Intragastric balloon and impact on weight loss: experience in quito, equador / Balão intragástrico e impacto na perda de peso: experiência em quito, equador

ABSTRACT BACKGROUND: Obesity is associated with different medical conditions, such as cardiologic, respiratory, gastrointestinal, and genitourinary, and constitutes a severe health problem. AIMS: This study aimed to evaluate the use of intragastric fluid-filled balloon in the reduction of weight and other measurements related to body composition. METHODS: This is a retrospective, monocentric study involving all patients who opted for the intragastric balloon Spatz® placement from January 2018 to July 2019, with fulfillment of inclusion and exclusion criteria. The patients were analyzed after 6 and 12 months after the intragastric fluid-filled balloon placed. RESULTS: A total of 121 subjects were included in this study, with 83 (68.6%) females and 38 (31.4%) males. The mean age was 36 years and height was 1.64±0.09. Weight mean and standard deviation was 89.85±14.65 kg, and body mass index was 33.05±4.03; body mass index decreased to 29.4 kg/m2 with a mean weight of 79.83 kg, after 12 months of follow-up. There were statistical differences between body mass index and the 12 months in fat percentage, fat-free mass (kg), visceral fat area, and basal metabolic rate. There was a significant variation according to gender, with males having highest reduction. The percentage of excess weight loss was 46.19, and the total weight loss was 9.24 at the end of the study. CONCLUSIONS: The study demonstrated a benefit of intragastric fluid-filled balloon on weight loss after 12 months. At the end of treatment, body mass index and the measurements of body composition were significantly lower. Men benefited more than women from the treatment.

RESUMO RACIONAL: A obesidade está associada a diferentes condições médicas, tais como cardiológicas, respiratórias, gastrointestinais, geniturinárias entre outras e constituem um grave problema de saúde. OBJETIVOS: Avaliar o emprêgo do balão intragástrico na redução de peso e em outras medidas relacionadas à composição corporal. MÉTODOS: Estudo retrospectivo, monocêntrico, incluindo todos os pacientes que optaram pela colocação de balão intragástrico Spatz® entre janeiro de 2018 e julho de 2019, com cumprimento dos critérios de inclusão e exclusão. RESULTADOS: Cento e vinte e um indivíduos foram recrutados neste estudo. A média de idade foi de 36 anos e estatura de 1,64±0,09, sendo 83 (68,6%) do sexo feminino e 38 (31,4%) do sexo masculino. A média do peso e o desvio padrão foram de 89,85±14,65 kg e o índice de massa corporal foi de 33,05±4,03. Após 12 meses, o índice de massa corporal diminuiu para 29,4 kg/m2 com um peso médio de 79,83 kg. Foram registradas diferenças estatísticas no índice de massa corporal, no percentual de gordura, massa livre de gordura (kg), área de gordura visceral e taxa metabólica basal. Houve variação significativa de acordo com o sexo, sendo o masculino com maior redução. O porcentual de perda de excesso de peso foi de 46,19% e de perda de peso total de 9,24 %ao final do estudo. CONCLUSÕES: O estudo demonstrou benefícios do balão intragástrico na perda de peso após 12 meses de colocação do balão. Ao final do tratamento, o índice de massa corporal e as medidas de composição corporal foram significativamente menores. Os homens se beneficiaram mais do que as mulheres do tratamento.

Baipás gástrico versus manga gástrica para el controlde diabetes tipo 2 en pacientes obesos / Gastric bypass versus gastric sleeve for the management of type 2 diabetes in obese patients

Introducción. La diabetes mellitus tipo 2 y la obesidad son enfermedades con alta prevalencia, gran morbi-mortalidad y elevados costos en salud. La cirugía bariátrica ha demostrado efectividad para inducir pérdida de peso y un control adecuado de la glicemia. Métodos. Estudio observacional analítico retrospectivo, realizado entre 2014 y 2019 en una institución de alta complejidad. Se incluyeron pacientes prediabéticos y diabéticos sometidos a cirugía bariátrica tipo baipás gástrico en Y-de-Roux o manga gástrica. Se analizaron la mejoría o resolución de la diabetes y la pérdida del exceso de peso a los 6, 12, 24 y 36 meses luego de la cirugía. Resultados. Se incluyeron 103 pacientes en el estudio, 45 pacientes diabéticos y 58 pacientes prediabéticos. La única variable perioperatoria con diferencia estadísticamente significativa fue el tiempo quirúrgico mayor en el baipás (70 vs. 47,5 minutos; p<0,001). La pérdida de exceso de peso fue mayor en el baipás. Los pacientes diabéticos sometidos a baipás tuvieron un mayor porcentaje de resolución o control comparados con los sometidos a manga gástrica. En los pacientes prediabéticos hubo resolución en ambos grupos luego de 24 meses de seguimiento. Conclusión. El baipás gástrico y la manga gástrica presentan excelentes resultados en cuanto a pérdida de peso y control metabólico en pacientes con diabetes mellitus tipo 2 y prediabetes, pero en nuestros pacientes se lograron resultados superiores en ambos aspectos con el baipás gástrico

Introduction. Type 2 diabetes mellitus and obesity are diseases with high prevalence, high morbidity and mortality and high health costs. Bariatric surgery has proven effective in inducing weight loss and adequate glycemic control. Methods. Retrospective analytical observational study conducted between 2014 and 2019 in a high-complex institution. Prediabetic and diabetic patients undergoing Roux-en-Y gastric bypass or gastric sleeve were included; analyzing the improvement or resolution of diabetes and the loss of excess weight at 6, 12, 24 and 36 months after surgery. Results. One-hundred and three patients were included in the study, 45 diabetic patients and 58 pre-diabetic patients. The only perioperative variable with a statistically significant difference was the longer surgical time in the bypass (70 vs. 47.5 min; p<0.001). Loss of excess weight was always greater in bypass. Diabetic patients who underwent bypass had a higher percentage of resolution or control compared to those who underwent the sleeve procedure. In pre-diabetic patients, there was 100% resolution in both groups after 24 months of follow-up. Conclusion. Gastric bypass and gastric sleeve present excellent results in terms of weight loss and metabolic control in patients with type 2 diabetes mellitus and pre-diabetes, but superior results in both aspects were achieved with the first technique in our patients

