Estudios de brechas de especialidades médicas: alcances y limitaciones de su aplicación

Abordar la planificación de recursos humanos en salud requiere de metodologías rigurosas y con datos de calidad que sean factibles y útiles para la toma de decisiones informadas. Se plantea identificar los principales aportes, las limitaciones y algunos desafíos del proceso de estimación de brechas entre la necesidad y oferta real de los recursos humanos en salud desde una perspectiva de salud pública. La metodología se basa en analizar los estudios en Uruguay a partir de fuentes primarias y una revisión de bibliografía de estudios de casos en el mundo. La realización de los estudios de brechas en las especialidades médicas son técnicamente factibles en sistemas de salud de diversos países. La información se encuentra disponible de manera directa en las bases de datos o a través de la elaboración de variables proxy, dependiendo de si el enfoque está más centrado en la demanda y utilización real de los servicios o en la identificación de los problemas y la necesidad de salud de la población.

Addressing human resources planning in healthcare requires rigorous methodologies and high-quality data that are feasible and useful for informed decision-making. The objective is to identify the primary contributions, limitations, and some challenges of the gap estimation process between the actual need and supply of human resources in health, from a public health perspective. The methodology relies on analyzing studies from Uruguay using primary sources and conducting a literature review of case studies from various countries worldwide. The conduct of gap studies in medical specialties is technically feasible in healthcare systems across various countries on all five continents. The information is readily available either directly in databases or through the creation of proxy variables, depending on whether the focus is more on the actual demand and utilization of services or on the identification of problems and health needs of the population.

Abordar o planejamento de recursos humanos em saúde requer metodologias rigorosas com dados de qualidade que sejam viáveis e úteis para a tomada de decisões informada. Propõe-se identificar as principais contribuições, limitações e alguns desafios do processo de estimativa de lacunas entre a necessidade e a real oferta de recursos humanos em saúde, numa perspectiva de saúde pública. A metodologia baseia-se na análise de estudos do Uruguai a partir de fontes primárias e na revisão bibliográfica de estudos de caso em vários países do mundo. A realização de estudos de lacunas em especialidades médicas é tecnicamente viável nos sistemas de saúde de vários países dos cinco continentes. A informação é disponibilizada diretamente nas bases de dados ou através do desenvolvimento de variáveis proxy, dependendo se a abordagem está orientada na real procura e utilização dos serviços ou na identificação de problemas e necessidades de saúde da população.

Impact of an Assessment‑Based Training Module on Communication Skills in Phase I Indian Medical Undergraduates

Introduction:Good communication skills (CSs) are not only the crux of a good doctor–patient relationship but also the foundation over which any human relationship is based. The aim of this study was to assess the impact of training on CS in Phase I MBBS students in a Government Medical College in West Bengal, India. MaterialsandMethods: One hundred and eighty‑four Phase I medical students were trained on how to communicate properly with their peers, seniors, teachers, college authorities, department staff, patient relatives, and other health professionals. Each participant underwent a set of three assessments (presession, postsession, and late postsession) for both knowledge and skills in CS. After postsession assessment, feedback by the faculties and peers was provided and reflections were obtained from the participants. A prevalidated questionnaire and Gap‑Kalamazoo CS Assessment Form (with some modification) were used for knowledge and skill’s assessment, respectively. At the end of the module, feedback was collected from the participants. Data were tabulated and results were compared and interpreted. Results: Mean score and standard deviation for knowledge assessment were 5.29 ±1.35, 9 ±1.20 and 8.55 ±0.97 in T1, T2, and T3 and for skills’ score were 17.78 ±4.89, 26.32 ±5.04 and 30.77 ±3.66 in SA1, SA2, and SA3, respectively. Most participants showed improvement in T2 with mean improvement score (T2–T1) of 79.57 ±47.25 and mean retention score (T3–T1) of 71.9 ±47.84. About 52% of participants showed deterioration in T3 with late deterioration score (T3–T2) of−4.06±11.42. 33% showed no change in knowledge, i.e., they retained their improvements, whereas 15% showed further improvement. Fifty‑two percent of participants showed skills’ improvement by scores of 7–12, 43% showed retention by 13–18, and late deterioration was shown by 82%, their scores dropped by 0–6. Conclusion: The training module was successfully implemented, and participants appreciated this type of participant centric assessment‑based teaching learning module. They learned about the effective ways of communication in a fun manner and were determined to apply all that they have learned

