Artificial intelligence, applications and challenges in simulation-based education

The rapid advancement of Artificial Intelligence (AI) has taken the world by "surprise" due to the lack of regulation over this technological innovation which, while promising application opportunities in different fields of knowledge, including education, simultaneously generates concern, rejection and even fear. In the field of Health Sciences Education, clinical simulation has transformed educational practice; however, its formal insertion is still heterogeneous, and we are now facing a new technological revolution where AI has the potential to transform the way we conceive its application.

El rápido avance de la inteligencia artificial (IA) ha tomado al mundo por "sorpresa" debido a la falta de regulación sobre esta innovación tecnológica, que si bien promete oportunidades de aplicación en diferentes campos del conocimiento, incluido el educativo, también genera preocupación e incluso miedo y rechazo. En el campo de la Educación en Ciencias de la Salud la Simulación Clínica ha transformado la práctica educativa; sin embargo, aún es heterogénea su inserción formal, y ahora nos enfrentamos a una nueva revolución tecnológica, en la que las IA tienen el potencial de transformar la manera en que concebimos su aplicación.

Gasto de bolsillo en salud en la familia con diabetes-hipertensión durante la pandemia del covid-19 / Out-of-pocket health spending in the family with diabetes-hypertension during the covid-19 pandemic

Determinar el gasto de bolsillo en salud en las familias con diabetes mellitus y/o hipertensión arterial y el porcentaje del ingreso familiar durante la pandemia del Covid-19. Estudio de gasto de bolsillo en salud que incluyó muestreo consecutivo de 268 familias de México. El ingreso trimestral familiar se definió como la suma de ingresos de cada uno de los integrantes de la familia, el gasto en salud se definió como el total de erogaciones que tuvo la familia para cubrir los diferentes servicios de salud, y porcentaje de gasto en salud se definió como la relación del gasto total trimestral y el gasto corriente del hogar, valores expresados en pesos mexicanos. El promedio trimestral del gasto de bolsillo en salud en la familia con diabetes mellitus y/o hipertensión arterial en la dimensión consulta fue $975,82 y en la dimensión medicamentos $1,371.22; el gasto promedio total trimestral fue $3,133.08. El ingreso trimestral de la familia después de la pandemia del covid-19 fue $85,348.86 lo que representa 5,93% menos del ingreso trimestral antes de la pandemia. El gasto trimestral en salud fue $3,133.08, lo cual corresponde a 3,45% y 3,67% del ingreso trimestral familiar antes y después de la pandemia del Covid-19 respectivamente (AU)

Determine out-of-pocket health spending in families with diabetes mellitus and/or high blood pressure and the percentage of family income during the Covid-19 pandemic. Study of out-of-pocket health spending that included consecutive sampling of 268 families in Mexico. The quarterly family income was defined as the sum of income of each of the family members, health spending was defined as the total expenses that the family had to cover the different health services, and percentage of health spending. It was defined as the relationship between total quarterly expenditure and current household expenditure, values expressed in Mexican pesos. The quarterly average of out-of-pocket health expenditure in the family with diabetes mellitus and/or arterial hypertension in the consultation dimension was $975.82 and in the medication dimension $1,371.22; The average total quarterly expense was $3,133.08. The family's quarterly income after the covid-19 pandemic was $85,348.86, which represents 5.93% less than the quarterly income before the pandemic. The quarterly health expenditure was $3,133.08, which corresponds to 3.45% and 3.67% of the family's quarterly income before and after the Covid-19 pandemic respectively (AU)

Autorías en manuscritos científicos de terapia ocupacional: un estudio descriptivo / Autoria em manuscritos científicos de terapia ocupacional: um estudo descritivo / Authorship in scientific manuscripts in occupational therapy: a descriptive study

Resumen Introducción Los beneficios de la autoría múltiple son indudables, pero en ocasiones el número de autores es desproporcionadamente mayor que el contenido intelectual. Objetivo Conocer la autoría media en el ámbito terapia ocupacional y valorar sus posibles determinantes. Método Se incluyeron 19 revistas de la disciplina. Seleccionamos artículos de investigación y revisiones sistemáticas. Resultados Encontramos una media de 3,5 autores, con un aumento de 0,9 (R2=0,86) de 2011 a 2020. El número de autorías múltiples es mayor que de autorías individuales. Los tres posibles determinantes del aumento de la autoría parecen ser: (a) la visibilidad (las revistas open access/charge aumentan el número de autorías en 40,2%); (b) el factor de impacto (las revistas JCR [Journal Citation Report] aumentan en 15,7% frente a los otros); y (c) los cuartiles (las revistas ESCI [Emerging Sources Citation Index] aparecen en el panorama de las publicaciones y las SSCI/SCI [Social Science Citation Index/ Science Citation Index]experimentan su mayor subida de 10.5% en los Q1 [Primero Cuartil]). Conclusión Este estudio aporta por primera vez una información completa y contrastada, donde se muestra la autoría media de los artículos de terapia ocupacional y los determinantes que influyen.

