Patógenos bacterianos y resistencia a los antibióticos en otitis media aguda / Bacterial pathogens and antimicrobial resistance in acute otitis media

Introducción: Estudios recientes señalan un aumento de la prevalencia de Haemophilus influenzae y una disminución de Streptococcus pneumoniae entre las bacterias causantes de otitis media aguda (OMA). El objetivo del estudio es conocer la distribución de microorganismos patógenos identificados en Urgencias en los menores de 14 años con OMA y su patrón de resistencias. Pacientes y métodos: Estudio retrospectivo, analítico y unicéntrico incluyendo pacientes menores de 14 años diagnosticados de OMA en los que se recogió un cultivo de secreción ótica en el servicio de urgencias pediátricas de un hospital terciario entre 2013 y 2021. Resultados: Durante el periodo de estudio se registraron 14.684 episodios con diagnóstico de OMA, recogiéndose en 768 cultivo de secreción ótica. La mediana de edad fue de 2 años, el 57% varones y el 70% habían presentado al menos una OMA previa. Los patógenos más frecuentemente aislados fueron: Haemophilus influenzae, 188 (24,5%; de ellos, 15,5% resistentes a ampicilina); Streptococcus pyogenes, 86 (11,2%); Staphylococcus aureus, 82 (10,7%); Streptococcus pneumoniae, 54 (6,9%; de ellos, 9,4% con resistencia intermedia a penicilina); Pseudomonas aeruginosa, 42 (5,5%) y Moraxella catarrhalis, 11 (1,4%). En el 34,9% no se aislaron patógenos. Conclusiones: Haemophilus influenzae es la primera causa de OMA en menores de 14 años. Este hecho, junto a la baja tasa de aislamientos y resistencia a penicilina de Streptococcus pneumoniae, cuestiona la idoneidad de la amoxicilina a dosis elevadas como tratamiento antibiótico empírico de la OMA.(AU)

Introduction: Recent studies show an increase in the prevalence of Haemophilus influenzae and a decrease in Streptococcus pneumoniae among the bacteria that cause acute otitis media (AOM). The objective of our study was to analyse the distribution of pathogens identified in children aged less than 14 years presenting to the emergency department with AOM and their patterns of antimicrobial resistance. Patients and methods: Single centre retrospective, analytical study in patients aged less than 14 years with a diagnosis of AOM in whom an ear drainage sample was collected for culture in the paediatric emergency department of a tertiary care hospital between 2013 and 2021. Results: During the study period, there were 14,684 documented care episodes corresponding to children with a diagnosis of AOM. An ear drainage culture was performed in 768 of those episodes. The median age of the patients was 2 years, 57% were male and 70% had a previous history of AOM. The most frequently isolated pathogens were: Haemophilus influenzae (n=188 [24.5%]; 15.5% of them resistant to ampicillin), Streptococcus pyogenes (n=86 [11.2%]), Staphylococcus aureus (n=82 [10.7%]), Streptococcus pneumoniae (n=54 [6.9%]; 9.4% with intermediate resistance to penicillin), Pseudomonas aeruginosa (n=42 [5.5%]) and Moraxella catarrhalis (n=11 [1.4%]). No pathogen was isolated in 34.9% of cases. Conclusions: Haemophilus influenzae is the leading cause of AOM in children aged less than 14 years. This, combined with the low frequency of isolation and penicillin resistance of Streptococcus pneumoniae, calls into question the appropriateness of high-dose amoxicillin for empiric treatment of AOM.(AU)

Efectividad de la formación teórico-práctica en soporte vital básico a monitoras de comedores escolares desde Atención Primaria / Effectiveness of theoretical-practical training in basic life support for school canteen monitors from Primary Care

Introducción: las enfermedades cardiovasculares constituyen un problema de salud pública a nivel mundial y dentro de ellas destaca la parada cardiorrespiratoria (PCR). Los comedores escolares son espacios con potencial riesgo de presenciar una PCR. Materiales y métodos: estudio analítico cuasiexperimental de intervención. Las participantes recibieron formación mediante una plataforma virtual interactiva y una sesión de simulación clínica presencial sobre maniobra de Heimlich, reanimación cardiopulmonar (RCP) básica y uso del desfibrilador externo semiautomático (DESA). Se realizó un análisis descriptivo de la población a estudio y un análisis estadístico comparativo entre el resultado obtenido en un test previo y otro posterior a la formación virtual. Se creó una variable restando la puntuación obtenida antes de la formación a la obtenida después de la misma. Se analizó mediante observación directa la simulación clínica. Se definió la significación estadística con una p <0,05. Análisis estadístico con SPSS versión 19.0. Se siguieron los principios de la Declaración de Helsinki y las directrices sobre buenas prácticas clínicas. Resultados: la totalidad de la muestra eran mujeres con edad mediana de 48,50 años. La nota mediana del test previo fue de 6,7/10 y el test posterior tuvo un resultado constante de 10/10. La diferencia entre el test posterior y el previo tuvo una mediana de 3,3 (p 0,01) y se constató en la simulación que el aprendizaje fue óptimo. Conclusiones: la formación en RCP es una estrategia de impacto social, relacionada con una mejora en la respuesta ante un caso de PCR, disminuyendo la morbimortalidad que esta implica. (AU)

Introduction: cardiovascular diseases constitute a public health problem worldwide, among which cardiopumonary arrest (CPA) stands out. School canteens are spaces where there is a possibility of witnessing CPA. Materials and methods: quasi-experimental interventional and analytical study. Participants received training through an interactive virtual platform and a face-to-face clinical simulation session on the Heimlich manoeuvre, basic cardiopulmonary resuscitation (CPR) and the use of the semiautomatic external defibrillator (SAED). We carried out a descriptive analysis of the study population and a comparative statistical analysis of the results obtained in the tests conducted before and after the virtual training. We created variable corresponding to the subtraction of the pre-training score from the post-training score. Clinical simulation was analysed by direct observation. Statistical significance was defined as p < 0.05. The statistical analysis was carried out with SPSS version 19.0. The study adhered to the principles of the Declaration of Helsinki and the guidelines on good clinical practice. Results: the entire sample consisted of women with a median age of 48.50 years. The median score in the pre-test was 6.7/10, and the score in the post-test was uniformly 10/10. The median difference between the pre- and post-training tests was of 3.3 points (p 0.01) and the simulation evinced that the learning was optimal. Conclusions: training in CPR is a strategy that has social impact in terms of the improvement in the response to a CPA events, achieving a reduction in the associated morbidity and mortality. (AU)

Metodología científica para Cirugía Vascular. Estudios analíticos experimentales. El ensayo clínico / Experimental analytical studies. The clinical trial

Como hemos comentado anteriormente en un artículo previos, los estudios analíticos son aquellos en los que hay grupos de comparación que nos permiten el estudio de asociación de factores de estudio con eventos finales o resultados, como por ejemplo el tabaquismo y el desarrollo de AAA. En este artículo trataremos los estudios analíticos experimentales o, simplemente experimentales ya que podemos considerar que siempre los experimentales son analíticos al existir 2 grupos de comparación, por ejemplo, supervivencia de 2 tipos diferentes de tratamiento. (AU)

As we have previously discussed in a previous article, analytical studies are those in which there are comparison groups that allow us to study the association of study factors with final events or outcomes, such as smoking and the development of AAA. In this article, we will analyze the experimental analytical studies or, simply, experimental ones, because we can consider experimental studies to be analytical by nature, given the presence of 2 comparison groups, for example, the survival rates of 2 different types of treatment. (AU)