Estimación de brechas de geriatras en Chile / Estimation of geriatrician gaps in Chile

Antecedentes: el envejecimiento de la población chilena y la transición epidemiológica que atraviesa el país, ha incrementado la necesidad de formar, entre otros especialistas, a médicos geriatras. Objetivo: estimar la brecha de geriatras en Chile de acuerdo con necesidades epidemiológicas de la población de 65 años y más. Método: se realizó una estimación de brecha de horas de geriatra para la red de salud, a partir de una consulta a 57 geriatras de laboralmente activos de un total de 156 geriatras registrados a enero del 2021. En dicha consulta se indagó sobre tiempo de duración de consulta y frecuencia de consultas ideales de acuerdo con la capacidad funcional de las personas mayores a nivel nacional y por región obtenida de la encuesta Casen 2017. Resultados: a febrero del 2022 existe un total de 162 geriatras en Chile, cifra que equivale a un geriatra por cada 15.806 personas de 65 años y más. De acuerdo con la estimación realizada, se requeriría en Chile, un total de 1.244.689 horas de geriatra anual, equivalentes a la existencia de 589 geriatras a nivel nacional. Conclusión: según los resultados del estudio, a nivel nacional se necesitarían de un total de 589 geriatras para cubrir las necesidades de atención de las personas mayores con algún nivel de dependencia. De acuerdo con estas cifras, al primer trimestre del 2022 el país presentaría una brecha de 427 geriatras. Ante lo elevada de esta brecha, se cree necesario avanzar en estrategias de formación general en geriatría y gerontología en los equipos de salud y socio-sanitarios.

Background:The ageing between the Chilean population and the epidemiological transition that the country is going through has increased the need to train, among other specialists, geriatric doctors.Objective: To estimate the gap between geriatricians in Chile according to the epidemiological needs of the population aged 65 years and over. Method:An estimate of the gap in geriatrician hours was made for the health network based on a consultation of 57 active geriatricians out of 156 registered as of January 2021. In this consultation, the duration and frequency of ideal consultations were inquired according to the functional capacity of the elderly at the national level and by region obtained from the Casen 2017 survey.Results: as of February 2022, there are 162 geriatricians in Chile, equivalent to one geriatrician for every 15,806 people aged 65 years and over. According to the estimate, a total of 1,244,689 hours of annual geriatrician would be required in Chile, equivalent to 589 geriatricians nationwide. Conclusion:According to the study's results, at the national level, a total of 589 geriatricians would be needed to cover the care needs of older people with some level of dependen-ce. According to these figures, in the first quarter of 2022, the country would present a gap of 427 geriatricians. Given the highness of this gap, it is believed necessary to advance general training strategies in geriatrics and gerontology in health and socio-health teams

Diferencia de edad entre cónyuges por nivel educativo en América Latina. El caso de Bolivia, Ecuador y Uruguay / Diferença de idade entre cônjuges por nível de escolaridade na América Latina. O caso de Bolívia, Equador e Uruguai / Spousal age difference by education in Latin America. The case of Bolivia, Ecuador and Uruguay

Resumen El objetivo del estudio es hacer un análisis descriptivo de la asociación entre la educación y la diferencia de edad entre los cónyuges en uniones de distinto sexo y conocer cómo ha evolucionado esta relación a lo largo de las cohortes en las últimas décadas a la luz del incremento del nivel educativo de la población en América Latina, en particular de las mujeres. Se hizo un análisis descriptivo utilizando muestras de rondas censales desde 1970 hasta 2010 de tres países de la región, Bolivia, Ecuador y Uruguay, seleccionando a hombres y a mujeres de 25 a 29 años de edad. Tanto en hombres como en mujeres, no se observa en general un descenso significativo de la diferencia etaria a lo largo de las cohortes. Mientras en las mujeres se observó una relación negativa entre la diferencia etaria entre cónyuges y nivel educativo, en los hombres se constató mayor heterogeneidad entre los países.