Resumo Introdução Os benefícios da autoria múltipla são indiscutíveis, mas às vezes o número de autores é desproporcionalmente maior que o conteúdo intelectual. Objetivo Conhecer a média de autoria no campo da terapia ocupacional e avaliar seus possíveis determinantes. Método Foram incluídos 19 periódicos da área. Selecionamos artigos de pesquisa e revisões sistemáticas. Resultados Encontramos uma média de 3,5 autores com aumento de 0,9 (R2=0,86) de 2011 a 2020. O número de autorias múltiplas é maior que o de autorias individuais. Os três possíveis determinantes do aumento da autoria parecem ser a: (a) visibilidade (os periódicos de acesso aberto/cobrança aumentam o número de autorias em 40,2%); (b) o fator de impacto (os periódicos JCR [Journal Citation Report] aumentam 15,7% em relação ao demais) e (c) os quartis, //periódicos ESCI [Emerging Sources Citation Index] aparecem no cenário editorial e SSCI/SCI [Social Science Citation Index/ Science Citation Index]experimentam seu maior aumento de 10,5% no primeiro quartil [Q1]). Conclusão Este estudo fornece pela primeira vez informações confiáveis ​​e contrastadas, mostrando a autoria média de artigos de terapia ocupacional e os determinantes que a influenciam.

Abstract Introduction The benefits of multiple authorship are undoubted, but sometimes the number of authors is disproportionately greater than the intellectual content. Objective To know the average authorship in the occupational therapy field and assess its possible determinants. Method 19 journals of the discipline were included. We select research articles and systematic reviews. Results We found an average of 3.5 authors, with an increase of 0.9 (R2=0.86) from 2011 to 2020. The number of multiple authorships is greater than individual authorships. The three possible determinants of the increase in authorship seem to be: (a) visibility (open access/charge journals increase the number of authorships by 40.2%); (b) the impact factor (JCR [Journal Citation Report] journals increase by 15.7% compared to others) and (c) quartiles (ESCI Emerging Sources Citation Index] journals appear in the publishing landscape and SSCI/SCI [Social Science Citation Index/ Science Citation Index]experience their biggest rise of 10.5% in Q1 [First Quartile]). Conclusion This study provides complete and contrasted information for the first time, showing the average authorship of occupational therapy articles and the determinants that influence it.

La educación interprofesional en el desarrollo de la identidad profesional en terapia ocupacional: una revisión de alcance / A educação interprofissional no desenvolvimento da identidade profissional em terapia ocupacional: uma revisão de escopo / Interprofessional education in the development of professional identity in occupational therapy: a scoping review

Resumen Objetivo analizar el desarrollo histórico, la naturaleza y el volumen de la literatura científica de la Investigación sobre Educación Interprofesional en terapia ocupacional, así como los tipos de intervenciones que se desarrollan. Método Se utilizó un scoping review con un marco metodológico de cuatro etapas para capturar la evidencia que describe cómo las Investigación sobre Educación Interprofesional y la identidad profesional ha sido conceptualizada e integradas en la terapia ocupacional. Las bases de datos incluidas fueron MEDLINE, EMBASE, PubMed, Pubmed Central, ERIC, PsychInfo, Cinahl, Ciberindex, Dialnet, Scopus, Web of Science, Cochrane y Scielo. Como criterios de inclusión los artículos debían describir conceptos relacionados con la terapia ocupacional y otras disciplinas, identidad profesional y la educación interprofesional en estudiantes y/o profesionales. Del listado final se analizaron las variables: información demográfica, objetivo/propósito del estudio, detalles metodológicos, tipos de intervenciones realizadas y resultados/hallazgos principales. Resultados 18 artículos cumplieron los criterios y 16 se tuvieron en cuenta para la síntesis cualitativa. Predomina la investigación universitaria (92,3%). El 75% de la muestra de las investigaciones se concentra en estudiantes. La investigación mixta representa el 50% del estudio. Las intervenciones más numerosas en Investigación sobre Educación Interprofesional son prácticas en el aula (62,5%) frente a prácticas de campo (37,5%). Conclusión este estudio muestra la fortaleza de las prácticas ligadas a la educación interprofesional y su vínculo para desarrollar la identidad profesional. La formación de colaboración interprofesional en comparación con la educación clínica tradicional, aumenta la identidad profesional a través de la autoeficacia percibida de los estudiantes.

Resumo Objetivo analisar o desenvolvimento histórico, a natureza e o volume da produção científica sobre pesquisa em educação interprofissional em terapia ocupacional, bem como os tipos de intervenções que são desenvolvidas. Método Uma revisão de escopo com uma estrutura metodológica de quatro estágios foi usada para capturar evidências que descrevem como a pesquisa em educação interprofissional e a identidade profissional foram conceituadas e integradas à terapia ocupacional. As bases de dados incluídas foram MEDLINE, EMBASE, PubMed, Pubmed Central, ERIC, PsychInfo, Cinahl, Ciberindex, Dialnet, Scopus, Web of Science, Cochrane e Scielo. Como critérios de inclusão, os artigos deveriam descrever conceitos relacionados à terapia ocupacional e outras disciplinas, identidade profissional e educação interprofissional em estudantes e/ou profissionais. Da lista final, foram analisadas as variáveis: informações demográficas, objetivo/finalidade do estudo, detalhes metodológicos, tipos de intervenções realizadas e principais resultados/achados. Resultados 18 artigos atenderam aos critérios e 16 foram considerados para a síntese qualitativa. Predomina a pesquisa universitária (92,3%). 75% da amostra da pesquisa se concentra nos alunos. A pesquisa mista representa 50% do estudo. As intervenções mais numerosas na Pesquisa em Educação Interprofissional são as práticas de sala de aula (62,5%) em oposição às práticas de campo (37,5%). Conclusão este estudo mostra a força das práticas vinculadas à educação interprofissional e seu vínculo com o desenvolvimento da identidade profissional. O treinamento interprofissional colaborativo, em comparação com a educação clínica tradicional, aumenta a identidade profissional por meio da autoeficácia percebida pelos alunos.