Epilepsia y desigualdad: descripción demográfica y análisis de la dificultad para el acceso a recursos avanzados en una población de un área de salud pequeña / Epilepsy and inequality: demographic description and analysis of the difficulty in accessing advanced resources in a population in a small health area

Introducción: La epilepsia es una enfermedad neurológica muy frecuente que implica una elevada morbimortalidad. La epilepsia farmacorresistente (EFR) supone un desafío terapéutico superior, incluso para expertos en la materia. A pesar de ello, el acceso a recursos avanzados para este tipo de pacientes continúa siendo dificultoso y desigual. El objetivo de este estudio es analizar la desigualdad en una población perteneciente a un hospital de primer nivel. Pacientes y métodos Se llevó a cabo un estudio transversal observacional analítico con pacientes epilépticos que acuden a consultas de neurología del área IX del Servicio Murciano de Salud. Se describen variables demográficas, clínicas, terapéuticas, pronósticas y de equidad, y se analizan diferencias significativas entre distintos subgrupos. Resultados En el estudio se incluyó a 68 pacientes con una media de edad de 42,93 años. El tipo de epilepsia principal fue la focal (64,7%), y los fármacos más usados fueron el levetiracetam (33,8%), el ácido valproico (27,9%) y la lamotrigina (22,1%). La EFR se dio en 18 pacientes (el 26,5% del total) y sólo cuatro se encontraban en seguimiento activo en una unidad de epilepsia, lo que implica que el 71% no accedía a un recurso necesario (advanced therapeutic gap). Conclusiones Este estudio demuestra que la desigualdad en la epilepsia continúa siendo un problema, especialmente en ciertas áreas geográficas, con una falta de acceso a atención avanzada en pacientes que más lo necesitan. La solución puede conseguirse aumentando recursos humanos y materiales que mejoren la atención global del paciente, reforzando así tanto los hospitales de referencia como las unidades de epilepsia. (AU)

INTRODUCTION: Epilepsy is a very common neurological disease with high morbidity and mortality. Drug-resistant epilepsy (DRE) poses a major therapeutic challenge, even for experts in the field. Despite this, access to advanced resources for this type of patient remains difficult and unequal. The aim of this study is to analyse inequality in a population belonging to a first level hospital. PATIENTS AND METHODS An analytical observational cross-sectional study was conducted on epileptic patients attending neurology consultations in Area IX of the Murcian Health Service. Demographic, clinical, therapeutic, prognostic and equity variables are described, and significant differences between different subgroups are analysed. RESULTS The study included 68 patients with a mean age of 42.93 years. Focal epilepsy was the main type (64.7%), and the most commonly used drugs were levetiracetam (33.8%), valproic acid (27.9%) and lamotrigine (22.1%). DRE occurred in 18 patients (26.5% of the total) and only four were under active follow-up in an epilepsy unit, meaning that 71% did not have access to a necessary resource (advanced therapeutic gap). CONCLUSIONS This study demonstrates that epilepsy inequality continues to be a problem, especially in certain geographical areas, with a lack of access to advanced care for patients who need it most. The solution can be achieved by increasing human and material resources to improve overall patient care, thus strengthening both referral hospitals and epilepsy units. (AU)

Vitamin D deficiency in adolescents with obesity-Altered metabolism or environmental factors? / Deficiencia de vitamina D en adolescentes con obesidad: ¿alteración metabólica o factores ambientales?

Introduction: obesity childhood is related to vitamin D deficiency. The aim of this study was to compare vitamin D status between adolescentswith obesity living in an urban area and in a rural area. We hypothesized that environmental factors would be decisive in reducing the bodycontent of vitamin D in patients with obesity.Methods: a cross-sectional clinical and analytical study (calcium, phosphorus, calcidiol and parathyroid hormone) was carried out in a group of259 adolescents with obesity (BMI-SDS > 2.0), 249 adolescents with severe obesity (BMI-SDS > 3.0) and 251 healthy adolescents. The placeof residence was categorized as urban or rural. Vitamin D status was defined according to the US Endocrine Society criteria.Results: vitamin D deficiency was significantly higher (p < 0.001) in severe obesity (55 %) and obesity groups (37.1 %) than in the control group(14 %). Vitamin D deficiency was more frequent in severe obesity (67.2 %) and obesity groups (51.2 %) living in urban areas than in those livingin rural areas (41.5 % and 23.9 %, respectively). The patients with obesity living in urban residence did not present significant seasonal variationsin vitamin D deficiency in contrast to those patients with obesity living in rural residence.Conclusions: the most probable mechanism for vitamin D deficiency in adolescents with obesity, rather than altered metabolic is the environmentalfactors (sedentary lifestyle and lack of adequate sunlight exposure). (AU)

Introducción: la obesidad está relacionada con la deficiencia de vitamina D. El objetivo del presente estudio fue comparar el estado de vitaminaD entre adolescentes con obesidad con residencia urbana y rural. Se hipotetiza que los factores ambientales serían determinantes en la reduccióndel contenido corporal de vitamina D en pacientes con obesidad.Métodos: estudio transversal clínico y analítico (calcio, fósforo, calcidiol y PTH) en un grupo de 259 adolescentes con obesidad (IMC-SDS >2,0), 249 adolescentes con obesidad severa (IMC-SDS > 3,0) y 251 adolescentes sanos. El estado de vitamina D se definió de acuerdo con loscriterios de la Sociedad Americana de Endocrinología.Resultados: la deficiencia de vitamina D fue superior (p < 0,05) en los grupos de obesidad severa (55 %) y obesidad (37,1 %) respecto al grupode control (14 %). La prevalencia de deficiencia de vitamina D fue superior (p < 0,05) en los grupos de obesidad severa (67,2 %) y obesidad(51,2 %) con residencia urbana respecto a los que vivían en áreas rurales (41,5 % y 23,9 %, respectivamente). Los pacientes con obesidad yobesidad severa con residencia urbana no presentaban variaciones estacionales en la deficiencia de vitamina D en contraste con los pacientescon residencia rural.Conclusiones: el mecanismo más probable para la deficiencia de vitamina D en adolescentes con obesidad, más que alteraciones metabólicas,serían los factores ambientales (sedentarismo y falta de exposición solar adecuada). (AU)

Satisfacción con los cuidados de Enfermería proporcionados en una unidad de hospitalización de agudos de salud mental / Satisfaction with Nursing care provided at a hospitalization unit for acute Mental Health patients

Objetivo: analizar la satisfacción del paciente sobre los cuidados recibidos por el personal de Enfermería durante su ingreso en una unidad de hospitalización de agudos de salud mental.Métodos: estudio trasversal analítico realizado en 2021 en la unidad de hospitalización de agudos de Psiquiatría de un hospital del Vallés Occidental en Cataluña (España). La población de estudio fueron las personas con un ingreso superior a una semana que cumplimentaron la escala de Evaluación del Cuidado CAT-V (rango 27-135), en su versión validada al español. Además, se recogieron las variables clínicas de los participantes: a) tipo de ingreso: voluntario/involuntario, b) diagnóstico del ingreso, c) utilización de contención mecánica, d) consumo de tóxicos. Se realizó análisis univariado y comparativo de las variables recogidas.Resultados: se incluyeron 100 pacientes, con una media de edad de 42,5 años (19-72). El 55% (p= 55) fue mujer. La satisfacción obtuvo una puntuación mediana (P25-P75) de 114 (103-125), situándose en el cuarto cuartil de satisfacción. Los valores de satisfacción se mantuvieron en el cuarto cuartil, sin mostrar diferencias estadísticamente significativas en ninguno de los factores considerados, excepto en los valores relacionados con el uso de contención mecánica, que mostró diferencias estadísticas (p= 0,023), con peor percepción de satisfacción del cuidado para aquellos en los que se usaron, mediana (P25-P75) 96,5 (87-114), frente a los que no, 116 (108-125). Aunque no se observaron diferencias significativas para el resto de variables estudiadas se destaca que aumenta la satisfacción en los ingresos voluntarios y en las personas de mayor edad.Conclusiones: los pacientes presentaron alta satisfacción del cuidado recibido por el personal de Enfermería durante su ingreso en una unidad de hospitalización de agudos de salud mental. La prevalencia del uso de contenciones mecánicas tiene un impacto negativo sobre la satisfacción del cuidado recibido. (AU)