Consenso del Comité de Psiquiatría de Enlace de la Asociación Colombiana de Psiquiatría sobre el diagnóstico y tratamiento del delirium en el contexto de la pandemia por COVID-19 / Consensus of the Liaison-Psychiatry Committee of the Colombian Psychiatric Association on the Diagnosis and Treatment of Delirium in the Context of the COVID-19 Pandemic

RESUMEN La pandemia por el nuevo coronavirus denominado SARS-CoV-2 plantea retos sin precedentes en la atención de la salud. Entre ellos se cuenta el aumento en los casos de delirium. La enfermedad grave por SARS-CoV-2, COVID-19, tiene vulnerabilidades comunes con el delirium y produce alteraciones en órganos como el pulmón o el cerebro, entre otros, que tienen potencial para precipitar el trastorno mental; de hecho, este puede ser la primera manifestación de la infección, antes de la fiebre, el malestar general, la tos o las alteraciones respiratorias. Está ampliamente sustentado que el delirium incrementa la morbilidad y la mortalidad de quienes lo padecen durante una hospitalización, por lo que se debe buscar activamente para realizar las intervenciones pertinentes. Ante la ausencia de evidencia sobre el abordaje del delirium en el contexto de la COVID-19, se elaboró este consenso sobre tres aspectos fundamentales: diagnóstico, tratamiento no farmacológico y tratamiento farmacológico, en pacientes ingresados en el hospital general. El documento contiene recomendaciones sobre uso sistemático de herramientas diagnósticas, cuándo hospitalizar al paciente con delirium, la aplicación de acciones no farmacológicas dentro de las restricciones que impone la COVID-19 y la utilización de antipsicóticos teniendo en cuenta los efectos secundarios más relevantes y las interacciones farmacológicas.

ABSTRACT The pandemic caused by the new coronavirus named SARS-CoV-2 poses unprecedented challenges in the health care. Among them is the increase in cases of delirium. The severe SARS-CoV-2 disease, COVID-19, has common vulnerabilities with delirium and produces alterations in organs such as the lungs or the brain, among others, which have the potential to trigger the mental disorder. In fact, delirium may be the first manifestation of the infection, before fever, general malaise, cough or respiratory disturbances. It is widely supported that delirium increases the morbidity and mortality in those who suffer from it during hospitalization, so it should be actively sought to carry out the relevant interventions. In the absence of evidence on the approach to delirium in the context of COVID-19, this consensus was developed on three fundamental aspects: diagnosis, non-pharmacological treatment and pharmacological treatment, in patients admitted to the general hospital. The document contains recommendations on the systematic use of diagnostic tools, when to hospitalize the patient with delirium, the application of non-pharmacological actions within the restrictions imposed by COVID-19, and the use of antipsychotics, taking into account the most relevant side effects and pharmacological interactions.

Encuesta a psiquiatras y residentes de psiquiatría en Colombia sobre sus prácticas preventivas y terapéuticas del delirium / Survey of psychiatrists and psychiatry residents in Colombia about their preventive and therapeutic practices in delirium

RESUMEN Objetivo: describir las prácticas farmacológicas y no farmacológicas para el delirium, realizadas por residentes de psiquiatría y psiquiatras en Colombia. Métodos: encuesta anónima basada en el consenso de expertos del Comité de Psiquiatría de Enlace de la Asociación Colombiana de Psiquiatría y en la literatura. Enviada por correo electrónico a los adscritos a la asociación. Resultados: Participaron 101 clínicos. Las medidas preventivas no farmacológicas como psi-coeducación, corrección de problemas sensoriales o higiene del sueno son realizadas por el 70% o más. Solo cerca de uno de cada 10 hace parte de algún programa multicomponente preventivo institucional. La prescripción preventiva de fármacos fue menor del 20%. Respecto al tratamiento no farmacológico, más del 75% hace corrección de dificultades sensoriales, control de estímulos y reorientación. Nadie indicó que en su centro la atención esté organizada para potenciar el tratamiento no farmacológico. El 17,8% no usa fármacos en el tratamiento. Los que los usan prefieren haloperidol o quetiapina, especialmente en casos hiperactivos o mixtos. Conclusiones: Las prácticas de los encuestados coinciden con las de otros expertos en el mundo. En general, las acciones no farmacológicas son iniciativas individuales, lo que evidencia la necesidad de que las instituciones colombianas de salud se comprometan con el abordaje del delirium, especialmente cuando su prevalencia y consecuencias son indicadores de calidad en la atención.

ABSTRACT Objective: To describe pharmacological and non-pharmacological practices for delirium, carried out by psychiatry residents and psychiatrists in Colombia. Methods: An anonymous survey was conducted based on the consensus of experts of the Liaison Psychiatry Committee of the Asociación Colombiana de Psiquiatría [Colombian Psychiatric Association] and on the literature review. It was sent by email to the association members. Results: 101 clinicians participated. Non-pharmacological preventive measures such as psychoeducation, correction of sensory problems or sleep hygiene are performed by 70% or more. Only about 1 in 10 participants are part of an institutional multi-component prevention programme. The preventive prescription of drugs was less than 20%. Regarding non-pharmacological treatment, more than 75% recommend correction of sensory difficulties, control of stimuli and reorientation. None of the participants indicated that the care at their centres is organised to enhance non-pharmacological treatment. 17.8% do not use medication in the treatment of delirium. Those who use it prefer haloperidol or quetiapine, particularly in hyperactive or mixed motor subtypes. Conclusions: The practices of the respondents coincide with those of other experts around the world. In general, non-pharmacological actions are individual initiatives, which demonstrates the need in Colombian health institutions to commit to addressing delirium, in particular when its prevalence and consequences are indicators of quality of care.