Abstract Objective To analyze the historical development, nature, and volume of scientific literature on Interprofessional Education Research in occupational therapy, as well as the types of interventions carried out. Method A scoping review was used with a four-stage methodological framework to capture evidence describing how Interprofessional Education Research and professional identity has been conceptualized and integrated into occupational therapy. The databases included were MEDLINE, EMBASE, PubMed, Pubmed Central, ERIC, PsychInfo, Cinahl, Ciberindex, Dialnet, Scopus, Web of Science, Cochrane, and Scielo. As inclusion criteria, articles had to describe concepts related to occupational therapy and other disciplines, professional identity, and interprofessional education in students and/or professionals. From the final list, the following variables were analyzed: demographic information, study objective/purpose, methodological details, types of interventions carried out, and main results/findings. Results 18 articles met the criteria and 16 were considered for qualitative synthesis. University research predominated (92.3%). 75% of the research sample focuses on students. Mixed research represents 50% of the study. The most numerous interventions in Interprofessional Education Research are in-class practices (62.5%) versus field practices (37.5%). Conclusion This study shows the strength of practices linked to interprofessional education and their link to developing professional identity. Interprofessional collaboration training compared to traditional clinical education increases professional identity through perceived self-efficacy of students.

Desarrollo y aplicación de un protocolo de evaluación de los movimientos generales de Prechtl en lactantes. De la teoría a la práctica / Development and application of a protocol for the evaluation of Prechtl's general movements "from theory to practice"

Introducción. Las guías internacionales plantean que la evaluación de los movimientos generales en los recién nacidos puede ser una herramienta altamente predictiva para el diagnóstico temprano de la parálisis cerebral. Su uso en países en desarrollo como Colombia es limitado, por ello el diseño de un protocolo de evaluación de los movimientos generales permitiría optimizar el acceso de poblaciones de riesgo a esta herramienta. Objetivos. Desarrollar un protocolo de evaluación de los movimientos generales y los desenlaces en el desarrollo de los niños con riesgo de parálisis cerebral después de los 14 meses y evaluar su aplicabilidad en niños con dificultades de acceso a los servicios de salud. Métodos. El protocolo se planteó con un esquema de valoración de cuatro etapas. Según la edad al momento de ingreso al programa, se realizaron ajustes para la valoración, el análisis y el seguimiento de los pacientes. Los videos, que fueron grabados según las recomendaciones publicadas en la literatura médica relacionada con la metodología utilizada, fueron evaluados por profesionales certificados. Resultados. Se reporta el protocolo sugerido para la evaluación cualitativa y semicuantitativa de los movimientos generales y se presentan los resultados de su aplicación en 11 niños incluidos en la prueba piloto. Este protocolo, que fue diseñado con base en una revisión de la literatura y la experiencia de dos de los investigadores, incluye información para grabar los videos, realizar la evaluación médica, aplicar la evaluación cualitativa de Prechtl de los movimientos generales del recién nacido y el examen neurológico infantil Hammersmith. Conclusión. La evaluación de los movimientos generales constituye una herramienta valiosa para la valoración del riesgo de parálisis cerebral en lactantes. La utilización de un protocolo garantiza una evaluación seriada y sistemática, por lo que es conveniente implementar su uso en centros de atención primaria y mejorar la accesibilidad a estas herramientas.

Introduction. International guidelines set up that the evaluation of the general movements in newborns could be a highly predictive tool for the early diagnosis of cerebral palsy. Their use in developing countries such as Colombia is limited; thus, the design of a protocol for the evaluation of general movements would allow to optimize the access of at-risk populations to this tool. Objectives. To develop a protocol for the evaluation of the general movements and outcomes in the development of the children at risk of presenting cerebral palsy after 14 months of age and assess its applicability in children with difficult access to healthcare services. Methods. The protocol was raised using a four-stage evaluation scheme. According to the age at the time of entry into the program, adjustments were made for the assessment, analysis and follow-up of the patients. The videos, which were recorded according to the recommendations published in the medical literature related to the methodology used, were evaluated by certified professionals. Results. The suggested protocol for the qualitative and semiquantitative evaluation of the general movements is reported and the results of its application in 11 children included in the pilot test are presented. This protocol, which was designed based on a literature review and the experience of two of the researchers, includes information to record the videos, perform the medical evaluation, apply the Prechtl´s qualitative evaluation of the general movements of the newborn and the Hammersmith infant neurological evaluation. Conclusion. The evaluation of the general movements constitutes a valuable tool for the assessment of the risk of cerebral palsy in infants. The use of a protocol guarantees a serial and systematic evaluation; therefore, it is convenient to implement its use in primary care centers and improve the accessibility to these tools.

