Ergonomia en actividades académicas desde casa

Introducción: A consecuencia de la emergencia sanitaria por el virus SARS-CoV2, las actividades académicas migraron de forma repentina a un entorno de trabajo remoto; esto provocó que los hogares de todo el mundo se convirtieran en el asentamiento urgente de las estaciones de trabajo académico. La ergonomia como disciplina científica cobra relevancia al ser un aliado subsanador para mitigar los riesgos asociados con la aparición de lesiones musculoesqueléticas. De acuerdo con la memoria estadística del Instituto Mexicano de Seguridad Social, IMSS1, en el primer año de pandemia de COVID-19 se registraron 30 860 atenciones por lesiones en la región de manos y muñecas, 9696 en la zona de cabeza y cuello, 6251 dorsopatías y 1673 atenciones por astenopia a jóvenes de entre 18 a 29 años que desarrollaban actividades escolares. Objetivo: En este sentido, se aborda la presente investigación para conocer la composición de los espacios de trabajo académico en casa y analizar si existen factores o elementos que incidan en el riesgo de lesiones musculoesqueléticas en los estudiantes del nivel superior. Metodología: A través de un modelo de ecuaciones estructurales que cuenta con el constructo latente de las posibles lesiones (PL) en manos, espalda, piernas, cabeza, vista, oído, agotamiento físico y la respiración, las variables observables se atribuyen a los espacios utilizados para las actividades académicas en casa, muebles y equipos, Condiciones y Medio Ambiente (CyMAT). Resultados y discusión: Se encontró que un mal diseño de la estación de trabajo académico en casa, aunado a la utilización inadecuada de los muebles y equipos, aumenta la posibilidad de presentar síntomas asociados con las LMEs y, por tanto, daños en la salud del estudiante. Conclusión: La mediación de las estaciones de trabajo a través de la implementación de elementos ergonómicos mejora de forma sustancial la calidad de trabajo académico en casa, y hace evidente la importancia de la ergonomía como disciplina científica.

Introduction: As a result of the health emergency of the SARS-CoV2 virus, academic activities suddenly migrated to a remote work environment, causing homes around the world to become the urgent settlement of academic workstations. Ergonomics as a scientific discipline becomes relevant as it is a healing ally to mitigate the risks associated with the appearance of musculoskeletal injuries. According to the statistical report of the Mexican Institute of Social Security, IMSS1, in the first year of the COVID 19 pandemic, 30,860 care for injuries in the hands and wrists region, 9,696 in the head and neck area, 6,251 dorsopathies and 1,673 care for asthenopia were registered to young people between 18 and 29 years old who develop school activities. Objective: In this sense, this research is addressed to know the composition of academic workspaces at home and analyze if some factors or elements affect the risk of musculoskeletal injuries in students of the higher level. Methodology: Through a structural equations model that has the latent construct of possible injuries (PL) in the hands, back, legs, head, eyesight, hearing, physical exhaustion, and breathing; the observable variables are attributed to the spaces used for academic activities at home, furniture and equipment, conditions and environment (CyMAT) Results and discussion: It is explored that a bad design of the academic workstation at home coupled with the inappropriate use of furniture and equipment increases the possibility of presenting symptoms associated with SCI and therefore, damage to the student's health. Conclusion: The mediation of workstations through the implementation of ergonomic elements substantially improves the quality of academic work at home, making evident the importance of ergonomics as a scientific discipline

Parenteral nutrition: the prison that allows survival in the face of intestinal failure

Objective: Intestinal failure refers to a reduction in intestinal function that necessitates intravenous supplementation of macronutrients, water, or electrolytes due to the intestine's inability to absorb these substances adequately to maintain health and growth. This study aims to explore the experiences and challenges faced by patients enrolled in the intestinal rehabilitation program at Hospital Pablo Tobón Uribe in Medellín. Methodology: This qualitative study adopts a hermeneutic approach and utilizes grounded theory techniques. The sampling process involved both selective and theoretical sampling. A total of 20 semi-structured interviews were conducted, with eight interviews including contributions from family members. The data analysis commenced with open coding, followed by the grouping of codes into descriptive categories. Dimensions and properties were identified within these categories, and analytical categories were subsequently developed through axial and selective coding. This iterative process led to the emergence of the final paradigm matrix. Results: The study revealed that the healthcare system inadequately addresses the needs and expectations of patients with intestinal failure, leading to increased uncertainty about the disease's origin and future prognosis. Intestinal failure and its treatment disrupt various aspects of patients' lives, including personal, family, and work domains. Social stigmatization and rejection are prominent, underscoring the importance of support from family and close individuals in facilitating adaptation and revaluing life. Conclusions: Coping with the challenges of intestinal failure entails embracing the necessity of relying on parenteral nutrition, which is perceived as a prison that paradoxically enables survival.

Objetivo: la insuficiencia intestinal es la reducción de la función intestinal que requiere la suplementación intravenosa de macronutrientes, agua o electrolitos, pues el intestino no logra la absorción mínima para mantener la salud y el crecimiento. El objetivo es comprender el significado que tiene afrontar la condición de insuficiencia intestinal en pacientes que pertenecen al programa de rehabilitación intestinal del Hospital Pablo Tobón Uribe de Medellín. Metodología: estudio cualitativo con enfoque hermenéutico que utilizó técnicas de la teoría fundamentada. El muestreo fue primero selectivo y luego teórico. Se realizó un total de 20 entrevistas semiestructuradas; 8 de las cuales tuvieron el aporte de familiares. El análisis inició por la codificación abierta. Los códigos obtenidos se agruparon en categorías descriptivas, y en ellas se identificaron dimensiones y propiedades que se utilizaron para elaborar categorías analíticas mediante la codificación axial y selectiva que permitió emerger la matriz del paradigma final. Resultados: las necesidades y expectativas de los pacientes con insuficiencia intestinal no son suficientemente atendidas por el sistema de salud, lo que genera mayor incertidumbre sobre el origen de la enfermedad y aún más sobre su futuro. La insuficiencia intestinal y su tratamiento trastornan la vida personal, familiar y laboral. El rechazo social es marcado, por lo que el apoyo familiar y de las personas cercanas es fundamental para lograr la adaptación que les permite revalorar la vida. Conclusiones: afrontar la condición de insuficiencia intestinal representa la experiencia de requerir necesariamente de nutrición parenteral, la cual se percibe como una prisión que paradójicamente permite sobrevivir.