Factores de resiliencia y bienestar en familias colombianas / Resilience factors and familiar well-being in Colombian families

Resumen Las familias, en la actualidad, enfrentan nuevos retos y cambios que comprometen su capacidad de adaptación y su bienestar. Este estudio tuvo como objetivo describir y comparar indicadores de resiliencia familiar y bienestar familiar de 442 familias colombianas ubicadas geográficamente en Bogotá (n = 196), Santa Marta (n = 81) y Cali-Palmira (n = 145). El diseño fue analítico transversal. Las familias diligenciaron el Índice Familiar de Regeneración y Adaptación (FIRA-G) para valorar la resiliencia y el Índice de Bienestar de los miembros de la Familia (FMWB). Los resultados demostraron relaciones significativas y positivas entre bienestar familiar y resiliencia familiar al igual que una relación inversa y significativa entre indicadores de resiliencia negativos como tensión, distrés y tensión familiar con indicadores positivos de resiliencia familiar tales como coherencia, fortaleza y apoyo social. La comparación entre ciudades evidenció divergencias entre las familias de Bogotá y Cali-Palmira, en los niveles de bienestar familiar, estresores familiares y apoyo de parientes y amigos. En el caso de la ciudad de Santa Marta se encuentran diferencias en los estresores familiares con Cali-Palmira y en apoyo social comunitario con Bogotá. La discusión se orienta a mostrar que la resiliencia familiar es resultado de la participación de varios elementos: los recursos familiares adaptativos positivos que le permiten a las familias reducir el estrés y enfrentar las demandas del ambiente, la presencia de los dos padres en familias sin indicadores clínicos que hace que la carga de estrés sea compartida -lo cual abona el terreno para la resiliencia familiar-, y el apoyo social manifestado en ayudas externas al núcleo familiar por parte de la comunidad, los parientes y los amigos.

Abstract Currently, modern families are coping with different stressful situations. The family studies are focused on the conceptual perspective, political perspective and methodological topic and they leave aside the familiar dynamics and functioning. This paper was interested in describing and comparing indicators of family resilience and family welfare of 442 Colombian families. This study had three hypotheses: The first one is focused on differences in well-being family dimension per location; the second hypothesis was focused on significant differences in family resilience per location, and the third one was interested in significant relations in family resilience and family well-being. The theoretical support to this research is the McCubbin and Patterson's resilience model called Double ABCX and Family Adaptation and Adjust Response Model by Patterson. The family well-being is considered a result of internal family functioning and is measured by the family member perception about the concern about health problems, fears, anger and sadness. Family resilience is understood as the capacity to recover from adversity. This capacity strengthens families and improves their resources. In this theoretic resilience approach the resilience is a dynamic result to the adaptation phase and the family well-being is the final adjustment. The design was cross-sectional analytical with a convenience sample. The families were interviewed in their homes, from each family both parents and a child between 9 and 17 years old participated. They are located geographically in Bogotá (n = 196), Santa Marta (n = 81) and Cali-Palmira (n = 145). Families completed the Family Member Well-being Index (FMWB) and the Family Regeneration and Adaptation Index (FIRA-G) to assess resilience. Families residing in Bogotá showed significant differences with those of Cali-Palmira in the dimension of family well-being, family stress and support from friends and family. While families located in Santa Marta showed differences with respect to the families located in Cali-Palmira in family stress and in community and social support. The father correlations between the family resilience index and the well-being family index is strong and inverse with the family stress and the family well-being summarized. The mother well-being family perception is significant associated with family resilience, and these correlations was strongest with family well-being summarized. The family stress index, strains and distress exposed moderate and inverse relations with the positive resilience family summarized. The discussion deals with family resilience as a product of the dynamic interaction in the hole family system and is oriented to the fact that the presence of support from family and friends reduces the burden of family stress, promotes support in the face of crisis and, in general, improves the well-being and family adaptation. In general, the differences reflect varied resilience trajectories that depend on the challenges posed by the close context of the city where they live. An approach to this result leads us to think as a hypothesis not yet widely explored, in the mobility factor of cities, which limits contact with close family networks. In big cities like Bogotá, its internal mobility compromises the times and spaces of daily life, and thus allows or prevents families from organizing their relationships in the different areas of their social life. Resilience occurs through positive adaptive family resources that included social support and family coherence and allow families to reduce stress and meet the demands of the environment. On the other hand, the presence of the two parents in families without clinical indicators shows that the burden of shared stress helps family resilience, which is also fed by the presence of external aids to the family nucleus, such as the support of the community, family and friends.

El desarrollo del sí mismo en la infancia: Contribuciones teóricas y metodológicas desde la teoría del self dialógico (TSD) y la psicología semiótico-cultural / Self Development in Childhood: Theoretical and Methodological Contributions from Dialogical Self Theory (TSD) and Semiotic-Cultural Psychology

Este artículo tiene como propósito presentar una aproximación teórica y metodológica para el estudio del desarrollo del sí mismo en la niñez. Tomando como punto de partida la Teoría del Self Dialógico (TSD) y el abordaje de la Psicología Semiótico-Cultural, se propone el concepto de Posicionamiento Dinámico de Sí (PDS). Se plantea que el niño tiene un papel activo en la construcción de sus procesos de desarrollo. Metodológicamente, se propone indagar por las construcciones de indicadores del desarrollo del sí mismo a partir de observaciones en las interacciones y de las construcciones narrativas de niños y de sus otros significativos. Finalmente se sugiere que futuras investigaciones que se enfoquen en el estudio del sí mismo deben centrarse en darle una voz al niño y recuperar el carácter dinámico y dialógico del desarrollo

The purpose of this article is to present a theoretical and methodological approach to the study of the development of the self in childhood. Taking as starting point the Theory of the Dialogic Self (TSD) and the approach of the Semiotic-Cultural Psychology, the concept of Dynamic Positioning of Yes (PDS) is proposed. It is stated that the child has an active role in the construction of their development processes. Methodologically, it is proposed to investigate the constructions of indicators of the development of the self from observations in the interactions and narrative constructions of children and their significant others. Finally, it is suggested that future research focusing on the study of the self should focus on giving a voice to the child and recover the dynamic and dialogical character of the development

Prevalencia de violencia física, abuso verbal y factores asociados en trabajadores/as de servicios de emergencia en establecimientos de salud públicos y privados / Verbal and physical abuse towards health care workers in emergency services

Background: One of the peculiarities of our society is the increase in violence and its repercussions in various areas. Health care is not an exemption. Aim: To determine the prevalence of physical violence, verbal abuse towards emergency service health care workers at two public and two private health centers in the province of Concepción, Chile. Material and Methods: A questionnaire for Work Violence in Health Centers, with dimensions about physical violence and verbal abuse was applied to 366 health care workers, stratified according to center and occupational categories. Results: Thirteen percent of workers perceived physical violence. Paramedical technicians had the higher risk of perceiving this type of violence. Fifty nine percent of workers perceived verbal abuse. Nurses and administrative staff had the higher risk of perceiving this type of violence. The most common offenders were patients and family. The most common form of coping with abuse was avoiding a reaction. Most of the physical and verbal aggressions were not reported or denounced. Conclusions: There is a high prevalence of verbal abuse and physical violence in emergency services, which requires measures to achieve a zero tolerance to violence in these spaces.

