8%). Most mothers and patients rated the result as good. There was no significant difference in the score, with respect to the number of harvested costal cartilages. To separate them by age, poorer results were obtained at surgery before 10 years of age than in older (p < 0.03). Conclusion: Ear reconstruction and supraperichondrial technique for costal cartilage allows obtain good results in donor site. There is high satisfaction when evaluated by the patient and his mother, as well as observers. The result is not dependent on the number of harvested cartilage, but is related to age at surgery, best results were obtained in patients operated over 10 years of age.

Objetivo: Evaluar presencia de secuela en zona dadora de pacientes sometidos a reconstrucción auricular con cartílago costal con técnica suprapericóndrica. material y método: Corte transversal; pacientes menores de 15 años. Cartílagos fueron levantados con pericondrio. Evaluación de zona dadora fue realizada por tres observadores independientes (escala validada de Strasser: deformidad, asimetría, contorno y cicatriz). A niños y madres se les aplicó encuesta de satisfacción. En el análisis de la asociación entre variables se utilizan pruebas no paramétricas. Resultados: 19 reconstrucciones, 18 pacientes, mediana edad 8 (6-15) años, seguimiento 50 (14-96) meses, número de cartílagos costales obtenidos 3 (2-4) unidades. Evaluación de expertos: excelente en 2 (10,5%) casos, bueno en 10 (52,6%) y regular en 7 (36,8%). La mayoría de las madres y pacientes calificó como bueno el resultado. No hubo diferencia significativa en el puntaje con respecto al número de cartílagos costales cosechados. Al separarlos por edad se obtuvo peores resultados en los intervenidos antes de los 10 años que en mayores (p < 0,03). Conclusión: La reconstrucción auricular con cartílago costal y técnica suprapericóndrica, permite obtener buenos resultados en zona dadora. Existe alta satisfacción al ser evaluada por el paciente y su madre, así como por los observadores. El resultado no es dependiente del número de cartílagos; sí en relación a la edad de la cirugía: mejores resultados en pacientes operados sobre los 10 años de edad, lo que concuerda con otros estudios.

Effectiveness of Intralesional Triamcinolone in the Treatment of Keloids in Children.

BACKGROUND: The current treatment of keloids includes surgery, intralesional steroids, and radiotherapy, among others. Radiotherapy is not recommended in children due to its effects on growing tissues. Our aim was to study intralesional triamcinilone therapy of keloids in children and analyze the impact of body location, age of the lesion, and etiology of the keloid on clinical response. METHODS: We conducted a prospective clinical trial with patients 1 to 14 years of age evaluated for keloid treatment. A soft tissue ultrasound was performed to measure the keloid volume, prior to intralesional infiltration with triamcinolone acetonide. A posttreatment ultrasound quantified the volume differences attributed to therapy. For the analysis, Mann-Whitney/Wilcoxon test for paired samples and a multiple regression analysis were performed. RESULTS: Twenty-one patients with a total of 25 keloids were enrolled, with a median age of 12 years (range 6-14 yrs). The initial lesional volume was 1.25 cc (range 0.2-6.3 cc) and the final volume was 0.2 cc (range 0.0-1.53 cc), corresponding to 82.7% of size reduction (p < 0.001). Regarding the relationships between response and body location, etiology and age of the lesion, the multiple regression analyses obtained p-values of 0.46, 0.16, and 0.87, respectively. One patient failed to improve. Average follow-up was 30 months. CONCLUSIONS: Triamcinolone acetonide is highly effective for the treatment of pediatric keloids. There is no relationship between clinical response and the factors evaluated, such as lesion location, etiology and age of the keloid.

White spot syndrome virus (WSSV) infection in shrimp (Litopenaeus vannamei) exposed to low and high salinity.