Criterios para la identificación de síndromes de cáncer de mama hereditarios. Revisión de la literatura y recomendaciones para el Instituto Nacional de Cancerología - Colombia / Criteria for the identification of hereditary breast cancer syndromes. Review of the literature and recommendations for the Instituto Nacional de Cancerología - Colombia

Introducción. Los síndromes de cáncer de mama hereditario (SCMH) corresponden a un 5% a 10% de todos los casos de la enfermedad, en su mayoría explicados por mutaciones en los genes BRCA1 y BRCA2. Se han publicado múltiples guías y recomendaciones internacionales actualizadas, con el fin de dar lineamientos para seleccionar los casos con sospecha de un SCMH. Como antecedentes locales, el Instituto Nacional de Cancerología de Colombia cuenta con un "Programa institucional para la identificación y manejo de familias con sospecha de cáncer hereditario", con fines asistenciales, dentro del cual el cáncer de mama es la patología más remitida al servicio de genética (55%; 540/986). En el 21% de los casos con cáncer de mama que cumplieron criterios NCCN se diagnosticó un SCMH, la mayoría asociados a mutaciones en los genes BRCA1 y BRCA2 (12,3%) y en menor proporción a otros genes de susceptibilidad al cáncer de mama (8,6%).Objetivo. Identificar los criterios de selección más implementados para diagnosticar los casos de cáncer de mama hereditarios a través de una revisión de la literatura, y realizar un consenso Institucional sobre las indicaciones de remisión a consejería genética y solicitud de pruebas para fines diagnósticos y de tratamiento sistémico con iPARP. Materiales y métodos. Se realizó una revisión narrativa de la literatura científica publicada en los últimos 10 años, al 30 de agosto del 2021, sobre la prevalencia de mutaciones germinales en los genes BRCA1 y BRCA2, y en otros genes no BRCA, en pacientes con cáncer de mama, obteniéndose en total 146 y seleccionándose un total de 41 artículos. En el interior de las unidades funcionales de mama y tejidos blandos, genética y oncología clínica, se presentó la evidencia disponible, realizando una discusión amplia entre las tres unidades y finalmente se definieron las indicaciones para remisión a genética, para solicitar estudios genéticos y de tratamiento sistémico con iPARP.Resultados. Según lo reportado en la literatura, los principales criterios de sospecha de un SCMH deben incluir: el subtipo triple negativo, la presentación bilateral, la edad muy temprana de diagnóstico y los antecedentes familiares (AF) de cáncer de mama antes de los 50 años o cáncer de ovario a cualquier edad.Conclusiones. Se adoptan las recomendaciones de la NCCN para la remisión a consejería genética y solicitud de estudios genéticos para identificar cáncer de mama hereditario, y se establecen los criterios del estudio OlympiA para la solicitud de estudios genéticos con el fin de guiar el tratamiento sistémico con iPARP en el Instituto Nacional de Cancerología. Lo anterior permitirá que desde nuestra Institución se ofrezca adecuadamente este servicio a la población colombiana.

ntroduction: Hereditary breast and ovarian cancer syndromes (HBOC) represents 5% to 10% of all breast cancer cases, and BRCA1andBRCA2 explain most of these syndromes. Multiple guidelines and updated recommendations have been published to define which patients should be selected for genetic testing based on a clinical suspicion of a HBOC syndrome. For context, the Instituto Nacional de Cancerología from Colombia developed an "Institutional Program for the identification and management of families with suspected hereditary cancer" for healthcare purposes, within which breast cancer is the most referred pathology to the genetics service (55%; 540/986). Inherited cancer was diagnosed in 21% of the patients with breast cancer who met NCCN criteria; most of these were associated with BRCA1 and BRCA2 mutations (12.3%) and to a lesser extent to other breast cancer susceptibility genes (8.6%).Objective: To identify the most implemented selection criteria to diagnose inherited breast cancer cases, through a review of the literature, and to achieve an institutional consensus on the indications for referral to genetic counseling and genetic testing for diagnostic and systemic treatment with PARPi.Materials and methods: A narrative review of the scientific literature published in the last 10 years as of August 30, 2021 on the prevalence of germline mutations in the BRCA1 and BRCA2 genes, and in other non-BRCA genes, in patients with breast cancer was carried out. Overall, 146 articles were first identified but only 41 were selected. Within the functional units of breast and soft tissue, genetics and clinical oncology, the available evidence was presented and a broad discussion was carried out; finally the indications for referral to genetic counseling, for genetic testing and for systemic treatment with PARPi were defined.Results: As reported in the literature, clinical criteria for HBOC syndrome should include: triple negative subtype, bilateral presentation, very early age of diagnosis and family history (FH) of breast cancer before 50 years of age or ovarian cancer at any age. Conclusions: The NCCN recommendations for referral to genetic counseling and ordering genetic testing to diagnose HBOC cases are adopted at the Instituto Nacional de Cancerología from Colombia, as well as the OlympiA study criteria for ordering genetic testing to guide systemic PARPi therapy. This will allow our Institution to adequately offer this service to the Colombian population.

Trastorno límite de la personalidad (TLP), experiencias adversas tempranas y sesgos cognitivos: una revisión sistemática

Introducción: La investigación actual y los artículos rastreados sobre adversidad temprana y sesgos cognitivos en pacientes con trastorno límite de la personalidad (TLP) evidencian la relación entre estas variables y la gravedad de los síntomas clínicos de este trastorno. Objetivo: Revisar sistemáticamente la evidencia de la relación entre adversidad temprana, sesgos cognitivos y agudización de los síntomas del TLP. El vacío investigativo tiene que ver con el tipo específico de adversidad temprana y su relación con el tipo específico de sesgos cognitivos y el curso del TLP de pacientes con este diagnóstico. Metodología: Se realizó una revisión sistemática de la literatura y para reportar la evidencia se utilizó la versión 2020 de la declaración Prisma. Las bases de datos consultadas fueron Scopus, Pubmed, Web of Science y PsycInfo. En la búsqueda también se incluyeron bases de datos de literatura gris como Google Académico, Open Gray y WorldCat. Resultados: En total se incluyeron en el estudio 13 artículos que satisficieron criterios de originalidad, temática estudiada (adversidad temprana, funcionamiento cognitivo y sintomatología límite) y población indicada (pacientes con diagnóstico de TLP). Conclusiones: Si bien existe evidencia de que la adversidad temprana en general es un factor de riesgo para el TLP, se necesita más investigación para comprender los tipos específicos de adversidad que pueden estar más fuertemente relacionados con el desarrollo del TLP. Si bien algunos estudios han identificado sesgos cognitivos en individuos con TLP, poco se conoce sobre el modo en que estos sesgos se desarrollan y cambian con el tiempo, o según la etapa de exposición del paciente a la adversidad temprana.