Interacciones docente-estudiantes y maltrato infantil: análisis microgenético desde la perspectiva sociocultural 2 / Teacher-Student Interactions and Child Abuse: Microgenetic Analysis from a Sociocultural Perspective

Resumen Esta investigación tiene como objetivo caracterizar las significaciones sobre el maltrato infantil, que emergen en el contexto de un salón de clases de primero de primaria, en un colegio público de la ciudad de Bogotá. Este estudio se sustenta en la perspectiva sociocultural. Desde un enfoque idiográfico y por medio de análisis microgenéticos, se profundizó en el estudio de caso de Martina, quien, a partir de su práctica pedagógica, proporcionó elementos para caracterizar las significaciones que ha construido sobre el maltrato infantil y la manera en cómo estas son comunicadas a los niños. Metodológicamente, se solicitó a la profesora preparar un taller para sus estudiantes orientado hacia la prevención del maltrato infantil. También, se llevó a cabo una entrevista con la docente para complementar los análisis. Los resultados indican que las significaciones del maltrato infantil, que emergen en la práctica educativa de la educadora, están permeadas por un sistema cultural más amplio, a saber, la religión católica, y que a través de lo religioso se comunica con sus estudiantes para alinear sus objetivos a los de ellos. Futuras investigaciones podrían centrarse en el estudio de la práctica docente, de manera detallada, y considerar la cultura como elemento fundamental de la organización escolar.

Abstract This research aims to characterize connotations regarding child abuse from teacher-student interactions and relationships that occur inside a first grade classroom, located in a public school in the city of Bogotá. Theoretically, we support our work on the sociocultural perspective. We used the idiographic approach to characterize the case study of Martina, a first-grade teacher, through microgenetic analysis; who from her pedagogical practice and the design of a workshop aimed at preventing abuse provided us with elements to characterize the significations she has built on child abuse. The analysis of the results shows that the meanings and beliefs that emerge in her pedagogical practice are influenced by a cultural system, especially her religious beliefs, which are rooted in the Catholic religion. Finally, we find that it is necessary for future investigations and research to focus on pedagogical practices, taking into consideration culture as an important element in the school context.

Evaluación de las características operativas de la relación proteína/creatinina en orina ocasional para la detección de proteinuria significativa en gestantes con sospecha de preeclampsia / Assessment of the operational characteristics of the protein / creatinine ratio in occasional urine for the detection of significant proteinuria in pregnant women with suspected preeclampsia

Objetivo: analizar la sensibilidad y especificidad de la relación proteína / creatinina en orina como método de detección de proteinuria en mujeres con sospecha de preeclampsia, teniendo en cuenta como estándar de oro la proteinuria en 24 horas. Materiales y métodos: en un estudio de corte transversal se incluyeron mujeres con embarazo mayor a 20 semanas, hospitalizadas en la Clínica Universitaria Bolivariana de Medellín por sospecha de preeclampsia. Se excluyeron gestantes con infección urinaria al momento del estudio, antecedentes de patologías crónicas que pudieran causar proteinuria y aquellas que no completaron la recolección de la muestra. A todas las pacientes se les realizó una medición de la relación proteína / creatinina en orina ocasional y la proteinuria en 24 horas. Se evaluó la correlación entre estas dos pruebas y el punto de corte de la relación proteína / creatinina con mejor rendimiento para la detección de proteinuria significativa. Resultados: se incluyeron 200 muestras de orina, encontrando proteinuria significativa en un 27 % del total de las muestras. La relación proteína / creatinina en orina ocasional mostró una alta correlación con la proteinuria de 24 horas (r = 0,775; p < 0,01). El punto de corte con mejor rendimiento para la detección de proteinuria significativa fue 0,30 mg/ mg, con una sensibilidad de 83 %, especificidad de 98 %, LR positivo de 60 y LR negativo de 0,17. Conclusión: la relación proteína / creatinina en orina ocasional puede ser usada como un método rápido, alternativo, para la determinación de proteinuria en pacientes con sospecha de preeclampsia.

Objective: To analyse the sensitivity and specificity of the protein/creatinine ratio in the urine as a method for detecting proteinuria in women with suspected preeclampsia, considering 24-hour proteinuria as the gold standard. Materials and methods: Cross-sectional study that included women with more than 20 weeks of gestation, admitted to Clinica Universitaria Bolivariana in Medellín because of suspected preeclampsia. Pregnant women with urinary infection at the time of the study, patients with a history of chronic diseases that could cause proteinuria, and women who did not complete the sample collection were excluded. Urine protein/creatinine ratio as well as proteinuria were measured in all the patients included in the study. The correlation between the two tests and the cut-off point for the protein/creatinine ratio with the best performance for the detection of significant proteinuria were evaluated. Results: Overall, 200 urine samples were included and significant proteinuria was found in 27 % of the total number of samples. The protein/creatinine ratio in occasional urine was found to have a high correlation with 24-hour proteinuria(r = 0.775, p < 0.01). The cut-off point with the best performance for detecting significant proteinuria was found to be 0.30 mg /mg, with an 83 % sensitivity and a 98 % specificity, with a positive LR of 60 and a negative LR of 0.17. Conclusion: The protein/creatinine ratio in occasional urine may be used as a fast alternative method for determining the presence of proteinuria in patients with suspected preeclampsia.

Validación de la Escala Subjetiva de Carga mental de trabajo (ESCAM) en profesionales de la salud de Chile / Validation of the Subjective Mental Workload Scale (SCAM) in health professionals from Chile

El objetivo de este estudio es confirmar las características psicométricas de la Escala Subjetiva de Carga Mental de Trabajo (ESCAM) en trabajadores sanitarios de hospitales chilenos. Participaron en este estudio 379 trabajadores de tres hospitales. Los instrumentos utilizados fueron: (a) ESCAM y (b) el cuestionario SUSESO-ISTAS 21. Los resultados indican que ESCAM se estructura en cinco dimensiones: Demandas cognitivas y complejidad de la tarea, Características de la tarea, Organización temporal, Ritmo de trabajo y Consecuencias para la salud. Asimismo, se observan correlaciones significativas entre la puntuación total de ESCAM y sus dimensiones con los factores de SUSESO-ISTAS 21. Además, se comprobó la validez de la escala mediante el análisis de perfiles de carga mental con diferentes grupos profesionales.