Qualidade de vida e comportamentos durante a pandemia da COVID-19: Um estudo transversal / Quality of life and behaviors during the COVID-19 pandemic: A cross-sectional study

Pesquisa transversal com objetivo de analisar a associação entre qualidade de vida e comportamentos desenvolvidos por indivíduos hipertensos durante o período de isolamento social, devido à pandemia da COVID-19. O estudo foi realizado através de ligações telefônicas e avaliou adultos cadastrados na atenção primária de saúde. A prática de atividade física foi avaliada pelo Questionário Internacional de Atividade Física, sendo somadas a duração e a frequência das atividades e o tempo total sentado durante a semana e fim de semana. A qualidade de vida foi analisada através do Sistema Descritivo ­ EQ-5D, considerando o score utilidade e o estado geral de saúde. Presença de doenças e comportamentos durante o isolamento social, assim como aspecto emocional e ambiente para realização de atividades físicas foram analisados. Foram utilizados os testes t de Studant e ANOVA one way para comparação de grupos e ANCOVA para comparações entre os grupos ajustadas. A significância estatística foi pré-fixada em valores inferiores a 5%. Foram entrevistados 659 hipertensos, com idade entre 41 e 93 anos. Observou-se maior qualidade de vida naqueles que praticaram exercício físico (p = 0,015), que não relataram ter a saúde emocional afetada pela pandemia (p = 0,001) e que responderam ter ambiente favorável em casa para prática de atividade física, (p = 0,001). Em conclusão, a qualidade de vida associou-se aos comportamentos positivos dos participantes durante a pandemia, como a prática de atividade física, contudo é necessário que os órgãos públicos se atentem aos baixos níveis de atividade física da população provocados pela pandemia

Cross-sectional research with the objective of analyzing the association between quality of life and behaviors developed by hypertensive individuals during the period of social isolation, due to the COVID-19 pandemic. The study was carried out through telephone calls and evaluated adults registered in primary health care. The practice of physical activity was assessed by the International Physical Activity Questionnaire, adding the duration and frequency of activities and the total time sitting during the week and weekend. Quality of life was analyzed using the Descriptive System ­ EQ-5D, considering the utility score and general health status. Presence of diseases and behaviors during social isolation, as well as the emotional aspect and environment for carrying out physical activities were analyzed. Student's t-test and one-way ANOVA were used for group comparisons and ANCOVA for adjusted between-group comparisons. Statistical significance was pre-set at values below 5%. 659 hypertensive adults aged between 41 and 93 years were interviewed. A better quality of life was observed in hypertensive individuals who practiced physical exercise (p = 0.015), who did not report having their emotional health affected by the pandemic (p = 0.001) and who responded that they had a favorable environment at home for the practice of physical activity, (p = 0.001). In conclusion, QoL was associated with the positive behaviors of the participants during the pandemic, such as the practice of physical activity, however, it is necessary for public agencies to pay attention to the low levels of PA in the population caused by the pandemic

Relación de la seguridad alimentaria en el hogar y la composición corporal de los escolares deportistas de las escuelas deportivas del Gobierno Autónomo Municipal de La Paz, 2020 / Relationship between food security at home and body composition of school sportsmen of the sport schools of the Autonomous Municipal Government of La Paz, 2020

OBJETIVO: determinar la seguridad alimentaria en el hogar y su relación con la composición corporal de escolares que asisten a las Escuelas Deportivas del Distrito Cotahuma del Gobierno Autónomo Municipal de la ciudad de La Paz, 2020. MATERIALES Y MÉTODOS: estudio transversal con componente analítico en 65 deportistas. Determinando la seguridad alimentaria en el hogar y su relación con la composición corporal por medio de medidas antropométricas mediante protocolo ISAK. Se identificó condiciones físicas: fuerza, flexibilidad y resistencia. RESULTADOS: el 58,5% de los hogares contaban con seguridad alimentaria, el resto con algún grado de inseguridad. Gran parte de los escolares presentaron un estado nutricional normal, respecto al área muscular braquial 40% con exceso, y 56,9% normal y seguridad alimentaria en el hogar. Según porcentaje de grasa corporal la mayoría presentó depósitos normales. Del 4,6% de los deportistas que tenían obesidad, el 1,5% correspondió a seguridad alimentaria e inseguridad alimentaria leve y severa respectivamente. Del 3,1% de los escolares que contaban con un área muscular braquial baja, el 1,5% tenían inseguridad alimentaria leve y severa. Se asocia la seguridad alimentaria con la composición corporal (p valor< a 0,05) y un OR: 5 con IC de 1,5 a 17,6. CONCLUSIONES: los deportistas con mejor composición corporal fueron de gimnasia artística y de tenis de mesa. Los escolares que cuentan con Seguridad Alimentaria en el hogar tienen una probabilidad de 5 veces más de presentar una adecuada composición corporal en comparación con hogares que no cuenten con seguridad alimentaria.