Introduction: Current research and articles on early adversity and cognitive biases in patients with borderline personality disorder (BPD) demonstrate the relationship between these variables and the severity of the clinical symptoms of this disorder. Objective: The aim was to systematically review the evidence of the relationship between early adversity, cognitive biases, and exacerbation of symptoms of borderline personality disorder. The research gap concerns the particular type of early adversity and its relationship with the specific type of cognitive biases and the course of BPD in patients with this diagnosis. Methodology: We conducted a systematic literature review, and the Prisma statement version 2020 was used to report the evidence. The databases consulted were Scopus, Pubmed, Web of Science, and PsycInfo. Gray literature databases, such as Google Scholar, Open Gray, and WorldCat, were also included in the search. Results: We included 13 articles in the study that met the criteria for originality, studied theme (early adversity, cognitive functioning, and borderline symptomatology), and target population (patients diagnosed with a personality disorder). Conclusions: We found that while there is evidence that early adversity, in general, is a risk factor for BPD, further research is needed to understand the specific types of adversity that may be more strongly related to the development of BPD. In addition, although some studies have identified cognitive biases in individuals with BPD, little is known about how these biases develop and change over time or according to the stage of the patient's exposure to early adversity.

Is There a Place for Family-centered Cesarean Delivery during Placenta Accreta Spectrum Treatment? / Existe um lugar para cesariana centrada na família durante o tratamento do espectro da placenta acreta?

ABSTRACT Objective Placenta accreta spectrum (PAS) is a cause of massive obstetric hemorrhage and maternal mortality. The application of family-centered delivery techniques (FCDTs) during surgery to treat this disease is infrequent. We evaluate the implementation of FCDTs during PAS surgeries. Methods This was a prospective, descriptive study that included PAS patients undergoing surgical management over a 12-month period. The patients were divided according to whether FCDTs were applied (group 1) or not (group 2), and the clinical outcomes were measured. In addition, hospital anesthesiologists were surveyed to evaluate their opinions regarding the implementation of FCDTs during the surgical management of PAS. Results Thirteen patients with PAS were included. The implementation of FCDTs during birth was possible in 53.8% of the patients. The presence of a companion during surgery and skin-to-skin contact did not hinder interdisciplinary management in any case. Conclusion Implementation of FCDTs during PAS care is possible in selected patients at centers with experience in managing this disease.

Resumo Objetivo O espectro da placenta acreta (do inglês placenta accreta spectrum - PAS) é causa de hemorragia obstétrica maciça e mortalidade materna. A aplicação de técnicas de parto centrado na família (do inglês family-centered delivery techniques - FCDTs) durante a cirurgia para tratar esta doença é pouco frequente. Avaliamos a implementação das FCDTs durante as cirurgias do PAS. Métodos Estudo prospectivo e descritivo que incluiu pacientes com PAS submetidos a tratamento cirúrgico durante um período de 12 meses. Os pacientes foram divididos de acordo com a aplicação de FCDTs (grupo 1) ou não (grupo 2), e os resultados clínicos foram medidos. Além disso, anestesiologistas hospitalares foram entrevistados para avaliar suas opiniões sobre a implementação das FCDTs durante o manejo cirúrgico do PAS. Resultados Foram incluídos 13 pacientes com PAS. A implementação de FCDTs durante o parto foi possível em 53,8% das pacientes. A presença do acompanhante durante a cirurgia e o contato pele a pele não prejudicou o manejo interdisciplinar em nenhum caso. Conclusão A implementação de FCDTs durante o atendimento do PAS é possível em pacientes selecionados em centros com experiência no manejo dessa doença.

Drug-induced liver injury after covid-19 mRNA vaccine: case report

Case description: A 22-year-old female patient received the first dose of Pfizer-BioNTech vaccine (RNAm) against COVID-19; 6 days later, she presented abdominal pain located in the right hypochondrium and epigastrium, associated with emetic episodes. Re-consultation 21 days later due to the same symptoms; three days after the second dose of the vaccine was administered. Clinical findings: Pain on palpation in the right hypochondrium. Laboratories reported hepatocellular lesion and cholestasis, with negative amylase, hepatotropic virus and autoimmune hepatitis tests. Liver and biliary tract ultrasound and cholangioresonance were normal. Treatment and Results: Hyoscine and intravenous fluids as support therapy. She presented improvement in abdominal pain and progressive decrease of transaminases and bilirubin levels until normalization, and was discharged on the fifth day of hospitalization. A drug-associated hepatotoxicity (DILI) diagnosis was considered probable, in this case, secondary to vaccination against COVID-19. Clinical Relevance: The current SARS CoV-2 pandemic has spurred the development of new vaccines, the safety of which remains a concern. There is a likely causal relationship between vaccination and liver involvement in this clinical case, rather than simply a sporadic occurrence.