Resumo O objetivo do estudo é realizar uma análise descritiva da associação entre escolaridade e diferença de idade entre cônjuges em uniões de diferente sexo e como essa relação evoluiu ao longo das coortes nas últimas décadas em função do aumento da escolaridade da população da América Latina, especialmente para as mulheres. Foram utilizadas amostras de rodadas dos censos de 1970 a 2010 de três países da região − Bolívia, Equador e Uruguai −, selecionando homens e mulheres de 25 a 29 anos de idade. Para o total da amostra, não foi observada diminuição significativa na diferença de idade ao longo das coortes. Para as mulheres, verificou--se relação negativa entre a diferença de idade entre os cônjuges e a escolaridade. Para os homens, observou-se maior heterogeneidade entre os países.

Abstract The purpose of this study is to investigate the association between education and the age gap between spouses in heterosexual unions. The study also examines how this association has changed over time in different cohorts, especially among women, in the context of educational expansion in Latin America. The research used the data collected from census rounds conducted between 1970 and 2010 in Bolivia, Ecuador, and Uruguay. The sample included men and women aged between 25 to 29. The findings reveal that there was no significant decrease in the age difference throughout the cohorts for both men and women. However, a negative relationship was observed between the spousal age difference and educational level in women. On the other hand, men showed greater heterogeneity between countries.

Diagnosis and treatment of apical cyst of deciduous teeth with infection: a case report / 华西口腔医学杂志

There is a high incidence of chronic periapical periodontitis of deciduous teeth, however, there is a low incidence of the apical cyst. This paper reports a 7-year-old child with deciduous periodontitis caused by chronic periapical periodontitis of deciduous teeth. Through literature review, the etiology, imaging characteristics, diagnosis, differential diagnosis, and treatment methods were discussed to provide the basis for clinical diagnosis and treatment.

Prognosis assessment of strong ion gap in adult patients with cardiac arrest / 中华急诊医学杂志

Objective:To investigate the correlation between strong ion gap (SIG) and prognosis of adult hospitalized patients who experienced cardiac arrest (CA).Methods:A retrospective cohort study was conducted on adult CA patients (≥18 years old) who were admitted to the intensive care unit (ICU) for the first time from the Medical Information Mart for Intensive Care Ⅲ (MIMIC-Ⅲ) database from 2001 to 2012. The patients were divided into 3 groups based on the tertiles of serum SIG value. The clinical baseline characteristics and related data of CA patients were compared. Kaplan-Meier method was used to draw the 28- and 90-day cumulative survival curves of CA patients. Meanwhile, the log-rank test was used to compare the differences in the survival curves among different groups, and Cox proportional hazard regression model was established to analyze whether SIG was an independent predictor of all-cause mortality in CA patients.Results:Six hundred and six adult CA patients were eligible for final analysis. The patients were divided into 3 groups based on the tertiles of serum SIG value [<3.91 mmol/L ( n=202), 3.91~7.32 mmol/L ( n=202) and >7.32 mmol/L ( n=202)]. The mean age was (66.91±15.95) years and 382 patients (63.04%) were male. The all-cause mortality rates of ICU, 28 days and 90 days were 36.47%, 49.17% and 56.93%, respectively. There were significant differences in SOFA score, SIG, anion gap, pH, lactic acid, white blood cells, prothrombin time, creatinine, blood potassium, blood phosphorus, hypertension, coronary heart disease, cardiogenic shock, and ICU, 28-day and 90-day all-cause mortality among the 3 groups (all P<0.05). The Kaplan-Meier survival curves showed that the 28- and 90-day cumulative survival rates of CA patients decreased gradually with the increase of SIG level, and the differences were statistically significant among the 3 groups (all P<0.001). Multivariate Cox proportional hazard models showed that the increase of SIG level (>7.32 mmol/L) was an independent risk factor for 28-day ( HR=1.610, 95% CI: 1.177-2.203, P=0.003) and 90-day all-cause mortality ( HR=1.506, 95% CI: 1.123-2.019, P=0.006) among CA patients, after adjusting for the related confounders. Conclusions:The elevated SIG level (>7.32 mmol/L) is an independent predictor of 28- and 90-day all-cause mortality in CA patients. The calculation of SIG level in these patients is helpful for early identification of patients with poor prognosis.