OBJECTIVE: To determine food safety at home and its relationship with the body composition of schoolchildren who attend the Sport Schools of the Cotahuma District of the Municipal Autonomous Government of the city of La Paz, 2020. METHOD AND INSTRUMENTS: Cross-sectional study with an analytical component in 65 athletes. Determining food safety in the home and its relationship with body composition through anthropometric measurements using the ISAK protocol. Physical conditions were identified: strength, flexibility and endurance. RESULTS: 58.5% of the households had food security, the rest with some degree of insecurity. A large part of the schoolchildren presented a normal nutritional state, with respect to the brachial muscle area, 40% at home with excess, and, 9% normal and food security in it. According to percentage of body fat, most have normal deposits. Of the 4.6% of athletes who had obesity, 1.5% corresponded to food security and food insecurity level and severe respectively. Of the 3.1% of the schoolchildren who had a low brachial muscle area, 1.5% had level and severe food insecurity. Food safety is associated with body composition (p value <0.05) and an OR: 5 with a CI of 1.5 to 17.6. CONCLUSIONS: the athletes with the best body composition were in artistic gymnastics and table tennis. Schoolchildren with food security at home are 5 times more likely to have adequate body composition compared to households without food security.

The current situation and development of medical humanistic literacy education in medical colleges at home and abroad / 中华医学教育探索杂志

Medical humanistic literacy education is important in modern medical education. In the United States, Britain, Japan and other countries, many medical schools have incorporated medical humanistic literacy education into compulsory courses and attached great importance to its value. However, the humanistic literacy education in domestic colleges has not yet formed a systematic development. This article analyzes the current status and deficiencies of domestic medical humanistic literacy education by comparing the development stages and characteristics of foreign medical humanistic literacy education. This paper puts forward reasonable suggestions on the integration of medical humanistic literacy curriculum from three aspects: medical education structure and modes, teaching methods and the importance attached to medical literacy education, aiming to provide a reference for our country's reform of medical education.

Effect of COVID-19-restrictive measures on ambient particulate matter pollution in Yangon, Myanmar

BACKGROUND@#Particulate matter (PM) is recognized as the most harmful air pollutant to the human health. The Yangon city indeed suffers much from PM-related air pollution. Recent research has interestingly been focused on the novel subject of changes in the air quality associated with the restrictive measures in place during the current coronavirus disease-2019 (COVID-19) pandemic. The first case of COVID-19 in Myanmar was diagnosed on March 23, 2020. In this article, we report on our attempt to evaluate any effects of the COVID-19-restrictive measures on the ambient PM pollution in Yangon.@*METHODS@#We measured the PM concentrations every second for 1 week on four occasions at three study sites with different characteristics; the first occasion was before the start of the COVID-19 pandemic and the remaining three occasions were while the COVID-19-restrictive measures were in place, including Stay-At-Home and Work-From-Home orders. The Pocket PM@*RESULTS@#The results showed that there was a significant reduction (P < 0.001) in both the PM@*CONCLUSIONS@#We concluded that the restrictive measures which were in effect to combat the COVID-19 pandemic had a positive impact on the ambient PM concentrations. The changes in the PM concentrations are considered to be largely attributable to reduction in anthropogenic emissions as a result of the restrictive measures, although seasonal influences could also have contributed in part. Thus, frequent, once- or twice-weekly Stay-At-Home or Telework campaigns, may be feasible measures to reduce PM-related air pollution. When devising such an action plan, it would be essential to raise the awareness of public about the health risks associated with air pollution and create a social environment in which Telework can be carried out, in order to ensure active compliance by the citizens.

Influence of family smoking on children’s exposure to second-hand smoke in rural Taizhou City / 上海预防医学

Objective:To analyze the household smoking behavior of smokers in rural Taizhou City of Zhejiang Province， and to provide the basis for the intervention measures to reduce children's second-hand smoke （SHS） exposure. Methods:The investigation started in May 2018. A total of 418 smoking families in Luqiao and Linhai were included. Field face-to-face questionnaire survey was conducted and cotinine level in children's urine was measured. Kernel density estimation was used for curve fitting. The results were analyzed by Wilcoxon rank sum test and chi square test. Results:The age distribution of smokers in the family was bimodal. The younger smoker group was mainly the parents. The older group was mainly the other relatives such as grandfather. The age started smoking in the parent group was younger than that in relative group， but the average number of cigarettes smoked per day in relative group was higher than that in parent group （P<0.05）. The parent group had higher proportion than the relative group in having family smoking regulations or agreeing not to smoke in the room in the presence of children （P<0.001）.The proportion of the parent group who has heard about third hand smoke and electronic cigarette was higher than that of the relative group （P<0.001）.The detection rates of cotinine in urine of children were 91.05% and 86.96% in parent group and relative group， respectively. The urine cotinine level of the children in the parent group was higher than that in the grandfather group （P=0.049）. Conclusion:Children are more exposed to SHS when the smoker in the household are parents. In order to reduce children's SHS exposure， we should pay more attention to educate the parents with a family based tobacco control program.

Use of High-Flow Nasal Cannula in Users with acute Respiratory Diseases Receiving Hospital at Home / Uso de cánula nasal de alto flujo en usuarios con patologías respiratorias agudas en hospitalizacion domiciliaria

Introduction: Hospital at Home (HAH) is considered an extremely important service, showing great efficacy in the treatment of respiratory diseases. Objectives: To evaluate the effects of high-flow nasal cannulas (HFNCs), describe the experience of patients treated with this therapy as HC and propose a protocol that standardizes the use of this equipment in the context of acute respiratory diseases as home care. Materials and Methods: This was done by means of a quasi-experimental study with patients admitted to HAH between May and September 2019. For the statistical analysis we used Minitab 17.0. Results: 11 subjects met the inclusion criteria, with a mean age of 73 ± 7.8 years. 100% of them (N = 11) had been referred from the emergency service with oxygen requirements. 73.2% (N = 8) were admitted with diseases classified as J15 and J44; 18.1% (N = 2) had diagnosis code J84 and 9% (N = 1) had diagnosis code J46, according to the ICD-10 (International Classification of DiseasesTenth Edition). The mean duration of the HFNC connection was 7.5 ± 5.1 days. We used a mean flow of 35 ± 5.2 L/min, FiO2 of 33 ± 6.1% and a temperature of 32.3 ± 5.1 Degrees Celsius (°C). The clinical signs with statistically significant changes were (Kruskal Wallis, p < 0.05) the BORG Scale, UAM, RR and the SAFI Index. The SpO2 and HR didn't show statistically significant differences. Conclusion: Despite the fact that the number of patients under treatment was low, there are potentially significant effects in parameters of relevance for this type of diseases, and this may serve as a basis for future studies.

