Sistematización teórica para un estudio sobre el envejecimiento poblacional como fenómeno polisémico

El envejecimiento poblacional es uno de los problemas más latentes en la realidad actual cubana. Según cifras de la ONEI la población de más de 60 años asciende a más de dos millones de personas. Este es un fenómeno presente a lo largo del ciclo vital desde el mismo proceso de la concepción hasta la muerte; el que, a pesar de ser un fenómeno natural conocido por todos, ha resultado a muchos difícil aceptarlo como una realidad innata a todo ser. Dada la gran complejidad de los cambios que se producen durante el mismo, no ha de sorprender la existencia de más de 300 teorías a los fines de explicar el dónde, el cómo y el porqué de estos cambios. En el presente artículo se caracteriza doctrinalmente el fenómeno del envejecimiento poblacional en Cuba como proceso irreversible, único, individual, universal de cambio que involucra todas las dimensiones del ser humano y disminuye la velocidad de los procesos del cuerpo; sustentado su análisis en los fundamentos teóricos del mismo, así como en la visión totalizadora, que permite asumirlo como totalidad dialéctica, por ello se asume como objetivo Sistematizar una concepción teórica y metodológica que sustente el carácter polisémico del proceso de envejecimiento de la población. El estudio se desarrolla en el momento actual, como parte de un proceso de investigación que se acomete en el Tribunal Provincial de La Habana.

Population aging is one of the most latent problems in the current Cuban reality. According to ONEI figures, the population over 60 years of age amounts to more than two million people. This is a phenomenon present throughout the life cycle from the very process of conception until death; which, despite being a natural phenomenon known to all, has been difficult for many to accept as an innate reality to all beings. Given the great complexity of the changes that occur during it, it is not surprising that there are more than 300 theories in order to explain the where, how and why of these changes. In this article, the phenomenon of population aging in Cuba is doctrinally characterized as an irreversible, unique, individual, universal process of change that involves all dimensions of the human being, and slows down the processes of the body; Supporting its analysis on its theoretical foundations, as well as on the totalizing vision, which allows it to be assumed as a dialectical totality, for this reason it is assumed as an objective to Systematize a theoretical and methodological conception that supports the polysemic nature of the aging process of the population. The study is being carried out at the present time, as part of an investigation process that is being undertaken in the Provincial Court of Havana.

Ventilación de alta frecuencia oscilatoria en la Unidad de Cuidado Intensivo Neonatal del Hospital de San José, Bogotá DC, Colombia / High frequency oscillatory ventilation in the Neonatal Intensive Care Unit of San José Hospital, Bogota DC, Colombia

Objetivo: Describir la experiencia con la ventilación de alta frecuencia oscilatoria (VAFO) en recién nacidos, atendidos en la Unidad de Cuidado Intensivo Neonatal del Hospital de San José de Bogotá DC entre mayo de 2012 y mayo de 2014, y reportar la mejoría a las 6h de iniciada. Materiales y métodos: Serie de casos con recolección retrospectiva. Se analizaron datos demográficos, diagnóstico, parámetros clínicos y ventilatorios usados, su repuesta clínica y desenlaces. Resultados: Veinticuatro neonatos requirieron VAFO. La edad gestacional promedio fue de 36,5±3,7 semanas. El principal diagnóstico fue hernia diafragmática congénita (n = 15; 62%). Previo a la VAFO se usó la ventilación mecánica convencional en el 70%. Antes de la VAFO todos presentaban baja oximetría y en los que se reportaron gases arteriales (n = 16) hubo un trastorno de oxigenación severo, con mejoría a las 6h de iniciada la VAFO, aumento de 36+ mmHg en la PaO2 y disminución de 8 puntos en el índice de oxigenación (n = 9). La pCO2 tuvo un descenso de 11,5±3mmHg y el pH un aumento de 0,10±0,35. El 79% de los pacientes recibieron inotrópicos. La supervivencia fue del 29%, y el 100% requirió oxígeno complementario al egreso. Conclusión: Se observó que la VAFO mejora los trastornos de oxigenación y el equilibrio ácido base en las primeras 6h de iniciada en pacientes con enfermedades pulmonares severas. El desenlace depende más de la enfermedad de base que aqueja al paciente y sus complicaciones.

Objective: To describe the experience with high frequency oscillatory ventilation (HFOV) in newborns admitted to the Neonatal Intensive Care Unit of San José Hospital, Bogota DC between May 2012 and May 2014, and report the improvement in the initial 6 hours. Materials and methods: A retrospective study based on a series of cases, in which an analysis was performed on the demographic data, diagnoses, clinical parameters and ventilators used, as well as the response and outcomes. Results: A total of 24 neonates, with a mean age of 36.5 (±3.7) weeks, required HFOV. The main diagnosis (15; 62%) was congenital diaphragmatic hernia. Conventional mechanical ventilation was used prior to HFOV in 70% of cases. Before HFOV, all of them had a low oxygen levels by oximetry and the arterial blood gases (n = 16) showed a severe oxygenation disorder, which improved 6 hours after starting on HFOV. The PaO2 increased by 36+mmHg and there was a decrease of 8 points in the oxygenation index (n= 9). The pCO2 decreased by 11.5±3mmHg and the pH increased by.10±.35. Inotropic drugs were administered to 79% of the patients. The survival rate was 29% and 100% required complementary oxygen at discharge. Conclusion: It was observed that HFOV improved the oxygenation disorders and the acidbase balance in the first 6 hours after being started in patients with severe lung diseases. The outcome depends more on the underlying disease suffered by the patient and its complications.