Influence of cavity design on quality of margin and marginal adaptation and microleakage of all-ceramic CAD/CAM inlays / 北京大学学报(医学版)

OBJECTIVE@#To investigate the influence of 135° and 90° cavity design on quality of margin and marginal adaptation and microleakage of all-ceramic computer aided design/computer aided manufacturing (CAD/CAM) inlays.@*METHODS@#One hundred extracted human molars were prepared by criteria of buccal occlusal (BO) inlay. On the buccal, the mesial margin was prepared as 135° bevel while the distal margin was prepared as butt-joint. All-ceramic restorations were made in the Sirona CEREC AC CAD/CAM system with VitaBlocs Mark Ⅱ, Upcera UP.CAD, IPS e.max CAD, Upcera Hyramic and Lava Ultimate. The gaps between each inlay's mesial margin-abutment and distal margin-abutment were recorded under an optical microscope. Each inlay was adhered to the abutment and aged by thermal cycling for 10 000 times. Each specimen was cut into 3 slices after staining. Dye penetration was evaluated under an optical microscope for mesial and distal margins.@*RESULTS@#Mean marginal integrity rate, mean marginal gap value and mean depth of microleakage of 135° margin of Group Upcera Hyramic and Lava Ultimate were significantly better than those of Group VitaBlocs Mark Ⅱ, Upcera UP.CAD and IPS e.max CAD(P < 0.05). Mean marginal gap value, mean depth of microleakage and scale of mean depth of microleakage of 90° margin of Group Upcera Hyramic and Lava Ultimate were significantly better than those of Group Upcera UP.CAD and IPS e.max CAD (P < 0.05) while mean marginal integrity rate was not significantly different (P>0.05). Mean marginal integrity rate of 90° margin was significantly better than that of 135° margin in each group (P < 0.05) while mean depth of microleakage between different margins was not significantly different in each group (P>0.05). Mean marginal gap value of 90° margin of Group VitaBlocs Mark Ⅱ and IPS e.max CAD was significantly better than that of 135° margin (P < 0.05) while there was not significant difference in other 3 groups between 90° and 135° margin (P>0.05). Scale of mean depth of microleakage of 135° margin of Group Upcera Hyramic and Lava Ultimate was significant better than that of 90° margin (P < 0.05) while there was not significantly different in other 3 groups between 90° and 135° margin (P>0.05).@*CONCLUSION@#The mesial and distal margins of abutement of all-ceramic inlay should be prepared as butt-joint.

Mediating role of rumination in the relationship between expectation gap of social support and postpartum depression in primiparae / 中国实用护理杂志