Averiguando os caminhos da psicoterapia domiciliar / Ascertaining the ways of home psychotherapy

A psicoterapia domiciliar é uma prática pouco conhecida que, entretanto, adquire importância junto a pacientes com dificuldade de locomoção ou com presença de patologias que dificultem o acesso à hospitais/ clínicas. Tendo em vista a escassez de estudos sobre o tema, este artigo apresenta os resultados de uma pesquisa exploratória sobre o atendimento psicológico domiciliar, realizado com 21 psicólogos da cidade de Curitiba (PR). O objetivo foi identificar o tipo de clientela atendida, quais as abordagens e quais as principais vantagens e desvantagens relacionadas a esse tipo de atendimento. Identificou-se que essa modalidade é mais cômoda para o cliente, mas nem sempre para o profissional. Há predominância de algumas vantagens na psicoterapia realizada em domicílio como manutenção do vínculo terapêutico, maior acesso a informações importantes advindas da observação do ambiente e dos comportamentos espontâneos devido à familiaridade do paciente com o ambiente, o que possibilita novas referências para análise diagnóstica.

Home psychotherapy is a little-known practice that, however, acquires importance among patients with locomotion difficulties or with the presence of pathologies that make access to hospitals / clinics difficult. Considering the lack of studies on the subject, this article presents the results of an exploratory research on home psychological care, performed with 21 psychologists from the city of Curitiba (PR). The objective was to identify the type of clientele served, which approaches and what are the main advantages and disadvantages related to this kind of service. It was identified that this modality is more comfortable for the client, but not always for the professional. There is a predominance of some advantages in home psychotherapy as maintenance of the therapeutic link, greater access to important information from the observation of the environment and spontaneous behaviors due to the patient’s familiarity with the environment, which makes possible new references for diagnostic analysis.

Factores asociados a la violencia contra los adolescentes dentro del hogar en el Perú / Factors associated with violence against adolescents at home in Peru

RESUMEN Introducción: La adolescencia responde a un periodo de madurez y ajuste al mundo adulto, por ello, está influida por el contexto social y familiar, así como por las etapas previas de desarrollo. El objetivo de la presente investigación fue determinar los factores asociados a la violencia contra los adolescentes en su hogar en el Perú. Métodos. Se realizó un análisis secundario de la Encuesta Nacional de Relaciones Sociales 2015. La muestra fue de 1491 adolescentes entre los 12 a 17 años de edad. Se estimaron las razones de prevalencia (RP) crudas y ajustadas (RPa) usando la regresión de Poisson con varianza robusta. Resultados. Se encontró que las mujeres adolescentes (RPa: 1,4; IC 95%: 1,17-1,68) y los adolescentes que viven en hogares donde hay continuas peleas o discusiones entre los padres o los adultos que ahí viven (RPa: 2,75; IC 95%: 2,11-3,57) tienen un mayor riesgo de violencia. Conclusiones . Las mujeres y aquellos adolescentes en cuyas familias hay continuas discusiones entre los padres o adultos tienen un mayor riesgo de sufrir violencia en el hogar.

ABSTRACT Background: Adolescence responds to a period of maturity and adjustment to the adult world; therefore, it is influenced by the social and family context, as well as by the previous stages of development. The objective of the present investigation was to determine the factors associated with violence against adolescents at home in Peru. Methods. A secondary analysis of the National Survey of Social Relations 2015 was carried out. The sample was of 1491 adolescents between 12 to 17 years old. Raw (PR) and adjusted (PRa) prevalence ratios using Poisson regression with robust variance were estimated. Results . It was found that adolescent women (PRa: 1.4; 95% CI: 1.17-1.68) and adolescents who live in homes where there are continuous fights or arguments between parents or adults who live there (PRa: 2.75; 95% CI: 2.11-3.57) have a higher risk of violence. Conclusions. Women and adolescents who live in families where there are continuous arguments between parents or adults have high risk of domestic violence.

Initial and pulp chamber concentration of hydrogen peroxide using different bleaching products / Concentração de peróxido de hidrogênio na câmara pulpar utilizando diferentes produtos clareadores

Objective: This study's aim was to quantify the hydrogen peroxide (HP) penetration into the pulp chamber of teeth submitted to different protocols of bleaching. Material and Methods: Ninety premolars were randomly divided into nine groups according to the bleaching agent protocol (n = 10): control (no bleaching), carbamide peroxide 10% [10% CP], carbamide peroxide 16% [16% CP], carbamide peroxide 22% [22% CP], hydrogen peroxide 4% [4% HP], hydrogen peroxide 6% [6% HP], hydrogen peroxide 7.5% [7.5% HP], hydrogen peroxide 10% [10% HP] and hydrogen peroxide 35% [35% HP]. The penetration of HP was measured via spectrophotometric analysis of the acetate buffer solution from the pulp chamber. The absorbance of the resulting solution was determined in a spectrophotometer and converted into equivalent concentration of HP (µg/ mL). To analyze the concentration of HP, the titration of bleaching agents with potassium permanganate was used. Data were subjected to ANOVA and Tukey's test for pairwise comparison (α = 0.05). Results: Higher concentration of HP in the pulp chamber was found in the HP 35% group (p < 0.0001). No significant difference between at-home protocols were observed (p = 0.64). Titration values showed that the concentration of the products was similar to that claimed by the manufacturer. Conclusion: It follows that the amount of HP that reaches the pulp chamber is not proportional to the concentration of whitening gels, but depends on the application time recommended by the manufacturers (AU)