Objective: to analyse patient satisfaction regarding care received from the Nursing staff during their admission at a hospitalization unit for acute mental health patients.Methods: an analytical cross-sectional study conducted in 2021 at the hospitalization unit for acute Psychiatry patients at a Vallés Occidental hospital in Catalonia (Spain). The study population were those persons hospitalized for over a week who completed the Caring Assessment Tool CAT-V (range 27-135), in its version translated into Spanish. Besides, the clinical variables of participants were collected: a) type of admission: voluntary / involuntary, b) diagnosis at admission, c) use of mechanical restraint, d) use of toxic substances. There was univariate and comparative analysis of the variables collected.Results: the study included 100 patients, with 42.5 years as mean age (19-72); of these, 55% (p= 55) was female. Satisfaction obtained a median score (P25-P75) of 114 (103-125), and was placed in the fourth quartile. Satisfaction values stayed in the fourth quartile, without showing any statistically significant differences in any of the factors considered, except for those values associated with the use of mechanical restraint, which showed statistical differences (p= 0,023), with a worse perception of satisfaction with care in those for whom it was used, median (P25-P75) 96.5 (87-114), vs. those for whom it was not, 116 (108-125). Even though no significant differences were observed for the rest of variables studied, an increase in satisfaction stood out among voluntary admissions and older persons.Conclusions: patients presented high satisfaction with care received from Nursing staff during their admission at a hospitalization unit for acute mental health patients. The prevalence of the use of mechanical restraints had a negative impact on satisfaction with care received. (AU)

Análise longitudinal dos parâmetros ventilatórios e escore SOFA de pacientes com COVID-19 hospitalizados em uma UTI no Sul do Brasil / Longitudinal analysis of ventilatory parameters and SOFA score of patients with COVID-19 hospitalised in an ICU in southern Brazil

Introdução: embora o Coronavírus da Síndrome Respiratória Aguda Grave 2 (SARS-CoV-2) seja mais conhecido por causar patologias respiratórias substanciais, o vírus também pode resultar em várias manifestações extrapulmonares, sobretudo nas alas de cuidados intensivos. Frente a essas implicações multissistêmicas, a monitoração do suporte ventilatório e utilização do escore Sequential Organ Failure Assessment (SOFA) foram fundamentais no manejo do paciente crítico com COVID-19 nas Unidades de Terapia Intensiva (UTIs) durante a pandemia. Objetivo: esse estudo pretende analisar os parâmetros ventilatórios e escore SOFA de pacientes com COVID-19 numa UTI no sul do Brasil e as principais complicações ocasionadas. Metodologia: foi realizado um estudo de coorte retrospectivo que analisou prontuários de pacientes com diagnóstico de COVID-19 na UTI do Hospital Nossa Senhora da Conceição, no estado de Santa Catarina, entre março de 2020 a dezembro de 2021. Resultados: foram incluídos 448 pacientes, com média de idade de 58,5 (±15,1) anos, mediana de internação de 15 (9-24) dias e média de ventilação mecânica de 15 (±8,7) dias, evoluindo para óbito 63,3%. Durante a internação, 86,4% das pessoas sofreram complicações, dentre as mais prevalentes Insuficiência Renal Aguda (46,8%) seguida por Pneumonia Associada à Ventilação (41,9%) e Choque séptico (22%). Na evolução clínica, o escore SOFA e a relação da pressão parcial de oxigênio pela fração de oxigênio inspirado (PaO2/FiO2) foram fatores de desfecho desfavorável nas três semanas de internação, com SOFA ≥ 5 e relação PaO2/FiO2 < 200. Além disso, 3 dos 6 componentes do SOFA (renal, respiratório e coagulação) tiveram relação com a ocorrência de complicações. Conclusão: o escore SOFA e a relação PaO2/FiO2 tiveram relação no prognóstico de pacientes com COVID-19 durante as três semanas de internação na UTI. Além disso, o SOFA se mostrou um possível indicador de complicações intra-hospitalares durante a evolução clínica.

Introduction: although Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is best known for causing significant respiratory pathologies, the virus can also result in various extrapulmonary manifestations, particularly in intensive care wards. Faced with these multisystem implications, monitoring ventilatory support and using the Sequential Organ Failure Assessment (SOFA) score were fundamental in managing critically ill patients with COVID-19 in Intensive Care Units (ICUs) during the pandemic. Objective: this study will analyse the ventilatory parameters and SOFA score of patients with COVID-19 in an ICU in southern Brazil and the main complications caused. Methodology: a retrospective cohort study was carried out that analysed medical records of patients diagnosed with COVID-19 in the ICU of Hospital Nossa Senhora da Conceição, in the state of Santa Catarina, between March 2020 and December 2021. Results: 448 patients were included, with a mean age of 58.5 (±15.1) years, a median hospital stay of 15 (9-24) days, and mean mechanical ventilation of 15 (±8.7) days, with 63.3% dying. During hospitalisation, 86.4% of people suffered complications, among the most prevalent Acute Renal Failure (46.8%), followed by Ventilation Associated Pneumonia (41.9%) and Septic Shock (22%). In the clinical evolution, the SOFA score and the ratio of partial pressure of oxygen to the fraction of inspired oxygen (PaO2/FiO2) were factors of unfavourable outcome in the three weeks of hospitalisation, with SOFA ≥ 5 and PaO2/FiO2 ratio < 200. In addition, three of the six components of the SOFA (renal, respiratory and coagulation) were related to the occurrence of complications. Conclusion: the SOFA score and the PaO2/FiO2 ratio were related to the prognosis of patients with COVID-19 during the three weeks of ICU stay. Furthermore, the SOFA proved to be a possible indicator of in-hospital complications during clinical evolution.

INTERFERENCIA DE HEPARINA EN LA DETERMINACIÓN DE PROTEÍNAS TOTALES POR EL MÉTODO DE BRADFORD / Heparin interference in the Bradford protein quantification assay

La determinación de proteínas totales es una técnica de rutina utilizada en la industria biofarmacéutica durante los procesos de purificación de derivados plasmáticos y/o producción de proteínas recombinantes; y la elección del método analítico es un paso crítico para la obtención de resultados confiables. En este trabajo se demostró la interferencia de heparina (Hep), un compuesto comúnmente utilizado como excipiente en la formulación de Concentrados de Factores de la Coagulación (CFC), en la determinación de proteínas por el método de Bradford, cuya interferencia no está descripta como tal en los insertos de los kits comerciales de Bradford ni en la Farmacopea Europea. Esta interferencia fue demostrada tanto en soluciones de Albúmina Sérica Bovina (BSA) fortificadas con Hep, como en muestras de CFC. Para una solución de BSA 40 mg %, la concentración límite de Hep que no interfiere en la determinación de proteínas totales fue de 1,6 UI/ml. Cabe destacar que, si se trabaja a un nivel menor de concentración de proteínas, una proteína diferente o mezclas complejas de proteínas, se debe evaluar el grado de interferencia para cada caso particular, pudiéndose utilizar los valores obtenidos en este trabajo como referencia. Alternativamente, se evaluó la neutralización de la Hep con Polybrene (Poly), previo a la determinación de proteínas por Bradford. En el caso de soluciones de BSA, el efecto interferente se revirtió logrando una correcta cuantificación de proteínas, mientras que en las muestras de CFC, la neutralización con Poly no fue efectiva. Por lo tanto, para considerar el uso de Poly, previo a la aplicación del método de Bradford, debe evaluarse cada caso particular según las características de la muestra proteica en estudio. Si esto no es posible, se recomienda la utilización de un método alternativo, por ejemplo, el colorimétrico que utiliza ácido bicinconínico.