White spot syndrome virus (WSSV) has a worldwide distribution and is considered one of the most pathogenic and devastating viruses to the shrimp industry. A few studies have explored the effect of WSSV on shrimp acclimated to low (5 practical salinity units [psu]) or high ([40 psu) salinity conditions. In this work, we analysed the physiological response of WSSV-infected Litopenaeus vannamei juveniles that were acclimated to different salinities (5, 15, 28, 34 and 54 psu). We evaluated the osmotic response and survival of the shrimp at different times after infection (0 to 48 hours), and we followed the expression levels of a viral gene (vp664) in shrimp haemolymph using real-time PCR. Our results indicate that the susceptibility of the shrimp to the virus increased at extreme salinities (5 and 54 psu), with higher survival rates at 15 and 28 psu, which were closer to the iso-osmotic point (24.7 psu, 727.5 mOsmol/kg). Acute exposure to the virus made the haemolymph less hyperosmotic at 5 and 15 psu and less hypo-osmotic at higher salinities ([28 psu). The capacity of white shrimp to osmoregulate, and thus survive, significantly decreased following WSSV infection. According to our results, extreme salinities (5 or 54 psu) are more harmful than seawater.

Actualización en cáncer de próstata: generalidades y diagnóstico / Update in prostate cancer: overview and diagnosis

Resumen: El cáncer de próstata es una enfermedad clínicamente caracterizada por un periodode latencia largo y un crecimiento tumoral lento. En la actualidad, es un problema de granimportancia para la salud pública, pues es el segundo cáncer más frecuentemente diagnosticadoy corresponde a la sexta causa de muerte por cáncer en hombres en el mundo. Se caracteriza poruna gran heterogeneidad clínica y molecular. Su diagnóstico se basa en el uso de tres pruebasfundamentales: el examen del tacto rectal y la medición de los niveles séricos del antígenoespecífico de próstata (AEP), los cuales se usan frecuentemente en el tamizaje, y la biopsiaprostática, mediante la cual se confirma el diagnóstico de cáncer de próstata. Actualmente, el AEPse ha constituido en la principal herramienta tamiz para el cáncer de próstata; no obstante, existeuna gran controversia en torno a su uso. Por ello, están siendo ampliamente estudiados nuevosbiomarcadores, a fin de disponer de pruebas diagnósticas más sensibles y específicas. Dado queel AEP es una prueba ampliamente utilizada internacionalmente y que han surgido biomarcadoresadicionales para el diagnóstico temprano del cáncer de próstata, es de fundamental importanciaque el personal de la salud en general y el personal de laboratorio en particular puedan contarcon información con respecto al uso de éstas y su relación con otras herramientas diagnósticas,además de otros aspectos generales del cáncer de próstata.

Abstract: Prostate cancer is a disease clinically characterized by a long latency period and slow tumorgrowth rate. Prostate cancer is currently a major public health problem because it is the second mostcommonly diagnosed cancer, and the sixth major cause of cancer-related death in men in the world.It is characterized by clinical and molecular heterogeneity. Diagnosis is based on the use of threebasic tests: digital rectal examination, measurement of prostate-specific antigen (PSA) serum levels,frequently used in screening, and prostate biopsy, which confirms the diagnosis of prostate cancer.Nowadays, PSA has become the main testing way for prostate cancer screening, although there ismuch controversy about its use. Therefore, new biomarkers are being widely researched, in order toprovide more sensitive and more specific diagnostic tests. Provided that PSA is a globally used test,and additional tests for early diagnosis of prostate cancer have aroused, is it essential that healthpersonnel, and particularly laboratory personnel, are granted with information about their use, andtheir relationship with further diagnostic techniques, besides other general aspects of prostate cancer.

Initial human experience with restrictive duodenal-jejunal bypass liner for treatment of morbid obesity.