The aim of this study is to confirm the psychometric characteristics of the Subjective Mental Workload Scale (SCAM) in health workers of Chilean Hospitals. The instruments used were: (1) SCAM; (2) questionnaire SUSESO-ISTAS 21. The sample was composed of 379 workers from three hospitals. The findings showed that SCAM is structured in five dimensions: Cognitive demands and task complexity, Task characteristics, Temporal organization, Work rate, and Health consequences. Likewise, significant correlations between overall score of SCAM and its dimensions with the SUSESO-ISTAS 21 factors were found. Also, scale validity was verified through mental workload profiles with different professional groups.

Comparación de la actividad antimicrobiana de meropenem genérico y meropenem innovador por la técnica de micro dilución en cepas resistentes / Comparison of the antimicrobial activity of meropenem generic and innovative meropenem in resistant strains by micro dilution method

Objetivo: comparar la actividad antimicrobiana de meropenem genérico y meropenem innovador, frente a cepas resistentes de interés clínico mediante la técnica de micro dilución. Método: se determinó la concentración mínima inhibitoria y la concentración máxima bactericida según el protocolo de micro dilución del Clinical and Laboratory Standars Institute. Resultado: se determinó una concentración mínima inhibitoria de 320 µg/mL y una concentración máxima bactericida de 640 µg/mL para Staphylococcus aureus con ambos antibióticos, Escherichia coli presentó una concentración mínima inhibitoria de 640 µg/mL y una concentración máxima bactericida de 1 280 µg/mL con los dos antibióticos y por último Klebsiella pneumoniae tuvo una concentración mínima inhibitoria de 5 120 µg/mL y una concentración máxima bactericida de 2 0480 µg/mL con ambos antibióticos. Conclusión: no existen diferencias significativas en las concentración máxima bactericida y la concentración mínima inhibitoria de meropenem genérico y meropenem innovador(AU)

Objective: To compare the antimicrobial activity of generic meropenem and innovative meropenem on resistant strains of clinical interest by using the microdilution technique. Method: The minimum inhibitory concentration and maximum bactericidal concentration were determined by the microdilution according to the protocol set by the Clinical and Laboratory Standards Institute (CLSI). Result: Minimum inhibitory concentration (MIC) of 320 µg / mL and a maximum bactericidal concentration (MBC) of 640 µg/mL for both antibiotics against Staphylococcus aureus. MIC reached 640 µg/mL and MBC of 1 280 µg/mL in both antibiotics for Escherichia coli whereas the MIC was 5 120 µg/mL and WBC of 20 480 µg /mL with both antibiotics against Klebsiella pneumoniae. Conclusion: No significant differences were observed in minimum inhibitory concentration and maximum bactericidal concentration between generic meropenem and innovative meropenem(AU)

Desenvolvimento do Self Dialógico nos Primeiros Anos de Vida: Teoria e Pesquisas / Dialogical Self Development in Early Life: Theory and Research

RESUMO O presente artigo discute algumas das pesquisas recentes sobre o desenvolvimento do Self dialógico nos primeiros anos de vida. Revisamos os estudos publicados que tinham como fundamento teórico a emergência do Self. Identificamos que existe um rápido crescimento de pesquisas com bebês, contudo, pesquisas em fases iniciais de alfabetização são praticamente ausentes, a lacuna mais significativa se estende dos 4 aos 6 anos. Encontramos, ainda, que o modelo adulto da Teoria do Self Dialógico tenta ser adaptado para crianças, mas esse modelo precisa de transformações para dar conta dos processos de desenvolvimento do Self. Concluímos que, para a realização de pesquisas com crianças, seja incluída a análise microgenética de interações sociais das crianças em contextos específicos, com vistas ao estudo da emergência de seus processos de desenvolvimento.

ABSTRACT This article discusses some recent studies on the development of the dialogical self during the first years of life. We reviewed published studies that had the emergence of self as a theoretical basis. We identified an increasing number of studies with babies. However, studies realized during the early stages of literacy are absent, and the most significant gap extends from 4- to-6-year-old children. We found that there are attempts to adapt the adult model of the Dialogical Self Theory for children, but this model needs to change to account for processes of the development of self. We conclude by arguing that there is a need for microgenetic analysis of children's social interactions within specific contexts, in order to study the emergence of their development processes.

Psychosocial factors and mental work load: a reality perceived by nurses in intensive care units / Fatores psicossociais e carga mental de trabalho: uma realidade percebida pelos enfermeiros em Unidades de Terapia Intensiva / Factores psicosociales y Carga mental de trabajo: una realidad percibida por enfermeras/os en Unidades Críticas

OBJECTIVE: To analyse the perception of psychosocial factors and mental workload of nurses who work in intensive care units. It is hypothesised that nurses in these units could perceive psychosocial risks, manifesting in a high mental work load. The psychosocial dimension related to the position's cognitive demands is hypothesised to mostly explain mental work load. METHOD: Quantitative study, with a descriptive, cross-sectional, and comparative design. A total of 91% of the intensive care unit populations of three Chilean hospitals was surveyed, corresponding to 111 nurses. The instruments utilised included (A) a biosociodemographic history questionnaire; (b) the SUSESO-ISTAS 21 questionnaire; and (c) the Mental Work Load Subjective Scale (ESCAM, in Spanish). RESULTS: In total, 64% and 57% of participants perceived high levels of exposure to the psychosocial risks Psychosocial demands and Double shift, respectively. In addition, a medium-high level of overall mental load was observed. Positive and significant correlations between some of the SUSESO-ISTAS 21 and ESCAM dimensions were obtained. Using a regression analysis, it was determined that three dimensions of the psychosocial risk questionnaire helped to explain 38% of the overall mental load. CONCLUSION: Intensive care unit nurses felt that inadequate psychosocial factors and mental work overload existed in several of the tested dimensions. .