Perspectiva bioética acerca de la capacidad y el ejercicio de la autonomía de la voluntad de los enfermos de Alzheimer / Bioethics perspective about the capacity and autonomy of alzheimer's patients / Perspectiva bioética sobre a capacidade e exercício da autonomia da vontade pelos portadores da doença de alzheimer

A partir de la transdisciplinariedad a la que obliga el tema desde una perspectiva bioética, se analizan las condiciones que deben caracterizar el ejercicio de la autonomía de un enfermo de Alzheimer en estadios leves de la enfermedad, cuando ésta se ejercita en previsión de su propia y futura incapacidad, para así proteger su persona y sus bienes. Se vinculan la autonomía de la voluntad con la libertad, las características de esta enfermedad, la capacidad de las personas y su necesaria relación con la competencia. De tal forma que la bioética sea el puente necesario entre la enfermedad de Alzheimer y el ejercicio válido de la autonomía de la voluntad de esto enfermos...

The analysis of the conditions, that should characterized the autonomy of an Alzheimer's patient in mild stages of the disease, should be made through the transdiciplinarity imposed to this subject by the bioethics perspective, in the cases that this autonomy is exercised in anticipation of its own and future inability to protect their person and properties. The autonomy has a thigh relation with their freedom, the particularities of this disease, people's capacities and its necessary link with the competence. This way bioethics is the necessary bridge between Alzheimer's disease and the valid autonomy exercise of this patient's autonomy...

A partir da transdisciplinaridade que o tema obriga desde uma perspectiva bioética, são analisadas as condições que devem caracterizar o exercício da autonomia de um portador da doença de Alzheimer em estados leves da doença, quando ela é exercida em previsão de sua própria e futura incapacidade, para assim proteger sua pessoa e seus bens. Vincula-se a autonomia da vontade com a liberdade, com as características desta doença, com a capacidade das pessoas e sua necessária relação com a competência, de tal forma que a Bioética seja a ponte necessária entre a doença de Alzheimer e o exercício válido da autonomia da vontade destes doentes...

Introspección hacia su condición de un grupo de pacientes puertorriqueños con trastornos mentales / Introspection into the condition of the group of puertorican patients with mental disorders

The purpose of this study was to explore the degree of insight towards their condition of a group of Puerto Rican mental patients. A non-probabilistic (n = 51) sample was used for convenience and availability from the total patient population with mental conditions who received treatment, during June 1997, in a Diagnostic and Treatment Center (DTC) of the Puerto Rico Department of Health. Descriptive statistics were used, as well as the Cramer chi-square and the Mann Whitney t-test. Fifty two percent of the participants had a high level of insight and the participant's gender (t = 1.92, p = 0.05). Males obtained a higher average grading in the insight scale than females. It was expected that the studied population would be stable in their conditions since they were being treated at the outpatient level. Even so, almost half of the patients had a low level of insight towards their conditions. Implications of these results are very important for health education efforts, since almost half of the patients do not understand that they suffer a serious mental disturbance.

Obstetras y pediatras: Experiencia con la lactancia materna en sus programas de residencia / Obstetricians and pediatricians: experience with breastfeeding in their residency programs

A prior study had the objective of identifying knowledge and experience on breastfeeding of obstetricians and pediatricians in two private hospitals of the Metropolitan Area of San Juan, Puerto Rico. This study presents the experience of those physicians regarding breastfeeding education during their residency training. An exploratory research design was used, the sample was non-probabilistic and was selected according to availability for participation among the physicians who visited those hospitals during June, 1997. The studied sample included 29 pediatricians and 26 obstetricians. Descriptive statistics and crosstab tables were used to describe the results. It was found that participating physicians had little or no exposition to breastfeeding related topics during their respective residency programs. They are aware of the importance of their role in the achievement of successful breastfeeding. They perceive themselves as effective in stimulating breastfeeding although they recognize that they should have received better training on the subject. This attitude is worrisome in face of the fact that this same group presented significant deficiencies in a previous study with regards to knowledge in the management of breastfeeding.

Ginecólogos-obstetras y pediatras: conocimientos y experiencia hacia la lactancia materna / Gynecologists-obstetricians and pediatricians: knowledge and experience concerning breast feeding

The objective of this study was to identify the level of knowledge and the experience towards breastfeeding of medical personnel (obstetricians and pediatricians) in two private hospitals in Metropolitan San Juan, Puerto Rico. An exploratory research design was used for the study. The studied population consisted of obstetricians and pediatricians practicing in those hospitals. The sample was non-probabilistic and was selected according to availability for participation among the physicians who visited those hospitals in June 1997. The sample was made up of 55 physicians (29 pediatricians and 26 obstetricians). Descriptive statistics, crosstab tables, chi square and Fisher Exact tests were used to establish association between the physician's specialty and his/her knowledge and experience on breastfeeding. It was found that both the pediatricians and the obstetricians studied had lack of knowledge in areas related to breastfeeding and little practical experience in the management of breastfeeding