Protein quantification in biological samples is a routine assay used in the biopharmaceutical industry during the purification procedures of plasma-derived products and/or recombinant proteins. Thus, choosing the method for this purpose is a critical step to obtaining reliable results. In this work, it was shown that Heparin (Hep), a compound commonly used as an excipient in the formulation step of Coagulation Factor Concentrates (CFC), interferes in protein quantification by the Bradford assay. This interference was proved both in solutions of Hep-fortified Bovine Serum Albumin (BSA) and in CFC samples. For a 40 mg % BSA solution, the Hep concentration which shows no interference in protein quantification is 1.6 IU/ml. It should be noted that a specific analysis must be carried out if working at a lower protein concentration, with a different protein, or with complex protein solutions, so the values obtained in this work can be used as a reference. Alternatively, Hep neutralization with Polybrene (Poly) was evaluated before protein determination by Bradford. In the case of BSA solutions, the interference was reversed and correct protein quantification was achieved, whereas in the CFC samples, the results were unsatisfactory. Until now, Hep interference in the Bradford assay has not been described in the scientific literature, nor listed in the inserts of the commercial kits for protein quantification by this method. It was concluded that for protein samples containing Hep, the choice of an alternative method, such as the one that uses bicinchoninic acid, is the most convenient option to obtain reliable results

Sarcopenia em pacientes de 40 a 64 anos hospitalizados por insuficiência cardíaca / Sarcopenia in patients aged 40­64 years hospitalized for heart failure

Introdução: a insuficiência cardíaca (IC) e a sarcopenia são condições prevalentes e inter-relacionadas, figurando como importantes causas de limitações funcionais. Objetivo: avaliar critérios de sarcopenia, e suas relações com parâmetros cardiometabólicos, em pacientes de 40 a 64 anos hospitalizados por IC. Metodologia: estudo de corte transversal com caráter analítico envolvendo indivíduos com IC confirmada. A massa muscular apendicular (MMA) foi avaliada através da absorciometria por raios-X de dupla energia (DXA), considerando-se baixa MMA mulheres com MMA/altura² <5,5 kg/m² ou MMA/índice de massa corporal (IMC) <0,512 e homens com MMA/altura² <7,0 kg/m² ou MMA/IMC <0,789. Baixa força de preensão manual (FPM) foi considerada quando <16 kg em mulheres e <27 kg em homens. Resultados: avaliou-se 109 pacientes (50,5% mulheres), com mediana de idade de 58 anos. Constatou-se baixa MMA em 41,3% e baixa FPM em 64,2%, não havendo correlação significativa entre FPM e MMA em nenhum dos gêneros. Baixa MMA se associou ao gênero masculino (68,9% versus 35,9%; p=0,001), a maiores idades (60,0 [53,0-63,0] versus 57,0 [51,3-60,0] anos; p=0,039) e maiores níveis séricos de paratormônio (48,0 [30,5-94,4] versus 29,9 [23,0-54,1] pg/mL; p=0,009). Baixa FPM se associou a maior sintomatologia cardíaca (75,7% com baixa FPM tinham classificação funcional da New York Heart Association III-IV, versus 51,3% daqueles com FPM normal; p=0,009). Conclusões: há uma relevante prevalência de sarcopenia em pacientes de 40 a 64 anos hospitalizados por IC, observando-se maior frequência de baixa MMA nos homens, associação entre baixa FPM e sintomatologia cardíaca, e maiores níveis de paratormônio naqueles com perda muscular.

Introduction: heart failure (HF) and sarcopenia are prevalent and interrelated conditions, being important causes of functional limitations. Objective: to evaluate sarcopenia criteria, and their relationship with cardiometabolic parameters, in patients aged 40­64 years hospitalized for HF. Methodology: Cross-sectional study including patients with established HF. Appendicular skeletal muscle mass (ASMM) was assessed using dual-energy X-ray absorptiometry (DXA), considering low ASMM women with ASMM/height² <5.5 kg/m² or ASMM/body mass index (BMI) <0.512 and men with ASMM/height² <7.0 kg/m² or ASMM/BMI <0.789. Low handgrip strength (HGS) was considered when <16 kg in women and <27 kg in men. Results: we evaluated 109 patients (50.5% women), with a median age of 58 years. Low ASMM was found in 41.3% and low HGS in 64.2%, with no significant correlation between HGS and ASMM in either gender. Low ASMM was associated with male gender (68.9% versus 35.9%; p=0.001), older age (60.0 [53.0-63.0] versus 57.0 [51.3-60, 0] years; p=0.039) and higher serum parathyroid hormone (48.0 [30.5-94.4] versus 29.9 [23.0-54.1] pg/mL; p=0.009). Low HGS was associated with greater cardiac symptoms (75.7% with low HGS had a New York Heart Association III-IV functional classification, versus 51.3% of those with normal HGS; p=0.009). Conclusions: there is a relevant prevalence of sarcopenia in patients aged 40­64 years hospitalized for HF, observing a higher frequency of low ASMM in men, an association between low HGS and cardiac symptoms, and higher levels of parathyroid hormone in those with muscle wasting.

Perfil reprodutivo de uma população de alta vulnerabilidade / Reproductive profile of a high vulnerability population

Introdução: padrões sexuais e reprodutivos são influenciados por fatores biopsicossociais. Dentre esses fatores, há a vulnerabilidade, conceito amplo, complexo e que determina maior atenção das políticas públicas. Objetivo: conhecer o perfil reprodutivo das mulheres que residem em uma área de alta vulnerabilidade na cidade de Curitiba-PR. Metodologia: descritivo, documental de caráter analítico observacional transversal. Coleta e análise de dados das Declarações de Nascidos Vivos (DNV) na Unidade de Saúde do Capanema e análise de dados públicos fornecidos pelo IBGE. Resultados: foram analisados 1199 DNVs, sendo 1011 mulheres com idades entre 13 e 49 anos, compreendidos entre os anos de 2003 a 2018. Foi possível a análise da Taxa de Fecundidade Total (TFT), via de parto, estado civil e escolaridade das parturientes. Discussão: a menor TFT foi apresentada na faixa etária de 13 a 15 anos (1,05 filhos/mulher) e a maior entre 36 a 49 anos (4,47 filhos/mulher). A via de parto vaginal correspondeu a 64% dos partos, enquanto que a via cirúrgica por cesárea aconteceu em 36% dos casos. Em relação à escolaridade, 3% apresentaram-se como analfabetas; 48% possuíam nível fundamental; 40% nível médio completo e 9% possuíam nível superior completo ou incompleto. Houve 0,5% de omissão da que escolaridade no momento do preenchimento dos dados. Os dados coletados sobre o estado civil foram considerados inconclusivos. Conclusão: Conclui-se que a Taxa de Fecundidade da população estudada está acima da Taxa de Fecundidade Total projetada para 2015 no Brasil nas faixas etárias acima de 19 anos e da taxa de fecundidade ideal para que haja uma reposição da população segundo o DATASUS (2021). Tais dados podem estar relacionados com a vulnerabilidade da comunidade em questão, corroborando com estudos que relatam maiores taxas de fecundidade relacionada a menor renda e menor escolaridade.