OBJETIVO: analisar a percepção de fatores psicossociais e a carga mental de trabalho de enfermeiros que trabalham em unidades de terapia intensiva. A hipótese é que os enfermeiros dessas unidades podem perceber os riscos psicossociais e manifestar uma alta carga mental de trabalho. Além disso, a dimensão psicossocial relacionada às demandas cognitivas do cargo explicaria a maior parte da carga mental de trabalho. MÉTODO: estudo quantitativo, com delineamento descritivo, transversal e comparativo. Foi examinada 91% da população das Unidades de Terapia Intensiva de três hospitais chilenos, correspondente a 111 enfermeiros. Os instrumentos utilizados incluíram (a) um questionário do histórico biossociodemográfico; (b) o questionário SUSESO-ISTAS 21; e (c) a Escala Subjetiva de Carga Mental de Trabalho (ESCAM). RESULTADOS: no total, 64% e 57% dos participantes perceberam um alto nível de exposição aos riscos psicossociais Demanda psicológica e Jornada dupla, respectivamente. Além disso, foi observado um nível de médio para alto de carga mental global. Foram obtidas correlações positivas e significativas entre algumas das dimensões do SUSESO-ISTAS 21 e do ESCAM. Utilizando uma análise de regressão, determinou-se que três dimensões do questionário de risco psicossocial ajudaram a explicar 38% da carga mental total. CONCLUSÃO: os enfermeiros das unidades de terapia intensiva percebem os fatores psicossociais e a sobrecarga mental de trabalho em várias de suas dimensões. .

OBJETIVO: analizar la percepción de Factores psicosociales y Carga mental de trabajo de enfermeras/os que laboran en Unidades Críticas. Se hipotetiza que los/as enfermeros/as de estas unidades pudieran percibir riesgos psicosociales; Mostrarán una Carga mental de trabajo alta; y la dimensión psicosocial relacionada con exigencias cognitivas del puesto explicará en mayor medida la Carga Mental. MÉTODO: estudio cuantitativo, de diseño descriptivo, transversal y comparativo. Se censó el 91% de la población de Unidades Críticas de tres hospitales chilenos, correspondiente a 111 enfermeras/os. Los instrumentos utilizados fueron: (a) Cuestionario de antecedentes biosociodemográficos; (b) Cuestionario SUSESO-ISTAS 21; y (c) Escala Subjetiva de Carga Mental de Trabajo (ESCAM). RESULTADOS: el 64% y el 57% de los/as participantes perciben un alto nivel de exposición a los riesgos psicosociales Demandas psicológicas y Doble presencia, respectivamente. Además, se obtiene un nivel de Carga mental global media-alta. Se obtuvo correlaciones positivas y significativas entre algunas dimensiones de SUSESO-ISTAS 21 y ESCAM, y mediante un análisis de regresión se obtuvo que tres dimensiones del cuestionario de riesgos psicosociales contribuyen a explicar un 38% de la Carga mental global. CONCLUSIÓN: las/os enfermeras/os de unidades críticas, perciben factores psicosociales inadecuados y sobrecarga mental de trabajo, en varias de sus dimensiones. .

Desenvolvimento das significações de si em crianças na perspectiva dialógico-cultural / The development of self meaning-making in children from a dialogic cultural perspective / Desarrollo de las significaciones de sí en niños en la perspectiva dialógico-cultural

A partir da abordagem da Psicologia Cultural e da Teoria do Self Dialógico, o objetivo da pesquisa consistiu em caracterizar e analisar as significações de uma criança em fase de transição da Educação Infantil (EI) para o Ensino Fundamental (EF) relativas às suas percepções e avaliações de si. Utilizando uma metodologia qualitativa de caráter idiográfico, acompanhamos um grupo de crianças durante seu último semestre na EI e os primeiros seis meses no EF, realizando observações diretas e sessões semiestruturadas diversas, devidamente filmadas, e entrevistas com pais e professores. Neste artigo analisamos o estudo de caso de Gisele, identificando três campos afetivo-semióticos (CAS) que configuram seu sistema de Self: ser versus não ser bonita, ser versus não ser inteligente e ser versus não ser amada. Estes três campos afetivo-semióticos evidenciam as fortes tensões no Self de Gisele. Com base nos dados obtidos, verificamos que a transição da EI para o EF permitiu a configuração e reconfiguração de diversos campos afetivo-semióticos no sentido da transformação e equilíbrio (desenvolvimento) do sistema de Self de Gisele. Isto ocorreu mediante a emergência de novas significações de si no contexto da dinâmica no interior dos referidos campos. Evidenciamos situações de conflito e a configuração de opostos capazes de levar à síntese de novos sentidos do Self dialógico em desenvolvimento.

Based on Cultural Psychology and the Dialogical Self Theory, the main goal of this study was to analyze the meaning making processes of a child in her transition from Preschool to Elementary School, regarding her Self-perceptions and Self-evaluations. Using a qualitative methodology with an idiographic focus, we followed a group of children during their last semester at Preschool and first semester at an Elementary School. We carried out direct observations, and semi-structured sessions, properly filmed, and interviews with the selected kids' parents and teachers. This article analyzes Gisele's case study. As a result of the empirical research, we identified three affective-semiotic fields that configure Gisele Self system: to be versus not be pretty, to be versus not be smart and to be versus not be loved. These four affective-semiotic fields highlight the tensions in Gisele self system. According to the results, the transition from Preschool to Elementary School configured and reconfigured several affective-semiotic fields towards the balance as well as the transformation (development) of Gisele Self system. The emergence of new Self-meanings provided for the dynamics inside the fields. We demonstrate how some conflicts and the emergence of opposites may eventually lead to the synthesis of new directions in dialogical Self development.

A partir del enfoque de la psicología cultural y de la Teoría del Self Dialógico, el objetivo de la presente investigación consistió en caracterizar y analizar las significaciones de un niño en fase de transición de la Educación Infantil-EI para la Educación Básica-EB, relacionadas a sus percepciones y evaluaciones de sí. Con el uso de una metodología cualitativa de carácter ideográfico, acompañamos a un grupo de niños durante su último semestre en la EI y los primeros seis meses en la EB, realizando observaciones directas y sesiones semiestructuradas diversas, debidamente filmadas, y entrevistas con padres de familia y profesores. En este artículo, analizamos el estudio de caso de Giselle, identificando tres campos afectivo-semióticos (CAS) que configuran su sistema de self: ser versus no ser bonita; ser versus no ser inteligente y ser versus no ser amada. Estos tres campos afectivo-semióticos evidencian las fuertes tensiones en el self de Giselle. Con base en los datos obtenidos, verificamos que la transición de la EI para la EB permitió la configuración y reconfiguración de diversos campos afectivo-semióticos en el sentido de la transformación y el equilibrio - o sea, desarrollo - del sistema de self de Giselle. Esto ocurrió mediante la urgencia de nuevas significaciones de sí en el contexto de la dinámica en el interior de los referidos campos. Evidenciamos situaciones de conflicto y la configuración de opuestos, capaces de llevar a la síntesis de nuevos sentidos del self dialógico en desarrollo.