Descripción del caso: Paciente femenina de 22 años, quien recibió primera dosis de vacuna Pfizer-BioNTech (RNAm) contra COVID-19; presenta 6 días después, dolor abdominal localizado en hipocondrio derecho y epigastrio, asociado a episodios eméticos. Reconsulta a los 21 días por la misma sintomatología; tres días posteriores a la aplicación de la segunda dosis de la vacuna. Hallazgos clínicos: dolor a la palpación en hipocondrio derecho. Los laboratorios reportaron lesión hepatocelular y colestasis, con amilasa, estudios para virus hepatotrópos y hepatitis autoinmune negativos. La ecografía de hígado, vías biliares y colangioresonancia fueron normales. Tratamiento y Resultados: hioscina 20 mg vía oral cada 8 horas y líquidos endovenosos como terapia de soporte. Presentó mejoría del dolor abdominal y descenso progresivo de transaminasas y bilirrubinas, hasta su normalización y se dio egreso al quinto día de hospitalización. Se consideró probable diagnóstico de hepatotoxicidad asociada a medicamentos (DILI), en este caso, secundario a la vacunación contra COVID-19. Relevancia Clínica: La pandemia actual por el virus SARS CoV-2 ha impulsado el desarrollo de nuevas vacunas, cuya seguridad sigue siendo un motivo de preocupación. En este caso clínico, hay una probable relación causal entre la vacunación y el compromiso hepático, en lugar de una simple aparición esporádica.

Safety and Revisit Related to Discharge the Sixty-one Spanish Emergency Department Medical Centers Without Hospitalization in Patients with COVID-19 Pneumonia. A Prospective Cohort Study UMC-Pneumonia COVID-19

ABSTRACT Background: Information is needed on the safety and efficacy of direct discharge from the emergency department (ED) of patients with COVID-19 pneumonia. Objectives: The objectives of the study were to study the variables associated with discharge from the ED in patients presenting with COVID-19 pneumonia, and study ED revisits related to COVID-19 at 30 days (EDR30d). Methods: Multicenter study of the SIESTA cohort including 1198 randomly selected COVID patients in 61 EDs of Spanish medical centers from March 1, 2020, to April 30, 2020. We collected baseline and related characteristics of the acute episode and calculated the adjusted odds ratios (aOR) for ED discharge. In addition, we analyzed the variables related to EDR30d in discharged patients. Results: We analyzed 859 patients presenting with COVID-19 pneumonia, 84 (9.8%) of whom were discharged from the ED. The variables independently associated with discharge were being a woman (aOR 1.890; 95%CI 1.176-3.037), age < 60 years (aOR 2.324; 95%CI 1.353-3.990), and lymphocyte count > 1200/mm3 (aOR 4.667; 95%CI 1.045-20.839). The EDR30d of the ED discharged group was 40.0%, being lower in women (aOR 0.368; 95%CI 0.142-0.953). A total of 130 hospitalized patients died (16.8%) as did two in the group discharged from the ED (2.4%) (OR 0.121; 95%CI 0.029-0.498). Conclusion: Discharge from the ED in patients with COVID-19 pneumonia was infrequent and was associated with few variables of the episode. The EDR30d was high, albeit with a low mortality.

Barreras para el ejercicio físico en estudiantes universitarios de Manizales, Colombia: diferencias por programa académico / Barriers to physical exercise in university students in Manizales, Colombia: differences by academic program / Barreiras para o exercício físico em estudantes universitários de Manizales, Colômbia: diferenças por programa acadêmico

Resumen Objetivo: analizar las barreras que impiden la práctica de ejercicio físico en estudiantes universitarios pertenecientes a programas académicos de pregrado de la ciudad de Manizales. Materiales y métodos: estudio con enfoque cuantitativo de tipo correlacional, cuya muestra corresponde a 2.576 estudiantes de pregrado presencial pertenecientes a cuatro universidades de la ciudad de Manizales. Para la recolección de datos se utilizó la escala de beneficios y barreras que tiene el ejercicio (EEBS) de Nola Pender. Resultados: las barreras mayormente reportadas se relacionan con el cansancio (67,7 %), la fatiga (60,24 %) y la falta de tiempo para realizar ejercicio físico (48,91 %). Se encontraron 13 barreras asociadas a los programas académicos, siendo los estudiantes de Bellas Artes, quienes se asociaron a un mayor número de barreras. Conclusión: el área de estudio de Bellas Artes se asoció a una mayor percepción de barreras, mientras que los estudiantes de Educación y Agronomía no consideraron barreras para la práctica del ejercicio físico. Los planes de estudios deben incluir espacios académicos y/o lúdicos que permitan una mayor motivación intrínseca y extrínseca para la práctica deportiva acorde a los intereses del área de conocimiento.

Abstract Objective: To analyze the barriers that prevent the practice of physical exercise in university students belonging to undergraduate academic programs in the city of Manizales. Materials and methods: Study with a correlational quantitative approach with a sample of 2,576 undergraduate students from four universities in the city of Manizales. The Nola Pender exercise benefits and barriers scale (EBBS) was used for data collection. Results: The most reported barriers were related to tiredness (67.7%), fatigue (60.24%) and lack of time to perform physical exercise (48.91%). Thirteen barriers associated with academic programs were found, being the Fine Arts students those who were associated with a greater number of barriers. Conclusion: The Fine Arts area of study was associated with a greater perception of barriers while the Education and Agronomy students did not consider barriers to the practice of physical exercise. The study plans must include academic and/or recreational spaces that allow greater intrinsic and extrinsic motivation for the practice of sports according to the interests of the area of knowledge.