BACKGROUND: The duodenal-jejunal bypass liner is an endoscopically placed and removable intestinal liner that creates a duodenal-jejunal bypass, leading to diabetes improvement and weight loss. The aim of the present study was to evaluate the clinical effects and safety of the duodenal-jejunal bypass liner combined with a restrictor orifice (flow restrictor). METHODS: The device was endoscopically implanted in 10 patients (body mass index 40.8 +/- 4.0 kg/m(2)) and removed after 12 weeks. Dilation of the restrictor orifice was performed as clinically indicated with a 6-, 8-, or 10-mm diameter through-the-scope balloon. The measured outcomes included the percentage of excess weight loss, total weight loss, adverse events, and gastric emptying (GE) at baseline, weeks 4 and 12 of implantation, and 3-5 months after device removal. GE was measured by scintigraphy at 1, 2, and 4 hours after implantation. RESULTS: The percentage of excess weight loss and total weight loss at explantation was 40% +/- 3% (range 21-64%) and 16.7 +/- 1.4 kg (range 12.0-26.0), respectively. The 4-hour GE was 98% +/- 1% at baseline, 72% +/- 6% at 4 weeks (P = 0.001 versus baseline), and 84% +/- 5% at 12 weeks (P <.05 versus baseline). After explantation, the rate of GE returned to normal in 7 of 8 subjects, but remained slightly delayed in 1 subject (84% at 4 hours). Episodes of nausea, vomiting, and abdominal pain required endoscopic dilation of the restrictor orifice with a 6-mm through-the-scope balloon in 7 patients and a 10-mm balloon in 1, with no clinically significant adverse events. CONCLUSION: Endoscopic implantation of a combination flow restrictor and duodenal-jejunal bypass liner induced substantial weight loss. The implanted patients exhibited delayed GE that was reversed after device removal.

Estándares e indicadores de calidad de atención con enfoque intercultural para centros de salud de primer nivel / sss

Con esta propuesta, la Cooperación Italiana en el marco del Programa"Apoyo al Desarrollo del Sistema Socio-Sanitario del Departamento de Potosí", tiene como objetivo avanzar más allá en el modelo actual de atención de salud, superando la dimensión científica y tecnológica por la que se caracteriza, viendo por conveniente incorporar la dimensión social y cultural del proceso salud - enfermedad - atención. Es así que en el Plan Operativo Anual 2007 se planea un trabajo de identificación de estándares e indicadoresde calidad de atención, enfocados en un principio de interculturalidad, que puedan permitir al personal de salud entender y ofrecer al paciente una atención integral. A través de esto, los prestadores de servicios de salud pueden asumir y empoderar actitudes de respeto y acercamiento frente a otrossujetos (usuarios, médicos tradicionales, parteras tradicionales, comunidad en general) que, en ocasiones, podrían tener concepciones contrapuestas...

Los estudiantes, los docentes y el aprendizaje / Students, teachers and learning

Un equipo interdisciplinario integrado por docentes de educación media y psiquiatras de niños y adolescentes trabajó durante dos años en un liceo de Montevideo analizando la situación de alumnos con dificultades diversas, en el marco de un enfoque de prevención en salud mental en ámbitos comunitarios.El objetivo de las acciones fue contribuir al proceso de aprendizaje de los alumnos y a la consecuente superación de sus logros. Para ello se fueron elaborando, para cada situación, estrategias de aprendizaje específicas que posibilitaran ese desempeño.Se partió de una definición operativa del aprendizaje concebido como un proceso esencial del desarrollo humano que permite al individuo conocer, ejercitar y ampliar sus capacidades, la que derivara en lo inmediato y en el futuro en hacerse dueño de su destino, crecer con dignidad y contribuir al desarrollo social y al intercambio democrático. Se encontró que: a) 12 por ciento de los alumnos necesitó una atención especializada. b) En ellas existía una paridad en ambos sexos. c) La distribución de la problemática fue la siguiente: de tipo fundamentalmente afectivo, 32 po ciento; intelectual, 26 por ciento; sensorial, 17 por ciento; neurológica, 13 por ciento; conductual, 4 por ciento. d) Se constató un alto grado de co-morbilidad. Se concluye que: a) Todas las dificultades de aprendizaje tienen una situación problemática de base, que es necesario estudiar y atender. b) Si lo anterior no es tenido en cuenta, con un diagnóstico y un tratamiento adecuados, se incurre en una serie de desinteligencias, configurando una yatrogenia que agrava la situación y compromete más aún su posible resolución. c) Se crea un bloqueo del proceso normal de aprendizaje que afecta al alumno, al docente y al conjunto del grupo de clase. d) Se vive durante el año curricular una experiencia relacional, laboral y vital negativa, que confirma la precedente y tiende a consolidar el desánimo