Introduction: sexual and reproductive patterns are influenced by biopsychosocial factors. Among these factors, there is vulnerability, a broad and complex concept that requires greater attention from public policies. Objective: to know the reproductive profile of women who live in an area of high vulnerability in the city of Curitiba-PR. Methodology: descriptive, documental, cross-sectional observational analysis. Collection and analysis of data from the Birth Certificates (BC) at the Capanema Health Unit and analysis of public data provided by the IBGE. Results: 1199 BCs were analysed, with 1011 women aged between 13 and 49 years old, between the years 2003 and 2018. It was possible to analyse the Total Fertility Rate (TFR), mode of delivery, marital status and level of education of the parturients. Discussion: the lowest TFR was observed in the age group from 13 to 15 years old (1.05 children/woman) and the highest between 36 to 49 years old (4.47 children/woman). Vaginal delivery corresponded to 64% of deliveries, while surgical caesarean section occurred in 36% of cases. Regarding schooling, 3% were illiterate; 48% had a fundamental level; 40% completed high school and 9% had completed or incomplete higher education. There was 0.5% omission of schooling attainment at the time of filling in the data. Data collected on marital status were considered inconclusive. Conclusion: it is concluded that the Fertility Rate of the studied population is above the Total Fertility Rate projected for 2015 in Brazil in the age groups above 19 years and the ideal fertility rate so that there is a replacement of the population according to DATASUS (2021). Such data may be related to the vulnerability of the community in question, corroborating with studies that report higher fertility rates related to lower income and lower education.

A clínica psicanalítica das urgências subjetivas no hospital universitário: construção de um caso clínico / Psychoanalysis of subjective urgencies at a university hospital: construing a clinical case / La clínica psicoanalítica de urgencias subjetivas en el hospital universitario: construcción de un caso clínico

O hospital constitui-se como um contexto em que a urgência subjetiva pode vir a se apresentar de forma frequente, instaurando, para cada sujeito, uma vivência de angústia. O objetivo desta pesquisa foi investigar as possibilidades para uma clínica das urgências subjetivas no contexto de um hospital universitário em Salvador, considerando as vivências em uma residência multiprofissional. Trata-se de uma pesquisa qualitativa de caráter exploratório, em que se realizou revisão teórica sobre o tema e se construiu um caso clínico, sob orientação psicanalítica. A escolha do caso baseou-se na escuta clínica ao longo dos atendimentos e da atuação em equipe multiprofissional, considerando os impasses ao longo do tratamento. Foram utilizados registros documentais produzidos pela psicóloga residente ao longo dos atendimentos, que ocorreram durante três meses. Os resultados apontam para as contribuições da escuta psicanalítica no tratamento das urgências e na atuação em equipe multiprofissional no contexto hospitalar. A subjetivação da urgência permitiu, no caso em questão, um tratamento pela palavra do que havia incidido diretamente no corpo como fenômeno. Conclui-se pela relevância em discutir o tema da urgência e suscitar novas pesquisas, reintroduzindo no contexto hospitalar a questão sobre a subjetividade.(AU)

Hospitals are contexts in which subjective urgency can frequently materialize, triggering an experience of anguish for each subject. Hence, this research investigates the possibilities of establishing a subjective urgency clinic at a university hospital in Salvador, considering the experiences in a multidisciplinary residence. A qualitative, exploratory research was conducted by means of a theoretical review on the topic and construction of a clinical case, under psychoanalytical advisement. The case was chosen based on clinical listening during the sessions and performance in a multidisciplinary team, considering the obstacles for long-term treatment. Data were collected from documentary records produced by the resident psychologist during three months. Results point to the contributions of psychoanalytic listening to treating subjective urgencies and to the performance of a multidisciplinary team in the hospital context. In the case in question, subjectivation of urgency allowed a treatment through the word of affecting phenomenon. In conclusion, discussing urgency and conducting further research, are fundamental to reintroduce subjectivity in the hospital context.(AU)

El hospital es un contexto en el que frecuentemente se puede percibir una urgencia subjetiva, estableciendo una experiencia de angustia para cada sujeto. El objetivo de esta investigación fue investigar las posibilidades de una clínica de urgencia subjetiva en el contexto de un hospital universitario en Salvador (Brasil), considerando las experiencias en una Residencia Multiprofesional. Se trata de una investigación cualitativa, de carácter exploratorio, en la que se realizó una revisión teórica sobre el tema y construcción de un caso clínico, con orientación psicoanalítica. La elección del caso se basó en la escucha clínica a lo largo de las sesiones y actuación en un equipo multidisciplinar, considerando los impasses para el tratamiento a largo plazo. Se utilizaron registros documentales elaborados por el psicólogo residente, durante las atenciones, que se realizaron durante tres meses. Los resultados apuntan a las contribuciones de la escucha psicoanalítica en el tratamiento de urgencias y en la actuación de un equipo multidisciplinario en el contexto hospitalario. La subjetivación de la urgencia permitió, en el caso en cuestión, un tratamiento a través de la palabra de lo que había afectado directamente al cuerpo como fenómeno. Se concluye que es relevante discutir el tema de la urgencia y plantear nuevas investigaciones, reintroduciendo el tema de la subjetividad en el contexto hospitalario.(AU)

Rasgos de personalidad y psicopatología en adolescentes con adicción a videojuegos / Personality traits and psychopathology in adolescents with videogame addiction

El trastorno por uso de videojuegos se incluyó recientemente en la 11ªedición de la Clasificación Internacional de Enfermedades. Se realizó un estudio transversal en cinco institutos, con una muestra final de 119 alumnos. El 6,4% (n = 23) de los sujetos tenía trastorno por uso de videojuegos. Los adolescentes con trastorno por uso de videojuegos mostraron bajos niveles de consciencia (F = 7,82; p = ,001) y amabilidad (F = 3,31; p = ,041); y puntuaron más alto en inadaptación escolar (SMC; F = 9,230; p < ,001)que los sanos. Obtuvimos dos funciones discriminantes que clasificaban correctamente al 60,5% (Z1 = 0,406 × Sexo + 0,560 × Conciencia - 0,677× SMC; Z2 = 0,915 × Sexo + 0,191 × Conciencia + 0,326 × SMC). Los sujetos con adicción se diferenciaban de los sanos en presentar inadaptación escolar y baja conciencia, mientras que ambos grupos con adicción se diferenciaban en que los alumnos con adicción a videojuegos eran en mayor proporción varones. La probabilidad de trastorno por uso de videojuegos aumentaba si el sujeto era varón (OR [CI 95%] = 4,82 (1,17-19,81); p =,029) con inadaptación escolar (OR [IC 95%] = 1,08 (1-1,17); p = ,047);mientras que el trastorno por uso de sustancias aumentaba si el sujeto presentaba neuroticismo (OR [IC 95%] =1,07 [1-1,14]; p < ,040), desajuste clínico (OR [IC 95%] = 1,10 [1,01-1,20]; p = ,020), inadaptación escolar(OR [IC 95%] = 1,06 [1-1,13]; p = ,048), bajo ajuste personal (OR [IC95%] = 0,94 [0,88-0,99]; p = ,047) y síntomas emocionales (OR [IC 95%]= 0,86 [0,78-0,96]; p = ,006). (AU)