Validación de escala subjetiva de carga mental de trabajo en funcionarios/as universitarios / Validation of subjective mental workload scale in academics staff

Objetivo: Evaluar las características psicométricas de la Escala Subjetiva de Carga Mental de Trabajo (ESCAM). Material y método: La población de este estudio estuvo constituida por 56 personas de ambos sexos, obtenidos a través de un censo a los y las funcionarios/as de dos facultades de una universidad chilena, quienes respondieron la Escala Subjetiva de Carga Mental de Trabajo y cuestionario de Evaluación de Riesgos Psicosociales. La fiabilidad fue comprobada con el coeficiente de alfa de Cronbach; para la validez de contenido, la escala fue revisada por expertos ad hoc; la validez de constructo fue evaluada por análisis factorial con rotación Varimax, y la validez de criterio se midió al correlacionar los resultados de la escala con el instrumento validado SUSESO-ISTAS 21. Resultados: Se obtuvo una adecuada confiabilidad (a=0.79), además una validez de contenido por análisis de expertos y prueba piloto; validez de criterio por análisis factorial; y validez de constructo por correlación de Pearson, las que confirmaron la estructura multidimensional de escala. Conclusiones: ESCAM es un instrumento fiable y válido para evaluar la percepción de Carga Mental de Trabajo.

Objective: Evaluate the psychometric characteristics of the Subjective Mental Workload Scale (SMWS). Materials and methods: the sample of this study consisted of 56 persons of both genders, obtained through a census of the staff of two faculties of a Chilean university, who answered the Subjective Mental Workload Scale and the psychosocial risks evaluation questionnaire. The reliability was verified by Cronbach alpha coefficient, for the validity of content, the scale was checked by ad hoc experts. Constructo validity was evaluated by factorial analysis with Varimax rotation, and the criterion validity was measured when the results of the scale were correlated with the validated instrument SUSESO-ISTAS 21. Results: the multidimensional structure of the scale was confirmed, with a suitable reliability (a=0.79), the criterion validity by factorial analysis, and the constructo validity by Pearson correlation. Conclusion: SMWS is indicated as a reliable and valid instrument to evaluate the Mental Workload Perception.

Humor gráfico y comprensión de deseos / Graphic Humor and Understanding of Desires

El presente artículo tiene como propósito documentar la comprensión de los deseos a partir de dos aproximaciones: situaciones que utilizan el humor gráfico y situaciones clásicas de preferencias con niños entre 2.8 y 3 años. Se trabaja con el método microgenético combinado con un estudio en series de tiempo durante 10 sesiones de aplicación (dos meses y medio). Se realizan dos tipos de análisis, uno intragrupo y uno intraindividual que permite capturar los diversos caminos por los cuales transitan los niños al enfrentarse a las tareas. Los resultados arrojan la identificación de tres tendencias en los desempeños: estable, descendente y ascendente. Igualmente, se pone en evidencia la importancia de trabajar otras vías para el estudio de los procesos cognitivos en términos metodológicos y se confirma el humor gráfico como alternativa para el estudio de los estados mentales.

This paper aims to document the understanding of desires from two approaches, one is graphic humor and the other is preferences with children between two years eight months and three years. Methodologically, we work with the microgenetic method combined with a time-series study over 10 sessions for two months. Two types of analysis are used, an intra-group and through an intra-subject one; the latter captures the various ways which children go when faced with tasks. The results identify three trends in performance: stable trend, downward trend, and upward trend. They also show the importance of working on other ways for the study of cognitive processes in terms of methodology and these results confirm graphic humor as an alternative for the study of mental states.

Atención en salud para migrantes: un desafío ético / Atenção na área da saúde para migrantes: um desafio ético / Health care for migrants: an ethical challenge

El artículo tiene como propósito evidenciar que el fenómeno migratorio en aumento en la sociedad actual, ha traído consigo oportunidades, pero también dificultades para sus protagonistas. La población migrante corresponde a un grupo vulnerable, especialmente en problemas sanitarios. La atención en salud del migrante representa un reto para la salud pública, no solo considerando políticas de acceso y de información, sino que sobre todo por la atención basada en un trato humanizado respetando las creencias, valores y expectativas. Una atención digna exige un compromiso real de los estados y sensibilidad de los proveedores de atención de los servicios de salud, si se pretende otorgar servicios integrales basados en el respeto de los derechos humanos a esta población.

O artigo tem como propósito evidenciar que o fenômeno migratório em aumento na sociedade atual, vem trazendo consigo oportunidades, mas também dificuldades para seus protagonistas. A população migrante corresponde a um grupo vulnerável, especialmente em problemas sanitários. A atenção ao migrante na área da saúde representa um desafio para a saúde pública, não considerando somente políticas de acesso e de informação, mas, sobretudo, pela atenção baseada num trato humanizado que respeite as crenças, valores e expectativas. Uma atenção digna exige um compromisso real dos estados e sensibilidade dos provedores de atenção dos serviços de saúde, se se pretende outorgar serviços integrais baseados no respeito dos direitos humanos a esta população.

This article aims to show that the growing phenomenon of migration in today's society has provided this community with opportunities, but also with difficulties. The migrant population is a vulnerable group, especially in sanitary matters. Health care for migrants presents a challenge for public health, not only in terms of policies regarding access and information, but most of all in matters of attention based on humanized treatment that is respectful of beliefs, values, and expectations. Dignified care demands a real commitment from the State and sensitivity on the part of health care service providers in order to offer the migrant population holistic services based on respect for their human rights.

Tres debates fundamentales en el campo de la teoría de la mente: aspectos teóricos y metodológicos / Three fundamental discussions in the field of the theory of mind: theoretical and methodological approaches / Três debates principais no campo da teoria da mente: aspetos teóricos e metodológicos

El objetivo de este artículo es analizar tres de los debates más representativos en el campo del desarrollo de la Teoría de la Mente (TdM) en los niños. Para este efecto se discutirán los siguientes temas: 1) el término TdM (Premack y Woodruff, 1978; Reddy, 2008; Wellman 1990/1995); 2) los mecanismos cognoscitivos involucrados en la comprensión de la TdM (Perner, 1991/1994; Leslie, 1987, 1994; Reddy, 2008); y 3) las tareas utilizadas para medir la TdM (Chandler, Fritz y Hala, 1989; Reddy, 2008; Wimmer y Perner, 1983). Las conclusiones apuntan a un cuestionamiento del término, a una mirada más amplia de las teorías que sustentan los mecanismos cognoscitivos y a una postura crítica de las estrategias metodológicas utilizadas en estos estudios.