Objetivo: o objetivo deste estudo foi quantificar a penetração do peróxido de hidrogênio (PH) na câmara pulpar dos dentes submetidos a diferentes protocolos de clareamento. Material e Métodos: Noventa pré-molares foram divididos aleatoriamente em nove grupos, de acordo com o protocolo do agente clareador (n = 10): controle (sem clareamento), peróxido de carbamida 10% [PC 10%], peróxido de carbamida 16% [PC 16%], peróxido de carbamida 22% [PC 22%], peróxido de hidrogênio 4% [PH 4%], peróxido de hidrogênio 6% [PH 6%], peróxido de hidrogênio 7,5% [PH 7,5%], peróxido de hidrogênio 10% [PH 10%] e peróxido de hidrogênio 35% [PH 35%]. A penetração de PH foi medida por análise espectrofotométrica da solução de tampão de acetato da câmara pulpar. A absorvância da solução resultante foi determinada em um espectrofotômetro e convertida em concentração equivalente de PH (µg / mL). Para analisar a concentração de PH, foi utilizada a titulação de agentes clareadores com permanganato de potássio. Os dados foram submetidos à ANOVA e teste de Tukey para comparação pareada (α = 0,05). Resultados: Foi encontrada maior concentração de PH na câmara pulpar no grupo PH 35% (p < 0,0001). Não foi observada diferença significativa entre os protocolos domiciliares (p = 0,64). Os valores de titulação mostraram que a concentração dos produtos era semelhante à reivindicada pelo fabricante. Conclusão: Conclui-se que a quantidade de PH que atinge a câmara pulpar não é proporcional à concentração de géis clareadores, porém depende do tempo de aplicação recomendado pelos fabricantes.(AU)

Dividuación e incomposibilidad de principios éticos en la autogestión del riesgo genotípico / Dividuation and Incompossibility of Ethical Principles in Genotypic Risk Self-management / Dividuação e incompatibilidade de princípios éticos na autogestão de risco genotípico

Propósito/Contexto. Hoy en día, con la posibilidad de detectar la predisposición genética de un número cada vez mayor de enfermedades, incluidos los ampliamente promocionados a nivel mundial y conocidos como "test genéticos del hogar", la genómica comienza a plantear conflictividades que no se consideraban años atrás. Metodología/Enfoque. En este artículo, tales conflictividades son estudiadas con una metodología cualitativa desde la ética de la convergencia de Ricardo Maliandi, en el contexto del concepto de dividuo propuesto por Gilles Deleuze y aplicado a estos avances científicos. Resultados/Hallazgos. Las personas se enfrentan a la nueva realidad de tener marcadores genéticos asociados con riesgos de enfermedades cuya prevención o tratamiento son aún limitados. De esta manera, el proceso de dividuación, a nivel genotípico, aumenta la conflictividad por el surgimiento de nuevas formas de incomposibilidad de óptimos entre los principios éticos. Discusión/Conclusiones/Contribuciones. Con la disponibilidad de estos avances tecnocientíficos, las personas no solamente deben preocuparse por su fenotipo; ahora deben comenzar a autogestionar su genotipo en un contexto de incertidumbre sobre su salud. Resulta necesario considerar el papel de las políticas sanitarias frente a estos desafíos; de sus orientaciones u omisiones dependerán las decisiones de las organizaciones y de la sociedad en general.

Purpose/Context. Today, with the possibility of detecting our genetic predis-position to an increasing number of diseases, including the widely promoted worldwide "at-home genetic testing," genomics has begun to raise conflicts that were not considered years ago. Method/Approach. This article studies such conflicts from Ricardo Maliandi's convergent ethics using a qualitative method, according to Gilles Deleuze' concept of dividual applied to these scientific advances. Results/Findings. People are facing the new reality of having genetic markers associated with risks of diseases whose prevention or treatment is still limited. Then, the dividuation process at the genotypic level increases conflict due to the emergence of new forms of optimal incompossibility between ethical principles. Discussion/Conclusions/Contributions. With these available techno-scienti-fic advances, individuals should not only worry about their phenotype but also about self-managing their genotype amidst the uncertainty of their health. It is necessary to consider the role of health policies in these challenges; the decisions of organizations and society will depend on their guidance or omissions.

Objetivo/Contexto. Hoje em dia, com a possibilidade de detectar a predispo-sição genética para um número cada vez maior de doenças, inclusive aquelas amplamente divulgadas mundialmente e conhecidas como "testes genéticos do lar", a genômica começa a suscitar conflitos que não eram considerados anos atrás. Metodologia/Abordagem. Neste artigo, tais conflitos são estudados com uma metodologia qualitativa a partir da ética da convergência de Ricardo Maliandi, no contexto do conceito de divisão proposto por Gilles Deleuze e aplica-do a esses avanços científicos. Resultados/Descobertas. As pessoas estão enfrentando a nova realidade de ter marcadores genéticos associados a riscos de doenças cuja prevenção ou tratamento ainda é limitado. Desse jeito, o processo de Dividuação, em nível genotípico, aumenta o conflito devido ao surgimento de novas formas de in-compatibilidade de ótimos entre os princípios éticos. Discussão/Conclusões/Contribuições. Com a disponibilidade desses avanços tecno-científicos, as pessoas não se devem preocupar apenas com seu fenótipo; agora eles devem começar a autogerir seu genótipo em um contexto de incerteza sobre sua saúde. É preciso considerar o papel das políticas de saúde diante desses desafios; as decisões das organizações e da sociedade em geral dependerão de suas orientações ou omissões.