Objective:To investigate the mediating effect of rumination in primiparae on the expectation gap of social support and postpartum depression, so as to provide a reference basis for early detection and intervention in the regulation of meternal postpartum depression.Methods:In this cross-sectional study, questionnaires were administered from November 2021 to March 2022 using the general information questionnaire, the Ruminant Thinking Response Scale, the Postpartum Social Support Scale, and the Edinburgh Postpartum Depression Scale to 266 primiparae at three tertiary level A hospitals, the First Affiliated Hospital of Xi′an Jiaotong University, the Second Affiliated Hospital of Xi′an Jiaotong University, and the Northwest Women′s and Children′s Hospital, for postpartum review, and the relationship between ruminant thinking, social support expectation gap, and postpartum depression was analyzed using correlation analysis, structural equation modeling, and application of Bootsrap method.Results:The social support expectation gap, ruminative thinking, and postpartum depression average scores were (16.74 ± 12.77), (39.43 ± 4.14), (6.77 ± 2.77) points, respectively.There were positive correlations between social support expectation gap and ruminative thinking, postpartum depression, and ruminative thinking and postpartum depression ( r=0.62, 0.75, 0.70, all P<0.01). Primiparae ruminative thinking partially mediated the relationship between social support expectation gap and postpartum depression, with the mediating effect accounting for 22% of the total effect. Conclusions:Social support expectation gap can directly affect the occurrence of postpartum depression, but also indirectly through ruminative thinking, and postpartum depression can be prevented and intervened from the perspective of reducing ruminative thinking in clinical practice.

Study on the good agricultural practice for Shanghai Pheretima / 药学实践杂志

Objective To establish the Good Agricultural Practice（GAP）for standard operation procedure of Shanghai Pheretima. Methods According to the comprehensive technical requirements of GAP standardized production of Chinese herbal medicine, the key technologies of standardized cultivation and processing were studied in Sangxin Town, Chongming District, Shanghai. Results The production area environment, variety characteristics, breeding technology, pest control, harvesting and processing, packaging, storage and transportation, quality monitoring and other technical links of Shanghai Pheretima were clearly defined and standardized. Conclusion This study provides practical basis for the standardization and modernization quality management of Shanghai Pheretima.

The Structure and Function of Glial Networks: Beyond the Neuronal Connections / 神经科学通报·英文版

Glial cells, consisting of astrocytes, oligodendrocyte lineage cells, and microglia, account for >50% of the total number of cells in the mammalian brain. They play key roles in the modulation of various brain activities under physiological and pathological conditions. Although the typical morphological features and characteristic functions of these cells are well described, the organization of interconnections of the different glial cell populations and their impact on the healthy and diseased brain is not completely understood. Understanding these processes remains a profound challenge. Accumulating evidence suggests that glial cells can form highly complex interconnections with each other. The astroglial network has been well described. Oligodendrocytes and microglia may also contribute to the formation of glial networks under various circumstances. In this review, we discuss the structure and function of glial networks and their pathological relevance to central nervous system diseases. We also highlight opportunities for future research on the glial connectome.

Compounded drugs as an alternative to the therapeutical gaps of inborn errors of metabolism

Abstract Inborn errors of metabolism are rare disorders with few therapeutic options for their treatments, which can make patients suffer with complications. Therefore, compounded drugs might be a promising option given that they have the ability of meeting the patient's specific needs, (i) identification of the main drugs described in the literature; (ii) proposal of compounding systems and (iii) calculation of the budgetary addition for the inclusion of these drugs into the Brazilian Unified Health System. The research conducted a literature review and used management data as well as data obtained from official Federal District government websites. The study identified 31 drugs for the treatment of inborn errors of metabolism. Fifty eight percent (58%) (18) of the medicines had their current demand identified, which are currently unmet by the local Health System. The estimated budget for the production of compounded drugs was of R$363,16.98 per year for approximately 300 patients. This estimated cost represents a budgetary addition of only 0.17% from the total of expenditures planned for drug acquirement. There is a therapeutic gap for inborn errors of metabolism and compounding pharmacies show potential in ensuring access to medicine therapy with a low-cost investment.