Gaming disorder (GD) was recently included in the 11th edition of theInternational Classification of Diseases. A cross-sectional study was conducted in five secondary schools, with a final sample of 119 students. A diagnosis of GD was made in 6.4% (n = 23) of this sample. Compared with healthy subjects, adolescents with GD showed low levels of conscientiousness(F = 7.82; p = .001) and agreeableness (F = 3.31; p = .041) and scored higherin school maladjustment (SMC; F = 9.23; p < .001). Two discriminating functions were obtained that allowed us to predict patient group allocation with a success rate of 60.5% (Z1 = 0.406 × Sex + 0.560 × Conscientiousness− 0.677 × SMC; Z2 = 0.915 × Sex + 0.191 × Conscientiousness + 0.326 ×SMC). Subjects with addiction differed from healthy subjects in presenting school maladjustment and low consciousness, while both groups of subjectswith addiction differed in that video game addiction was proportionally higher in boys. The probability of GD was higher if subjects were male (OR[95% CI]) = 4.82 [1.17-19.81]; p = .029) and had school maladjustment(OR [95% CI] = 1.08 [1-1.17]; p = .047); while that of substance use disorder was higher if the subjects had neuroticism (OR [95% CI] = 1.07[1-1.14]; p < .040), clinical maladjustment (OR [95% CI] = 1.10 [1.01-1.20]; p = .020), school maladjustment (OR [95% CI] = 1.06 [1-1.13]; p =.048), low personal adjustment (OR [95% CI] = 0.94 [0.88-0.99]; p = .047)and emotional symptoms (OR [95% CI] = 0.86 [0.78-0.96]; p = .006). (AU)

Impacto da meningite entre os anos de 2010 e 2020 no Brasil: um estudo documental / Impact of meningitis between the years 2010 and 2020 in Brazil: a documentary study

Introdução: a meningite é uma infecção que afeta as membranas as quais revestem o encéfalo e a medula espinhal, sendo incluída na Lista Nacional de Doenças de Notificação Compulsória. Objetivo: investigar o perfil epidemiológico de acometidos por meningite no Brasil, entre os anos de 2010 a 2020. Metodologia: trata-se de um estudo epidemiológico, retrospectivo, analítico e documental, pelo qual as informações acerca dos casos confirmados no Brasil foram extraídas através do Departamento de Informática do Sistema Único de Saúde (DATASUS). Para análise estatística foi utilizado o software Statistical Package for Social Sciences (versão 20.0). Resultados: no período analisado, foram notificados 187.508 casos de meningite, sendo 2012 o ano com maior número de casos (11,6%). A região que apresentou o maior número de mortes foi sudeste (54,2%), possuindo São Paulo como o estado de maior número de notificações (41%). O perfil foi composto, predominantemente, por indivíduos do gênero masculino (59,1%), com faixa etária entre ≤1 a 9 anos (47%) e etiologia viral (45,5%). O método quimiocitológico foi o mais utilizado (60,9%), o qual os enfermos evoluíam a alta (75,8%). Além disso, a meningite bacteriana apresentou a maior taxa de mortalidade (1,8/100.000 habitantes), enquanto a meningococcemia a maior taxa de letalidade (36,7%). Houve associação estatística positiva entre as variáveis: número de óbitos e faixa etária, número de óbitos e gênero e, número de óbitos e etiologia. Conclusão: é essencial a adoção de políticas públicas com escopo às populações de risco, sendo esse estudo, profícuo na construção de tais projetos.

Introduction: meningitis is an infection that affects the membranes that line the brain and spinal cord, being included in the National List of Compulsory Reporting Diseases. Objective: to investigate the epidemiological profile of people affected by meningitis in Brazil, between the years 2010 to 2020. Methodology: this is an epidemiological, retrospective, analytical and documentary study, through which information about confirmed cases in Brazil were extracted through the Department of Informatics of the Unified Health System (DATASUS). For statistical analysis, the Statistical Package for Social Sciences software (version 20.0) was used. Results: in the period analyzed, 187,508 cases of meningitis were reported, with 2012 being the year with the highest number of cases (11.6%). The region with the highest number of deaths was the Southeast (54.2%), with São Paulo as the state with the highest number of notifications (41%). The profile was predominantly composed of male individuals (59.1%), aged between ≤1 to 9 years (47%) and viral etiology (45.5%). The chemocytological method was the most used (60.9%), in which patients progressed to discharge (75.8%). In addition, bacterial meningitis had the highest mortality rate (1.8/100,000 population), while meningococcemia had the highest fatality rate (36.7%). There was a positive statistical association between the variables: number of deaths and age group, number of deaths and gender and number of deaths and etiology. Conclusion: it is essential to adopt public policies aimed at populations at risk, and this study is useful in the construction of such projects.

Avaliação dos óbitos por COVID-19 em médicos no Brasil / Evaluation of deaths by COVID-19 in doctors in Brazil

Introdução: a pandemia da doença do coronavírus 2019 (COVID-19) afetou a população mundial, especialmente os profissionais que atuam na linha de frente, como os médicos. Objetivo: avaliar os óbitos na população médica brasileira pela COVID-19. Metodologia: trata-se de um estudo ecológico e analítico sobre os óbitos por COVID-19 em médicos, no Brasil. Realizou-se análise descritiva e utilizaram-se os testes Qui-quadrado e Qui-quadrado de Pearson com simulações de Monte-Carlo (p˂0,05). A análise espacial foi realizada mediante mapa de densidade de Kernel. Resultados: foram incluídos 938 óbitos, e predominaram vítimas do sexo masculino (86,57%) com idade média de 66,24 anos. A taxa de mortalidade por COVID-19 variou de 82,2 óbitos por 100 mil médicos no sudeste a 739,2 no norte do Brasil. O maior número de óbitos foi apresentado na clínica médica (29,85%), que também obteve a maior taxa de mortalidade de 655,3. Observou-se diferença significativa entre os anos 2020 e 2021 para a faixa etária, com maior frequência nos grupos com mais de 60 anos (p=0,005) e para as áreas de atuação médica, com maior prevalência para a clínica médica (p=0,018). No ano de 2020, os estados brasileiros que apresentaram maiores taxas de mortalidades estão localizados, na sua maioria, nas regiões Norte e Nordeste. Conclusão: devem ser consideradas as diferentes situações que aumentam a vulnerabilidade dos médicos aos riscos de contrair a COVID-19; com isso ações de promoção, proteção e assistência à saúde devem ser aprimoradas, principalmente aos profissionais que estão na linha de frente, visando o preparo para pandemias.

Introduction: the pandemic coronavirus disease 2019 (COVID-19) has affected the world population, especially professionals who are working on the front lines, like the doctors. Objective: evaluate deaths in the Brazilian medical population using COVID-19. Methods: this is a study ecological and analytical on deaths in doctors due to COVID-19, in Brazil. Descriptive analysis was performed, and Pearson's chi-square and chi-square tests were used with Monte-Carlo simulations (p˂0.05). Spatial analysis was performed using density map a Kernel. Results: were included 938 deaths, predominantly male victims (86.57%) with a mean age of 66.24 years. The mortality rate due to COVID-19 ranged from 82.2 deaths per 100,000 doctors in the Southeast to 739.2 in the North of Brazil. The highest number of deaths was presented in the Medical Clinic (29.85%), which also had the highest mortality rate of 655.3. There was a significant difference between the years 2020 and 2021 for the age group, with greater frequency in groups over 60 years old (p=0.005) and for the areas of medical practice, with higher prevalence for Internal Medicine (p=0.018). The Brazilian states had the highest mortality rates in 2020 and were mostly from the North and Northeast regions. Conclusion: the different situations that increase the vulnerability of physicians to the risks of contracting COVID-19 must be considered. Therefore, actions for health promotion, protection and assistance must be improved, with these professionals who are on the front line, aiming to prepare for pandemics.