Preliminary study on the construction of national major science and technology infrastructure for translational medicine in China / 上海交通大学学报（医学版）

Objective • To explore the preliminary experience of the construction of national major science and technology infrastructure for translational medicine in China, and to provide reference for their future development. Methods • The current situation, experience and enlightenment of major science and technology infrastructure construction at home and abroad were sorted out by literature analysis, relevant recommendations were collected through expert interviews, and the preliminary experience of national major science and technology infrastructure construction for translational medicine in China was summarized. Results • The experience and enlightenment that can be used for reference from the construction of major science and technology infrastructure at home and abroad mainly included 7 aspects, i.e. high-quality team construction, device sharing, industry-academiaresearch collaboration, international cooperation, the cluster effect producing, talents cultivation and the scientific data sharing mechanism. In China, the construction of major science and technology infrastructure for translational medicine started late, and had a good try at the above first 5 aspects, but not so good at the last 2. At the same time, self-experience has been formed in taking full advantages of the supporting institutions and getting funds through multiple channels. Conclusion • The construction of national major science and technology infrastructure for translational medicine in China should learn from the development experience at home and abroad, combine our own characteristics, explore and innovate the system and mechanism, and seek new breakthroughs.

Does the use of reservoirs have any impact on the efficacy of at-home bleaching? a systematic review

Abstract To answer the following focused question through a systematic review: "Are the risk and intensity of tooth sensitivity (TS) and bleaching efficacy different between adult patients who undergo at-home bleaching using trays with reservoirs and those who use trays without reservoirs?". A comprehensive search was performed in the MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library, and grey literature without restrictions. Abstracts from conferences; unpublished and ongoing trial registries, dissertations and theses (ProQuest Dissertations and Periódicos Capes Theses databases) were searched. Only randomized clinical trials (RCTs) were included. We used the Risk of Bias tool (RoB) from the Cochrane Collaboration for quality assessment. After the removal of duplicates, title and abstract screening and full-text examination, nine RCTs remained for qualitative analyses. The great majority of the studies did not report the method of randomization, allocation concealment, and examiner blinding during color assessment. From the nine studies, eight were at unclear risk of bias. In regard to color change, four studies reported no change and two reported improved color change with reservoirs. Only four studies recorded tooth sensitivity and they reported no significant differences. Only one study reported greater gingival irritation with reservoirs. Lack of data reporting prevented us from running a meta-analysis. Further well-designed RCT should be conducted to answer this research question. So far there is not evidence to support that reservoirs in bleaching trays improve color change. PROSPERO - CRD42016037628

Resumo Para responder a seguinte questão de pesquisa através de uma revisão sistemática: "O risco e a intensidade de sensibilidade dentária (SD) e eficácia de clareamento são diferentes entre pacientes adultos que realizam clareamento caseiro usando moldeiras com reservatórios e aqueles que usam moldeiras sem reservatórios?". Uma pesquisa abrangente foi realizada no MEDLINE via PubMed, Scopus, Web of Science, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Cochrane e literatura cinzenta, sem restrições. Os resumos da conferência anual da Associação Internacional para Pesquisa Dental além de estudos registrados ou em andamento também foram pesquisados. Dissertações e Teses foram pesquisados utilizando o Capes Journal Dissertações e Teses ProQuest. Apenas ensaios clínicos randomizados (ECR) foram incluídos. Usamos a ferramenta Risk of Bias (RoB) da Cochrane para avaliação de qualidade. Após a remoção de duplicatas, triagem de título e resumo e exame de texto completo, nove ECRs permaneceram para análises qualitativas. A grande maioria dos estudos não relatou o método de randomização, ocultação de alocação e cegamento do examinador durante a avaliação de cores. Dos nove estudos, oito estavam sob risco claro de viés. Em relação à mudança de cor, quatro estudos não relataram nenhuma mudança e dois relataram melhora na mudança de cor com reservatórios. Apenas quatro estudos registraram a sensibilidade dentária e não relataram diferenças significativas. Apenas um estudo relatou maior irritação gengival com reservatórios. A falta de relatórios de dados nos impediu de executar uma meta-análise. Outros ECR bem desenhados devem ser conduzidos para responder a esta questão de pesquisa. Até agora não há evidências que sustentem que reservatórios em moldeiras de clareamento melhorem a mudança de cor. PROSPERO - CRD42016037628

Prácticas pa ra la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia) / Practices for the prevention of accidents in the home in caregivers of children from 1 to 5 years in a district of Cartagena (Colombia)

Introducción: los accidentes en la población infantil constituyen una importante causa de morbilidad y mortalidad convirtiéndose hoy día en un problema de salud pública mundial, principalmente la población más afectada son los niños en etapa preescolar, por la vulnerabilidad y dependencia del cuidador. Objetivos: describir las prácticas para la prevención de accidentes en el hogar en cuidadores de niños de 1 a 5 años en un barrio de Cartagena (Colombia). Materiales y métodos: estudio cuantitativo descriptivo transversal. Constituido por 354 cuidadores de niños menores de 5 años, se utilizó la técnica de observación y la aplicación del instrumento con base a la práctica N° 15 de AIEPI (Atención Integrada a las Enfermedades Prevalentes de la Infancia). Resultados: socio demográficamente los cuidadores fueron principalmente de género femenino (87%), con 20 ­ 29 años de edad (44,9%), madres de los niños (61,3%), conviven en unión libre (54,2%), son bachilleres (50,3%), de estrato uno (91,8%), amas de casa (62,7%), con hijos (93,8%), residen en casas (54,5%). Los niños de 1 a 5 años fueron mayoritariamente de género masculino (51,7%), y han presentado accidentes (75,1%), sobre todo, caídas (61,9%). El nivel de riesgo de accidentes en el hogar fue bajo (85%), y las prácticas de prevención suelen ser regulares (55,1%). Conclusión: los niños enfrentan relativamente bajo riesgo de accidente en el hogar, sin embargo, las prácticas para prevenirlos resultan ser regulares..(AU)