Critical analysis of moderate and severe retractions in the pars tensa and pars flaccida of the tympanic membrane,

Abstract Objectives: Analyze the prevalence of retractions in different areas of the Tympanic Membrane (TM), the correlations between the involvement of the Pars Tensa (PT) and Pars Flaccida (PF), and the air-bone gaps. Methods: A cross-sectional study. Patients with moderate and/or severe TM retraction of 2200 consecutive patients with chronic otitis media between August 2000 and January 2019 were included. Ears with previous surgery were excluded. Ears were classified as isolated PF and PT retractions and association of both. The degrees of severity and presence of effusion were evaluated. The data were analyzed using the SPSS Statistics software program. Results: 661 ears were included. The prevalence of isolated atical retractions was 24.9%, of isolated posterior quadrants was 10.6%, and of association of quadrants was 64%. There was no correlation between the retractions in the different areas of the TM (posterior and attic quadrants: r = 0.13; p = 0.041; anterior and posterior quadrants: r = 0.23; p = 0.013, anterior and attic quadrants: r = 0.06; p = 0.043). Effusion was present in 30.7% of the ears. ABG median was lower in ears with PF retraction (6.25 dB HL) than PT retraction, isolated (15 dB HL) or not (13.75 dB HL; p < 0.05); 72% of the ears had an ABG ≤ 20dB HL. For severity of the retraction of PF, the ABG was similar across groups. For the PT, there was a global difference in the medians of ABG in terms of the degree of severity, with a moderate correlation. Conclusion: The prevalence of moderate and severe retractions was 24.5%; 64% of the ears had an association of affected regions. There was no correlation between the retraction in the different areas of the TM. We found a significant correlation between the severity of retraction and the worsening of ABG threshold, only for PT. Evidence level: 4.

A review on synthesis of quantum dots and their biomedical applications

Quantum Dots (QDs) are ultra-fine nanometer-sized semiconductor particles with a core-shell structure possess both electrical and optical properties. Their unique ability to emit pure, monochromatic light on being exposed to light makes them extremely versatile in their applications. The color of the light emitted directly depends on their size and shape. Smaller QDs emit shorter wavelengths, closer to the violet end of the visible light spectrum (~380-450 nm), while larger QDs emit longer wavelengths i.e in reddish spectrum (~620-750 nm). Owing to their “tunability”, QDs can be exploited in a wide range of fluorescent, photonic, and electrochemical applications. QDs represent elements mainly from Group II-VI (e.g., CdSe) or Group III-V (e.g., InP) with the resultant optical and electronic properties of the quantum dots being somewhere between bulk semiconductor material and individual atoms or molecules. Besides applications in energy and photonics, they are under extensive investigation and development for use in disease diagnosis and therapy, specifically in the area of controlled drug delivery, biosensing and imaging. This review surveys the progress of research explores their properties, synthesis, applications, delivery systems in biology, and their toxicity

Desigualdad de resultados pruebas Saber-11 antes y durante la pandemia covid-19 (2014-2021) / Inequality in the results of Saber-11 Tests before and during the COVID-19 pandemic (2014 - 2021) / Desigualdade dos resultados dos testes do Saber-11 antes e durante a pandemia de Covid-19 (2014-2021)

Resumen (analítico) Se realizó un análisis descriptivo de la desigualdad en los resultados de las pruebas Saber-11 en el periodo 2014-2021 del departamento de Boyacá, Colombia, y los efectos de la pandemia del covid-19 en tales resultados, según áreas de conocimiento y nivel socioeconómico. Esta investigación se realizó con base en los datos de las pruebas Saber-11 obtenidos en la página del Instituto Colombiano para la Evaluación de la Educación. Se observó que en Boyacá el mejor desempeño lo obtienen los estudiantes de los colegios privados y de estratos 3, 4 y 5. Se evidencia el aumento de la brecha educativa en el departamento durante la pandemia del covid-19, producto de las desigualdades en el acceso a la educación y los problemas de conectividad en los territorios.