Resumo Objetivo: analisar as barreiras que impedem a prática de exercício físico em estudantes universitários pertencentes a programas académicos de formatura da cidade de Manizales. Materiais e métodos: estudo com enfoque quantitativo de tipo correlacional, cuja amostra corresponde a 2.576 estudantes de formatura presencial pertencentes a quatro universidades da cidade de Manizales. Para a coleita de dados se fez a escada de benefícios e barreiras que têm o exercício (EEBS) de Nola Pender. Resultados: as barreiras maiormente reportadas se relacionam com o cansaço (67,7 %), a fatiga (60,24 %) e a falta de tempo para fazer exercício físico (48,91 %). Acharam-se 13 barreiras associadas aos programas acadêmicos, sendo os estudantes de Belas Artes, quem se associaram a um maior número de barreiras. Conclusão: a área de estudo de Belas Artes se associou a uma maior percepção de barreiras, enquanto que os estudantes de Educação e Agronomia não consideraram barreiras para a prática do exercício físico. As diretrizes de estudos devem incluir espaços acadêmicos e/ou lúdicos que permitam uma maior motivação intrínseca e extrínseca para a prática esportiva acorde aos interesses da área de conhecimento.

Impact of lifestyle in prostate cancer patients. What should we do?

ABSTRACT Objective: This review aimed to analyze interventions raised within primary and tertiary prevention concerning the disease's incidence, progression, and recurrence of Prostate Cancer (PCa). Priority was given to the multidisciplinary approach of PCa patients with an emphasis on modifiable risk factors. Materials and Methods: We conducted a comprehensive literature review in the following databases: Embase, Central, and Medline. We included the most recent evidence assessing cohort studies, case-control studies, clinical trials, and systematic reviews published in the last five years. We only included studies in adults and in vitro or cell culture studies. The review was limited to English and Spanish articles. Results: Preventive interventions at all levels are the cornerstone of adherence to disease treatment and progression avoidance. The relationship in terms of healthy lifestyles is related to greater survival. The risk of developing cancer is associated to different eating habits, determined by geographic variations, possibly related to different genetic susceptibilities. Discussion: PCa is the second most common cancer in men, representing a leading cause of death among men in Latin America. Prevention strategies and healthy lifestyles are associated with higher survival rates in PCa patients. Also, screening for anxiety and the presence of symptoms related to mood disorders is essential in the patient's follow-up concerning their perception of the condition.

Curso de superación en gestión de riesgo frente a desastres naturales para los docentes de ciencias médicas

RESUMEN Fundamento: la superación docente sobre gestión de riesgo de desastres naturales en ciencias médicas de Cienfuegos se ha caracterizado por el insuficiente tratamiento de su contenido en la actividad profesional, a pesar de ser una temática de marcada importancia, concedida tanto a nivel nacional como internacional. Objetivo: diseñar un curso de superacion en gestión de riesgo frente a desastres naturales dirigido a los docentes de ciencias médicas. Métodos: investigación pedagógica realizada en la Facultad de Ciencias Médicas de Cienfuegos en el curso 2020-2021. Se realizó el diagnóstico de las necesidades de aprendizaje, se diseñó el curso y fue sometido a validación por expertos. Se impartió a un grupo de docentes que presentaron tesinas al finalizar el curso. Se utilizaron métodos del nivel teórico como el analítico-sintético, inductivo-deductivo, histórico-lógico, y del nivel empírico la modelación y la encuesta. Resultados: el curso fue estructurado en cinco temas que incluyeron los problemas relacionados con la identificación, el análisis y evaluación de riesgo, como parte de los pasos necesarios para comprender la gestión del riesgo y el aprendizaje de sus tres etapas: proactiva correctiva y reactiva. Los expertos lo consideraron factible, pertinente y de elevada calidad. Los cursistas presentaron tesinas con gran rigor científico metodológico que sirvieron de plataforma en proyectos investigativos y trabajos de ciencia, tecnología y sociedad. Conclusiones: el curso contribuyó al incremento de los conocimientos de los docentes de la Facultad de Ciencias Médicas de Cienfuegos en cuanto a la gestion de riesgo de desastres.

ABSTRACT Background: the teaching improvement on natural disaster risk management in medical sciences in Cienfuegos has been characterized by insufficient treatment of its content in professional activity, despite being an importance subject, granted both nationally and internationally. Objective: to design a course of improvement in risk management against natural disasters aimed at medical sciences teachers. Methods: pedagogical research carried out at the Cienfuegos Faculty of Medical Sciences in the 2020-2021 academic year. The learning needs diagnosis was carried out, the course was designed and it was submit to validation by experts. It was given to a group of teachers who presented thesis at the end of the course. Methods of the theoretical level such as analytical-synthetic, inductive-deductive, historical-logical, and of the empirical level modeling and survey were used. Results: the course was structured in five topics that included problems related to risk identification, analysis and evaluation, as part of the necessary steps to understand risk management and learning its three stages: proactive, corrective and reactive. The experts considered it feasible, relevant and of high quality. The students presented thesis with great scientific methodological rigor that served as a platform in research projects and works on science, technology and society. Conclusions: the course contributed to increase the teachers' knowledge of the Cienfuegos Medical Sciences Faculty regarding disaster risk management.