Análise descritiva da mini avaliação nutricional em idosos da universidade aberta à terceira idade ­ UATI / Descriptive analysis of the mini nutritional assessment in the elderly at the open university for the third age ­ UATI

Introdução: o envelhecimento populacional é um fenômeno universal devido ao processo de transição demográfica característico de diversos países. Nesse processo, observam-se alterações fisiológicas e nutricionais nos indivíduos, acompanhadas do declínio das atividades funcionais cotidianas. A Mini Avaliação Nutricional foi desenvolvida para detectar a desnutrição ou o risco nutricional. Trata ­ se de uma ferramenta simples, de fácil aplicação, efetiva e validada, para utilização em pacientes idosos. Objetivo: avaliar o estado nutricional através da aplicação da Mini Avaliação Nutricional (MAN) e fatores associados em idosos frequentadores da Universidade Aberta à Terceira Idade (UATI), situada em Salvador, Bahia. Metodologia: trata-se de um estudo observacional, analítico e de corte transversal, em que foram avaliados 52 idosos a partir de 60 anos, de ambos os sexos, admitidos entre os meses de fevereiro e junho de 2021. Na avaliação do estado nutricional, utilizou ­ se a MAN e, para a análise estatística, foi aplicado o programa Statistical Package for Social Science 20.0. A amostra foi categorizada em três grupos: adequado, risco de desnutrição e desnutrição. Utilizou-se o teste de qui quadrado, considerando p<0,05. Conclusão: os Resultados encontrados neste estudo mostram que há prevalência e um elevado risco de desnutrição nos pacientes idosos da UATI. Os grupos estudados se caracterizam por maior frequência do sexo feminino, faixa etária entre 60 e 69 anos, sem ocupação e com hipossuficiência financeira. A aplicação desse método de avaliação nutricional em idosos é de baixo custo e de fácil reprodutividade e tem demonstrado eficácia no rastreio da desnutrição de forma precoce, proporcionando intervenções nutricionais mais rápidas e efetivas, especialmente no contexto da saúde pública.

Introduction: population aging is a universal phenomenon due to the demographic transition process characteristic of several countries. In this process, physiological and nutritional changes are observed in individuals, accompanied by a decline in daily functional activities. The mini nutritional assessment was developed to detect malnutrition or nutritional risk. It is a simple, easy-to-apply, effective and validated tool for use in elderly patients. Objective: to evaluate the nutritional status through the application of the mini nutritional assessment (man) and associated factors in elderly people attending the universidade aberta à terceira idade (uati) [open university for the third age ­ elderly], located in salvador, bahia. Methods: this is an observational, analytical and cross-sectional study, in which 52 elderly people aged 60 years and over, of both sexes, admitted between february and june 2021, were evaluated. In the assessment of nutritional status, man was used and, for statistical analysis, the statistical package for social science 20.0 program was applied. The sample was categorized into three groups: adequate, risk of undernutrition and malnutrition. The chi-square test was used, considering p<0.05. Conclusion: the Results found in this study show that there is a prevalence and a high risk of malnutrition in elderly patients at the uati. The groups studied are characterized by a higher frequency of females, aged between 60 and 69 years, without occupation and with financial deficiency. The application of this method of nutritional assessment in the elderly is low-cost and easily reproducible and has been shown to be effective in screening for malnutrition at an early stage, providing faster and more effective nutritional interventions, especially in the context of public health.

Método para establecer la reserva funcional de la velocidad de marcha en una muestra de adultas mayores autosuficientes chilenas: la relevancia del estímulo / Method to establish the functional reserve of gait speed in a sample of self-reliant older Chilean women: The relevance of the stimulus

Antecedentes y objetivo: El envejecimiento como proceso complejo y multifactorial involucra cambios multisistémicos asociados al rendimiento físico con pérdida de funcionalidad, tal como la velocidad de marcha y su reserva. El estudio estableció el método que mejor evidencia la reserva funcional de velocidad de marcha (RFVM) según la incorporación de estímulos en mujeres adultas mayores (AM). Material y método: Estudio observacional analítico con muestra conformada por 30AM de entre 65-69años, autosuficientes sin riesgo, normopeso y sin sospecha de depresión, controladas en Centro Comunitario de Salud Familiar y Centro de Salud Familiar de Talca. La velocidad de marcha (VM) fue medida a través de tres métodos: M1 (marcha habitual), M2 (marcha máxima) y M3 (marcha máxima con estímulos), para posteriormente calcular la RFVM en las AM. El ejercicio se ejecutó en una pista de 10m que incluía 2m de aceleración, 2m de desaceleración y 6m centrales para medir el tiempo en segundos que demoraba en recorrerlos. Resultados: Las medias de velocidades de la muestra en los métodos habitual, máxima y máxima con estímulo fueron de 1,17, 1,38 y 1,57m/s, respectivamente; las reservas funcionales (RF) resultantes entre las diferencias de los métodos fueron: RF-A (M2−M1) 0,26m/s; RF-B (M3−M1) 0,45m/s y RF-C (M2−M3) 0,19m/s; para la mayoría de los casos y según orden correspondiente, las diferencias estadísticas fueron significativas. Conclusión: El método que mejor evidenció la RFVM fue a través de las diferencias de medias entre M3 y M1, siendo una forma objetiva de verificar esta dimensión del movimiento humano como expresión de funcionalidad de las AM. (AU)

Background and objective: Aging as a complex and multifactorial process involves multisystemic changes associated with physical performance with loss of functionality such as walking speed and reserve. The study established the method that best evidences the functional reserve (FR) of walking speed (FRWS) according to the incorporation of stimuli in older adults (OAs). Material and method: Analytical observational study with a sample made up of 30OAs between 65 and 69years, self-administered without risk, normal weight and without suspicion of depression, controlled in Centro Comunitario de Salud Familiar and Centro de Salud Familiar of Talca. The walking speed (WS) was measured by three methods: M1 (usual gait), M2 (maximum gait) and M3 (maximum gait with stimuli); to later calculate the FRWS in the AO, executed on a 10m track that included 2m acceleration, 2m deceleration and 6m centrals to measure the time in seconds it took to travel them. Results: The mean velocities of the sample in the usual, maximum and maximum stimulated methods were 1.17, 1.38 and 1.57m/s respectively; the resulting FRs between the method differences: FR-A (M2−M1) 0.26m/s; FR-B (M3−M1) 0.45m/s and FR-C (M2−M3) 0.19m/s, for most of the cases and according to the corresponding order, the statistical differences were significant. Conclusion: The method that best evidenced the FRWS was through the differences in means between M3 and M1, being an objective way to verify this dimension of human movement as an expression of OA functionality. (AU)

Validation of three analytical methods for quantification of acetaminophen by UV spectrophotometry

Introduction: Acetaminophen is a non-steroidal analgesic and antipyretic, whose mechanism is based on the inhibition of the cyclooxygenase enzyme responsible for the appearance of pain and inflammation. In Mexico, it is one of the drugs widely used for its effectiveness, which is why the objective of this study was to implement a method of chemical validation by ultraviolet spectrophotometry that allows the quantification of this active principle. Method: We worked with 4 dissolution media (HCl: 0.1N MeOH, 0.1M HCl, Methanol: Water in a ratio of 15:85 p / v and 0.2M phosphate buffer). All four media underwent analytical validation, measuring linear regression significance, precision, sample stability, and sensitivity. Results:The 0.1M HCl, MeOH: H2O (15:85 v / v) and Phosphate Buffer media comply with the significance of the intercept, linearity of the method, as well as the parameters of precision, stability, and with the limits of detection (DL) and the limit of quantification (QL). Discarding the HCl: 0.1N MeOH medium for not meeting the linearity parameters. Conclusions: Of the fourth means evaluated, three of them (0.1M HCl, Methanol: water, and phosphate buffer) can be used as alternatives in the quantification of this drug (AU)