Abstract (analytical) The authors conducted a descriptive analysis of inequality in the results of the standardized Saber-11 tests for students conducted in the period 2014-2021 in the department of Boyacá, Colombia and the effects of the COVID-19 pandemic on these results. The results were analyzed in accordance with areas of knowledge and students' socioeconomic level. This research was carried out using data from the Saber-11 tests that was obtained from the Instituto Colombiano para la Evaluación de la Educación website. It was observed that in Boyacá, the best academic results were obtained by students from private schools and those from the middle and upper classes (Strata 3, 4 and 5). An in-crease in the education gap in Boyacá during the COVID-19 pandemic was evidenced by the authors as a result of inequalities with access to education and connectivity problems in the state.

Resumo (analítico) Neste artigo, foi feita uma análise descritiva da desigualdade nos resultados dos testes do Saber-11 no período 2014-2021 do departamento de Boyacá-Colômbia, com o objectivo de analisar os resultados dos testes do Saber-11 e os efeitos do Covid-19 pandemia, de acordo com as áreas de conhecimento e nível socioeconómico. Esta investigação foi realizada com base nos dados dos testes do Saber-11º ano obtidos no site do Instituto Colombiano para la Evaluación de la Educación. Observouse que no departamento de Boyacá o melhor desempenho foi obtido por estudantes de escolas públicas e dos estratos 3, 4 e 5. Evidencia-se um aumento da lacuna educacional no departamento durante a pandemia de Covid-19, como resultado das desigualdades no acesso à educação e dos problemas de conectividade nos territórios.

Interpretación gasométrica avanzada en el paciente crítico / Advanced gasometric interpretation in critical patient / Interpretação gasométrica avançada no paciente crítico

Resumen: La interpretación gasométrica de forma rápida es muy útil en urgencias, ya que establecer de manera oportuna un diagnóstico es de suma importancia. Existen herramientas que nos permiten igualar la sensibilidad de los métodos complejos de Stewart. Evaluar la gasometría de manera tradicional, dependiendo de la escuela preferida: utilizando sólo el bicarbonato o el exceso de base; tiene baja sensibilidad diagnóstica cuando nos enfrentamos a escenarios donde existe más de un trastorno metabólico asociado. Proponemos los siguientes cinco pasos: evaluar el pH, déficit de base, anión gap, exceso de base y el índice cloro/sodio, que son importantes para identificar de manera rápida y sensible una gasometría en pacientes críticos.

Abstract: The interpretation of a gasometry of rapid form is very useful in an emergency department since to establish in an opportune way a diagnosis performs supreme importance. There exists hardware that allows us to equal the sensibility of the complex m ethods of Stewart. To evaluate the gasometry of a traditional way, depending on the favorite school: using only the bicarbonate or the base excess, it has low diagnostic sensibility when we face stages where more than one metabolic associate disorder exists. We propose the following five steps: to evaluate the pH, deficit of base, anion gap, excess of base, and the index chlorine/sodium, which are important to identify rapidly and sensitively a gasometry in critical patients.

Resumo: A interpretação gasométrica rápida é muito útil em emergências, pois é de suma importância estabelecer um diagnóstico em tempo hábil. Existem ferramentas que nos permitem igualar a sensibilidade dos métodos complexos de Stewart. Avaliar a gasometria da forma tradicional, dependendo da escola preferida: usando apenas bicarbonato ou excesso de base, tem baixa sensibilidade diagnóstica diante de cenários onde há mais de um distúrbio metabólico associado. Propomos as 5 etapas a seguir: avaliação do pH, déficit de base, lacuna aniônica, excesso de base e relação cloreto/sódio, importantes para identificar de forma rápida e sensível os gases sanguíneos em pacientes críticos.