Effect of a surgical care bundle on the incidence of surgical site infection in colorectal surgery: a quasi-experimental intervention

Background: Surgical site infections (SSI) have an important impact on morbidity and mortality. Objective: This study, therefore, sought to assess the effect of a surgical care bundle on the incidence of SSI in colorectal surgery. Methods: We conducted a quasi-experimental intervention study with reference to the introduction of a surgical care bundle in 2011. Our study population, made up of patients who underwent colorectal surgery, was divided into the following two periods: 2007-2011 (pre-intervention) and 2012-2017 (post-intervention). The intervention's effect on SSI incidence was analyzed using adjusted odds ratios (OR). Results: A total of 1,727 patients were included in the study. SSI incidence was 13.0% before versus 11.6% after implementation of the care bundle (OR: 0.88, 95% confidence interval: 0.66-1.17, p = 0.37). Multivariate analysis showed that cancer, chronic obstructive pulmonary disease, neutropenia, and emergency surgery were independently associated with SSI. In contrast, laparoscopic surgery proved to be a protective factor against SSI. Conclusions: Care bundles have proven to be very important in reducing SSI incidence since the measures that constitute these protocols are mutually reinforcing. In our study, the implementation of a care bundle reduced SSI incidence from 13% to 11.6%, though the reduction was not statistically significant.

Política Pública sobre violencia en el noviazgo: ¿asignatura perdida en Colombia? / Public Policy on Dating Violence: A Failed Subject in Colombia?

Resumen La violencia en el noviazgo (VN) se considera un problema de salud pública por los efectos a nivel físico, emocional, social, además al ser una etapa previa a la conformación de familias, los eventos violentos serán posiblemente replicados y generen violencia intrafamiliar. Se requiere de estrategias de intervención individual, familiar, comunitario y poblacional; surge entonces la necesidad de identificar si existen o no políticas públicas y legislación que aborden de manera directa la VN para el caso de colombiano.

Abstract Dating violence (DV) is considered a public health problem due to the physical, emotional, social effects. In addition to being a pre-family stage, violent events will possibly be replicated and could generate domestic violence. Individual, family, community, and population intervention strategies are required. There is then a need to identify whether or not public policies and legislation exist, which directly address DV in the Colombian case.

Consumption of osmo-dehydrated Andean Berry (Vaccinium meridionale Swartz) decreases levels of pro-inflammatory biomarkers of overweight and obese adults / Consumo de agraz osmodeshidratado (Vaccinium meridionale Swartz) disminuye los niveles de biomarcadores proinflamatorios de adultos con sobrepeso y obesidad

Background: A Body Mass Index (BMI) greater than 24.9 Kg/m2 promotes chronic inflammation due to increased secretion of pro-inflammatory adipokines. Consuming fruits rich in bioactive compounds such as berries is a promising strategy to counteract this effect. Objectives: Determine the effect of osmo-dehydrated Andean Berry consumption on inflammatory biomarkers (TNF-α, IL- 6, IL-1ß, and adiponectin) and plasma antioxidant capacity in overweight and obese adults after 21 days. Methods: Andean Berry was osmo-dehydrated in 70% sucrose syrup. Antioxidant activity, proximal composition, phenolic content, microbiological analysis, and sensory analysis of the product were determined. Twenty-five obese and overweight subjects consumed 35g of osmo-dehydrated berry for 21 days. Inflammatory biomarkers and antioxidant capacity in plasma were evaluated at the beginning and end of the study. Results: Osmo-dehydrated Andean Berry presented a total phenolic content of 692.7 ± 47.4 mg Gallic Acid Equivalents/100 g. All biomarkers evaluated in the subjects showed statistically significant differences (p> 0.05), except for CRP, before and after the study. IL-6 presented the more significant reduction among all pro-inflammatory adipokines with an effect size of 18.4 Conclusions: Regular consumption of osmo-dehydrated Andean Berry contributes to decreasing pro-inflammatory biomarkers and improves the plasma antioxidant capacity of overweight and obese adults

Antecedentes: un índice de masa corporal (IMC) superior a 24.9 kg/m2 promueve la inflamación crónica debido al aumento en la secreción de adipocinas proinflamatorias. El consumo de frutas ricas en compuestos bioactivos como las bayas es una estrategia prometedora para contrarrestar este efecto. Objetivo: Determinar el efecto del consumo de agraz osmodeshidratado en biomarcadores inflamatorios (TNF-α, IL- 6, IL-1ß y adiponectina) y capacidad antioxidante plasmática de adultos con sobrepeso y obesidad después de 21 días. Métodos: El agraz fue osmo-deshidratado en jarabe de sacarosa al 70%. Se determinó la actividad antioxidante, composición proximal, contenido fenólico, análisis microbiológico y análisis sensorial del producto. Veinticinco sujetos obesos y con sobrepeso consumieron 35 g de agraz osmodeshidratado durante 21 días. Se evaluaron biomarcadores inflamatorios y capacidad antioxidante en plasma al inicio y al final del estudio. Resultados: El agraz osmodeshidratado presentó un contenido fenólico total de 692.7 ± 47.4 mg GAE / 100 g. Todos los biomarcadores evaluados en los sujetos mostraron diferencias estadísticamente significativas (p> 0.05), a excepción de la PCR, antes y después del estudio. La IL-6 presentó la mayor reducción entre todas las adipocinas proinflamatorias con un tamaño del efecto de 18.4 Conclusiones: El consumo regular de agraz osmodeshidratado contribuye a disminuir los biomarcadores proinflamatorios y mejora la capacidad antioxidante plasmática de adultos con sobrepeso y obesidad