Introducción: El acetaminofén es un analgésico y antipirético no esteroideo, cuyo mecanismo se basa en la inhibición de la enzima ciclooxigenasa responsable de la aparición de dolor e inflamación. En México es uno de los fármacos ampliamente usados por su efectividad, es por ello, el objetivo de este estudio fue implementar un método de validación química por espectrofotometría ultravioleta que permita la cuantificación de este principio activo. Método: Se trabajó con 4 medios de disolución (HCl:MetOH 0,1N, HCl 0,1M, Metanol: Agua en proporción 15:85 p/v y solución amortiguadora de fosfatos 0,2M). Los cuatro medios se sometieron a una validación analítica, midiendo Significancia de la regresión lineal, precisión, estabilidad de la muestra y sensibilidad.Resultados:Los medios HCl 0,1M, MetOH:H2O (15:85 v/v) y Buffer de fosfatos cumplen con la significancia del intercepto, linealidad del método, así como los parámetros de precisión, estabilidad y con los límites de detección (DL) y el límite de cuantificación (QL). Descartando el medio de HCl: MetOH 0,1N por no cumplir con los parámetros de linealidad. Conclusiones: De los cuatro medios evaluados tres de ellos (HCl 0,1M, Metanol: agua y amortiguador de fosfatos) se pueden usar como alternativas en la cuantificación de este fármaco (AU)

Alcances de la aleatorización mendeliana para el control de confusores no observables en epidemiología / Scope of Mendelian randomization to control for unobserved confounding in epidemiology

La aleatorización mendeliana es un método epidemiológico propuesto para controlar las asociaciones espurias en los estudios observacionales. Estas asociaciones suelen estar causadas por la confusión derivada de factores sociales, ambientales y de comportamiento, que pueden ser difíciles de medir. La aleatorización mendeliana se basa en la selección de variantes genéticas que se utilizan como variables instrumentales, y que influyen en los patrones de exposición o están asociadas con un fenotipo intermedio de la enfermedad. El presente trabajo pretende discutir cómo seleccionar las variantes genéticas adecuadas como variables instrumentales y presentar las potenciales herramientas metodológicas para lidiar con las limitaciones propias de este método epidemiológico. El uso de variables instrumentales para exposiciones modificables tiene el potencial de atenuar los efectos de limitaciones comunes, como la confusión, cuando se eligen variantes genéticas robustas como variables instrumentales. (AU)

The Mendelian randomization is an epidemiologic method proposed to control for spurious associations in observational studies. These associations are commonly caused by confusion derived from social, environmental, and behavioral factors, which can be difficult to measure. Mendelian randomization is based on the selection of genetic variants that are used as instrumental variables that influence exposure patterns or are associated with an intermediate phenotype of the disease. The present work aims to discuss how to select the appropriate genetic variants as instrumental variables and to present methodological tools to deal with the limitations of this epidemiological method. The use of instrumental variables for modifiable exposures has the potential to mitigate the effects of common limitations, such as confusion, when robust genetic variants are chosen as instrumental variables. (AU)

Estudio metamétodo de la investigación cualitativa sobre las estrategiasde regulación emocional / A metamethod study of qualitative research on emotion regulation strategies

Los estudios metamétodo describen procedimientos y examinan si los análisis empleados son los adecuados para unámbito de investigación, que en este caso es la regulación emocional cuya relevancia psicológica ha aumentado enlos últimos años. El objetivo de este trabajo es el análisis metamétodo de las investigaciones cualitativas sobre lasestrategias de regulación emocional. El análisis se realizó a partir de la lectura de resúmenes y de textos completospartiendo de 317 publicaciones. Al aplicar los criterios de inclusión, la muestra final contó con 25 estudios. Sehalló coherencia entre los métodos de análisis y el foco de los estudios. La entrevista semiestructurada fue elprocedimiento común para la recogida de datos y el análisis temático el método más utilizado. El consenso entreinvestigadores fue el control de calidad habitual. Para avalar la integridad metodológica se recomienda a losinvestigadores cualitativos proporcionar más información sobre los procedimientos y enfoques.(AU)

Metamethod studies describe procedures and examine whether the analyses used are appropriate for an area ofresearch, in this case emotion regulation, which has increased in relevance within the field of psychology in recentyears. The objective of this study is to carry out a metamethod analysis of qualitative research on emotion regulationstrategies. The analysis was based on the reading of abstracts and full texts from 317 publications. When theinclusion criteria were applied, the final sample consisted of 25 studies. Findings indicated consistency between themethods of analysis employed and the focus of the studies. The semi-structured interview was the most commonprocedure for data collection and thematic analysis the most used method. Consensus among the investigatorswas the most widespread quality control. To support methodological integrity, it is recommended that qualitativeresearchers provide more information on procedures and approaches.(AU)

¿Cómo vivieron las personas con discapacidad la crisis de la covid-19? El caso de las personas apoyadas por entidades tutelares en España / How Did People with Disabilities Experience the COVID-19 Crisis? Situation of People Supportedby Guardianship Organizations in Spain

Las personas con discapacidad intelectual y del desarrollo (DID) apoyadas por entidades tutelares constituyen un grupo singular dentro de la población con DID. De ahí que la Asociación Española de Fundaciones Tutelares (AEFT) se haya propuesto conocer su experiencia durante la pandemia de la COVID-19, especialmente durante el confinamiento. Se ha llevado a cabo un estudio observacional, transversal, descriptivo y analítico mediante la aplicación de un cuestionario ad hoc en el que han participado 380 personas apoyadas por entidades asociadas a la AEFT. Los resultados indican que el 9 %tuvo un diagnóstico positivo por prueba PCR, el 24 % estuvo completamente aislado, un 16 % experimentó alteraciones de conducta y un 12 % de salud mental. Asimismo, se constató la clara desventaja de quienes viven en centros residenciales con puntuaciones globales dos puntos por debajo de quienes viven de manera independiente. Analizado por factores, en una comparación de personas que viven en residencias frente a aquellos que viven independientemente, se encontraron diferencias significativas. Estas tuvieron un impacto negativo en lo relativo a la información, la comunicación y contacto y, sobre todo, en la vida en comunidad para aquellas personas viviendo en centros residenciales. El estudio muestra, sin embargo, un efecto positivo en salud a favor de las residencias. Con todo, se concluye que es necesario seguir promoviendo la autonomía de las personas y la transición hacia un modelo habitacional más inclusivo que procure el pleno disfrute del artículo 19 de la Convención. (AU)

People with intellectual and developmental disabilities (IDD) support-ed by guardianship organizations are a unique group within the IDD population. For this reason, the Spanish Association of Guardianship Foundations (AEFT) aim to find out about their experience during the COVID-19 pandemic, especially during lock-down. An observational, cross-sectional, descriptive and analytical study was carried out through the application of an ad hoc questionnaire in which 380 people supported by entities associated with the AEFT participated. The results indicate that 9 % had a positive diagnosis by PCR test, 24 % were completely isolated, 16 % experienced be-havioral alterations and 12 % mental health problems. There was also a clear disadvan-tage for those living in residential care homes scoring overall two points lower compared to those living independently. Significant differences were found when breaking down by factors after a statistical comparison of subjects living in residential care home vs independent homes. These differences had a negative impact in information, commu-nication and contact and, above all, community living for people living in residentialcare homes. On the contrary the effect on health was positive in favour of the residential carehomes. Overall, it is concluded the need to continue promoting people’s autonomy and the transition towards a more inclusive housing model that seeks the full enjoyment of article 19 of the Convention. (AU)