Introduction: accidents in children are an important cause of morbidity and mortality,becoming today a global public health problem, mainly the most affected population are children in preschool, for the vulnerability and dependence of the caregiver. Objectives:to describe the practices for the prevention of accidents at home in caregivers of children from 1 to 5 years of age, in a neighborhood of Cartagena (Colombia). Materials and methods: quantitative, descriptive and cross-sectional study. Consisting of 354 caregivers of children under 5 years of age, the technique of observation and the application of the instrument was used based on practice No. 15 of IMCI (Integrated Management of Childhood Illness). Results: demographic partner caregivers were mainly female (87%), with 20 - 29 years of age (44.9%), mothers of children (61.3%), live together in a free union (54.2%), are high school graduates (50.3%), of stratum one (91.8%), housewives (62.7%), with children (93.8%), reside in houses (54.5%). Children from 1 to 5 years old were male (51.7%), and had accidents (75.1%), especially falls (61.9%). The level of accident risk in the home was low (85%), and prevention practices are usually regular (55.1%). Conclusion: children face relatively low risk of accident in the home, however, practices to prevent them turn out to be regular..(AU)

Social determinants of health associated with childhood accidents at home: An integrative review / Determinantes sociales de la salud asociados con accidentes domésticos en la infancia: una revisión integradora / Determinantes sociais da saúde associados a acidentes domésticos na infância: uma revisão integrativa

ABSTRACT Objective: to analyze the factors associated with childhood accidents at home according to the levels of the social determinants of health. Method: integrative review of the literature, with research in databases CINAHL, LILACS and PubMed, with the following main descriptors: child; social determinants of health; accidentes, home. We included 31 studies that related the social determinants of health and childhood accidents, in English, Portuguese and Spanish. Results: the proximal determinants identified were: age and sex of children, and ethnicity. Among the intermediate determinants of health, parental behavior, related to the supervision of an adult, prevailed. Parental employment and socioeconomic status were identified as distal determinants. Conclusion: the age and sex of the child, besides direct supervision, were the determinants most associated with accidents. The distal determinants should be better studied because their relation with the occurrence of domestic accidents has not been sufficiently clarified.

RESUMEN Objetivo: analizar los factores asociados a los accidentes domésticos en la infancia según los niveles de los determinantes sociales de la salud. Método: la revisión integradora de la literatura, con investigación en bases de datos CINAHL, LILACS y PubMed, con los siguientes descriptores principales: child; social determinants of health; accidentes, home. Se incluyeron 31 estudios relacionados con los determinantes sociales de la salud y accidentes domésticos en la infancia, en inglés, portugués y español. Resultados: los determinantes proximales identificados fueron: edad y sexo de los niños, y etnia. Entre los intermediarios, prevalecieron el comportamiento parental, relacionado a la supervisión de un adulto. El empleo de los padres y su situación socioeconómica fueron identificados como determinantes distales. Conclusión: la edad y el sexo de los niños, además de la supervisión directa, fueron los determinantes más asociados con los accidentes. Los determinantes distales deben ser más bien estudiados, pues su relación con la ocurrencia de los accidentes domésticos no se mostró suficientemente esclarecida.

RESUMO Objetivo: analisar os fatores associados aos acidentes domésticos na infância segundo os níveis dos determinantes sociais da saúde. Método: revisão integrativa da literatura, com pesquisa em bases de dados CINAHL, LILACS e PubMed, com os seguintes descritores principais: child; social determinants of health; accidentes, home. Foram incluídos 31 estudos que relacionaram os determinantes sociais da saúde e acidentes domésticos na infância, em inglês, português e espanhol. Resultados: os determinantes proximais identificados foram: idade e sexo das crianças, e etnia. Dentre os intermediários, prevaleceram o comportamento parental, relacionado à supervisão de um adulto. O emprego dos pais e a situação socioeconômica foram identificados como determinantes distais. Conclusão: a idade e o sexo da criança, além da supervisão direta, foram os determinantes mais associados aos acidentes. Os determinantes distais devem ser mais bem estudados, pois sua relação com a ocorrência dos acidentes domésticos não se mostrou suficientemente esclarecida.

Aesthetic effect of minimally invasive therapy on stained dental fluorosis / 中华地方病学杂志

Objective To observe the aesthetic effect of low concentration of at-home bleaching combined with microabrasion and resin infiltration on stained dental fluorosis.Methods Twenty-three patients with stained dental fluorosis were selected from June 2017 to June 2018 in Stomatological Hospital of Tianjin Medical University.All patients were treated with minimally invasive whitening technology of microabrasion,10％ low concentration of at-home bleaching and resin infiltration.The aesthetic treatment effect was observed before and after treatment by VITA aesthetic shade guide matching.Stained spots were chosen and colorimetric assay was performed using CMYK shade guide before treatment.According to the color of the splash,the light and shade were divided into light grade,medium grade and heavy grade.The CMYK data of the selected spot and complete decolorization ratio (stain decolorization rate) were recorded 1 week and half a year after treatment.Meanwhile,tooth sensitivity was recorded using visual analogue scale (VAS).Results The shades of 92 teeth of 23 dental fluorosis patients were increased more than 5 degrees after a series of whitening treatment,1 tooth was 2-4 degrees,and the total effective rate was 100.00％ (92/92).Decolorization rates of light grade,medium grade and heavy grade were 100.00％ (100/100),100.00％ (120/120) and 97.78％ (88/90),respectively,1 week after treatment.Half a year after treatment,bleaching decolorization rate had no significant difference compared with that of 1 week after treatment (P ＞ 0.05).Tooth sensitivity was 91.30％ (21/23).Almost all patients had mild and moderate teeth sensitivity during treatment.The symptoms of tooth sensitivity were disappeared after the treatment.Conclusions The whitening technology of microabrasion,10％ low concentration of at-home bleaching and resin infiltration has a significant decolorization whitening effect,and has a certain degree of stability and no sensitive teeth after treatment.It is worthy of clinical application.