The aim of this paper is to analyze three of the most representative debates in the field of development of children's Theory of Mind (ToM). This paper will discuss the following topics: 1) the term ToM (Premack and Woodruff, 1978; Reddy, 2008; Wellman 1990/1995); 2) the cognitive mechanisms involved in understanding ToM (Perner, 1991/1994; Leslie, 1987, 1994, Reddy, 2008); and 3) the tasks used to measure ToM (Chandler, Fritz and Hala, 1989; Reddy, 2008, Wimmer and Perner, 1983). The findings point to a questioning of the term, a broader view of the theories underlying cognitive mechanisms and a critical stand of the approaches used in these studies.

Neste artigo se analisam três debates representativos na área de desenvolvimento da Teoria da Mente (TdM) em crianças. Para o efeito, se debatem os seguintes assuntos: 1) o termo TdM (Premack e Woodruff, 1978; Reddy, 2008; Wellman 1990, 1995), 2) os mecanismos cognitivos envolvidos na compreensão do TdM (Perner, 1991, 1994; Leslie, 1987, 1994, Reddy, 2008), e 3) as tarefas utilizadas para medir a TdM (Chandler, Fritz e Hala, 1989; Reddy, 2008; Wimmer e Perner, 1983). As conclusões apontam para um questionamento do termo, uma visão mais ampla das teorias subjacentes aos mecanismos cognitivos e uma posição crítica das abordagens metodológicas utilizadas nestes estudos.

La salud como derecho en Colombia: 1999-2007 / A saúde como direito na Colômbia: 1999-2007 / Right to health in Colombia: 1999-2007

Se presenta un estado del arte basado en producción publicada sobre la salud como derecho en la última década. La metodología, enmarcada en el enfoque Cualitativo, utiliza técnicas de análisis de contenido y de discurso. Se aplicaron instrumentos con descriptores como: objetivos, temáticas, actores, enfoque y resultados. De los hallazgos pueden destacarse preocupaciones por la agudización de la crisis hospitalaria, el problema laboral y su relación con la salud, las barreras de acceso a los servicios y el deterioro de la salud pública. El estudio muestra dos perspectivas para configurar la política de salud: la libertad de mercado como mejor opción para asegurar la atención a la salud o la garantía de la salud desde el Estado como responsable fundamental.

We are presenting a state of art based on published books and articles on health as a right in the last decade. The methodology is part of the qualitative approach, using techniques of content analysis and discourse analysis. We applied instruments with descriptors such as: objectives, themes, actors and results. Among the findings may highlight concerns over the worsening of the hospital crisis, the labor problem and its relation to health, access barriers to services and the deteriorating situation of public health The balance shows two perspectives to set health policy: the free market as the best option to ensure the health attention or the guarantee of health from the State as a fundamental responsable.

Apresenta-se um estado da arte baseado na produção publicada sobre a saúde como direito na ultima década. A metodologia enfoca um estudo qualitativo, utilizando técnicas de análise de conteúdo e discurso. Utilizaram-se instrumentos com descritores como: objetivos, temáticas, atores, enfoque e resultados. Dos resultados, destacam-se: preocupações pelo crescimento da crise hospitalaria, o problema laboral e sua relação com a saúde, as barreiras de acesso aos serviços, e o deterioro da saúde pública. O estudo ilustra duas perspectivas para configurar a política de saúde: a liberdade do mercado como melhor opção para segurar a atenção à saúde; ou a garantia da saúde desde o Estado como responsável fundamental.

Evaluación de calidad de resúmenes de tesis de un programa de magíster en enfermería / Quality assessment of theses abstracts from a nursing master's degree program

El artículo presenta un estudio de tipo cuantitativo, descriptivo, correlacional, retrospectivo, cuyo objetivo es la evaluación de calidad de resúmenes de tesis de un programa de magíster en enfermería en una universidad chilena. La población en estudio quedó constituida por 84 resúmenes disponibles desde el período comprendido entre 1983-2007. El instrumento recolector de datos utilizado fue la pauta de evaluación de artículos científicos elaborada por Bobenrieth (2002) en las dimensiones de: título, identificación de autores y cuerpo del resumen, las que fueron modificadas para esta investigación. Los resultados muestran que el 85, 7 por ciento de los autores de los resúmenes corresponden a enfermeras del mundo académico y que el abordaje metodológico de los estudios es cuantitativo en un 92, 9 por ciento. Se constató que ninguno de los resúmenes evaluados logró el máximo puntaje en la escala. Las principales deficiencias detectadas son en la extensión de las palabras del título, la identificación incompleta de los autores y las conclusiones no relacionadas con objetivos ni resultados planteados. Resultó estadísticamente significativa la correlación de año de ingreso del autor y puntaje obtenido en la evaluación de calidad de los resúmenes de tesis (p=0,03). Llama la atención la gran dispersión de fenómenos estudiados. Se concluye que a año más reciente de ingreso del alumno al programa, mayores puntajes en la calidad de los resúmenes de las tesis. Existen aspectos dentro de las diferentes dimensiones evaluadas que requieren ser mejorados para elevar la calidad de la producción científica del postgrado.

This paper presents a quantitative, descriptive, correlational and retrospective study whose purpose is to assess the quality of theses abstracts from a Nursing Master's Degree Program in a Chilean university. The study considers 84 abstracts available since 1983-2007. The data was collected for this study using the assessment instrument for scientific articles proposed by Bobenrieth (2002) that considers: title, identification of authors, and the abstract, which were modified for this study. The results show that 85.7 percent of the abstract authors are nurses working in the academic world and that the methodological approach of the studies is 92.9 percent quantitative. We found that none of the abstracts evaluated obtained the maximum score. The main deficiencies detected were the number of words in the titles, incomplete author data, and the conclusions, which were unrelated either to the objectives or the results proposed. The correlation between the author's year of entry into the program and the score obtained in the quality assessment of the theses abstracts was statistically significant (p=0.03). We can conclude that the more recent the year of entry of the student into the program, the higher the scores in the quality of the abstracts. Certain aspects of the different dimensions evaluated need to be improved in order to increase the quality in the scientific production of the postgraduate program.