The importance of the rate of pure "attended deaths at home" for objective outcome indicator for assessing the prevalence of home care in Japan

BACKGROUND@#No study has yet been performed on the importance of the rate of pure "attended deaths at home," excluding examined deaths subjected to a postmortem examination. Therefore, in the present study, we investigated actual state of pure "attended deaths at home," in order to provide reference data for the future development of end-of-life care at home.@*METHODS@#We performed a detailed survey in Yokohama City according to the type of death, age, and underlying cause of death in cases of home deaths, based on the detailed version of the Vital Statistics Survey Death Forms. Then, we divided deaths occurring in each municipality in Kanagawa Prefecture into two categories: "examined deaths" or "attended deaths," which were also stratified by the place of death, based on the Vital Statistics, and data on number of death cases subjected to postmortem examination from the Kanagawa Prefectural Police Headquarters.@*RESULTS@#In 2013, the survey in Yokohama City showed large differences in age distribution and cause of death between examined and attended deaths. In 2014, home deaths accounted for 15.7% of all deaths in the prefecture, whereas the overall proportion of attended deaths at home was 6.9%.@*CONCLUSIONS@#We should utilize the rate of pure "attended deaths at home" for objective outcome indicator.

Diseño e implementación de un modelo de madurez de capacidades logísticas en servicios de atención médica domiciliaria / Design and Implementation of a Logistic Capability Maturity Model for Health Care Services at Home / Desenho e implementação de um modelo de maturidade de capacidades logísticas em serviços de atenção médica domiciliar

Resumen La prestación de servicios de atención médica domiciliaria (HHC) implica decisiones logísticas en el diseño, la implementación y el control del servicio. Muchas instituciones que prestan servicios de HHC en Colombia toman dichas decisiones de manera empírica y pocas veces se utilizan métodos cuantitativos para apoyarlas de manera sistematizada. Esta situación genera la necesidad de caracterizar el nivel de madurez de las capacidades logísticas de las instituciones que prestan servicios de HHC, con el objetivo de identificar brechas tecnológicas y posibles caminos de mejoramiento. En este trabajo se presenta el diseño de un modelo de madurez de capacidades logísticas en servicios de HHC, basado en el Capability Maturity Model (CMM). El modelo es implementado en una institución de salud habilitada para la prestación de servicios de HHC en Antioquia, Colombia. Los resultados evidencian las brechas existentes y la utilidad del modelo para identificar oportunidades de mejora a través de métodos cuantitativos.

Abstract Health Care Services at Home (HCSH) implies to make logistic decisions about the design, implementation and control of the services. Many institutions providing HCSH services in Colombia make these decisions empirically and in quite few times they are backed by quantitative methods in a systematic way. ^is situation creates the need to characterize the maturity levels of the logistic capability in the institutions providing HCSH aiming to identify the technological gaps and potential paths for improvement. This work provides the design of a logistic capability maturity model for the HCSH services based on the Capability Maturity Model (CMM). The model is implemented in a health institution set up to provide HCSH services in the Antioquia Province, Colombia. The results show the existing gaps as well as the model usefulness to identify the opportunities for improvement thanks to quantitative methods.

Resumo A prestação de serviços de atenção médica domiciliar (HHC) implica decisões logísticas no desenho, implementação e controle do serviço. Muita instituição que presta serviços de HHC na Colômbia toma tais decisões de forma empírica e raras vezes são utilizados métodos quantitativos para apoiá-las de maneira sistematizada. Tal situação gera necessidade de caracterizar o nível de maturidade das capacidades logísticas das instituições que prestam serviços de HHC, com o objetivo de identificar lacunas tecnológicas e possíveis caminhos de melhoramento. Neste trabalho apresenta-se o desenho de um modelo de maturidade de capacidades logísticas em serviços de HHC, baseado no Capability Maturity Model (CMM). O modelo é implementado em uma instituição de saúde habilitada para a prestação de serviços de HHC em Antioquia, Colômbia. Os resultados evidenciam as lacunas existentes e a utilidade do modelo para identificar oportunidades de melhora através de métodos quantitativos.

O ambiente domiciliar e seus riscos para quedas em idosos: uma revisão integrativa da literatura / The home environment and its risks for falls in the elderly: an integrative literature review / El entorno del hogar y sus riesgos para caídas en ancianos: una revisión bibliográfica integradora

O objetivo deste estudo foi identificar os fatores de risco associados à queda de idosos em ambiente domiciliar, por meio de uma revisão integrativa, realizada nas bases de dados LILACS, MEDLINE e BDENF, no período de 2007 a 2017. Entre os fatores de risco para a queda de idosos estão: idade, utilização de medicamentos, desempenhar determinadas atividades cotidianas de vida, dentre as mais notadas: ao levantar-se da cama, subir escadas, tomar banho, presença de tapetes sem antiderrapante com ausência de barra no banheiro, e acesso difícil ao interruptor de luz, o que acaba facilitando a queda aos idosos. Diante dos resultados desta pesquisa, existe a necessidade de mais pesquisas nesta temática para, então, ampliar-se o desenvolvimento de ações preventivas e de promoção à saúde em idosos.

The objective of this study was to identify the risk factors associated with the fall of the elderly in the home environment, through an integrative review, performed in the LILACS, MEDLINE and BDENF databases, from 2007 to 2017. Among the factors of risk for the fall of the elderly are: age, use of medicines, performing certain daily activities of life, among the most noteworthy: when getting out of bed, climbing stairs, taking a bath, the presence of non-slip mats with no bar in the bathroom, and difficult access to the light switch, which makes the fall easier for the elderly. Given the results of this research, there is a need for further research on this subject to expand the development of preventive actions and health promotion in the elderly.

El objetivo de este estudio fue identificar los factores de riesgo asociados con la caída de los ancianos en el entorno del hogar, a través de una revisión integradora, realizada en las bases de datos LILACS, MEDLINE y BDENF, de 2007 a 2017. Entre los factores de Los riesgos para la caída de los ancianos son: edad, uso de medicamentos, realizar ciertas actividades diarias de la vida, entre los más notables: al levantarse de la cama, subir escaleras, bañarse, la presencia de tapetes antideslizantes sin barra en el baño y difícil acceso al interruptor de la luz, lo que facilita la caída de los ancianos. Dados los resultados de esta investigación, es necesario realizar más investigaciones sobre este tema para ampliar el desarrollo de acciones preventivas y la promoción de la salud en los ancianos.