Principales problemáticas de las publicaciones científicas: un análisis en perspectiva latinoamericana / Central problems in scientific research publications: analysis through a latin american perspective

Resumen Se identifican y analizan las principales problemáticas de las publicaciones científicas, estudiando los diferentes componentes del ecosistema en el que se producen, con énfasis en la realidad latinoamericana. A través del relevamiento y análisis bibliográfico, se identifican como problemáticas la forma de acceso, los criterios de calidad y evaluación utilizados, la visibilidad, la barrera de la lengua y la brecha de género. Al mismo tiempo que se conceptualizan, se establecen vínculos entre dichos componentes lo que agrega complejidad al fenómeno y permite visualizar los modelos de comunicación científica vigentes. Dicha identificación pretende abrir espacios para la proposición de propuestas a futuro, que aporten en el sentido de brindar mayor acceso y reducir las inequidades observadas. Al mismo tiempo, la exposición del tema permite a los investigadores contar con mayores elementos a la hora de pensar y hacer visibles sus publicaciones. Desde la perspectiva latinoamericana se observaron ciertas particularidades en relación al crecimiento del movimiento de acceso abierto, sostenido muchas veces por instituciones y editoriales que pugnan por mejorar las formas de circulación, distribución, visibilidad y acceso, aunque cuenten con recursos limitados. Finalmente, se insiste en la necesidad de defender y potenciar el modelo de información científica basado en acceso abierto, como uno de los objetivos a promover para hacer frente a la privatización y comercialización del conocimiento producido por las comunidades científicas.

Abstract Identification and analysis of the main problems of scientific researches by studying the different components of the ecosystems they are produced, emphasising in Latin America's reality. Through surveying and bibliographical analysis, problems such as access ways, quality and evaluation criteria, visibility, language barriers and gender gap are identified. As they are defined, these concepts are also threaded, adding complexity to the matter and allowing to visualize scientific media current's state. Its purpose is to open the field for future proposals regarding greater access and narrowing the inequality gap. Besides, the topic's exposure provides researchers with a wider group of elements when thinking about their work and how to publish it. From a latin american perspective, there is observance of certain aspects linked to the growth of the open access movement, which is mainly sustained by insitutions and publishers that try to improve ways of distribution, circulation, visibilty and access, despite limited resources. Finally, the importance of defending and boosting the scientific information access model based on open access is strongly outlined, as one of the main policies that will allow to keep corporate interests apart from the knowledge scientific communities produce.

Kidney health for all: bridging the gap in kidney health education and literacy / Saúde dos rins para todos: preenchendo a lacuna de educação e conhecimento sobre a saúde renal

Abstract The high burden of kidney disease, global disparities in kidney care, and the poor outcomes of kidney failure place a growing burden on affected individuals and their families, caregivers, and the community at large. Health literacy is the degree to which individuals and organizations have, or equitably enable individuals to have, the ability to find, understand, and use information and services to make informed health-related decisions and actions for themselves and others. Rather than viewing health literacy as a patient deficit, improving health literacy lies primarily with health care providers communicating and educating effectively in codesigned partnership with those with kidney disease. For kidney policy makers, health literacy is a prerequisite for organizations to transition to a culture that places the person at the center of health care. The growing capability of and access to technology provides new opportunities to enhance education and awareness of kidney disease for all stakeholders. Advances in telecommunication, including social media platforms, can be leveraged to enhance persons' and providers' education. The World Kidney Day declares 2022 as the year of "Kidney Health for All" to promote global teamwork in advancing strategies in bridging the gap in kidney health education and literacy. Kidney organizations should work toward shifting the patient-deficit health literacy narrative to that of being the responsibility of health care providers and health policy makers. By engaging in and supporting kidney health-centered policy making, community health planning, and health literacy approaches for all, the kidney communities strive to prevent kidney diseases and enable living well with kidney disease.

Resumo A elevada carga da doença renal, disparidades globais no cuidado renal e desfechos ruins da insuficiência renal impõem uma sobrecarga crescente aos indivíduos afetados e suas famílias, cuidadores e a própria comunidade geral. Educação em saúde é o grau em que indivíduos e organizações têm, ou que igualmente permitem que indivíduos tenham, capacidade de encontrar, compreender e utilizar informações e serviços para tomar decisões e ações conscientes relacionadas à saúde para si e outros. Mais do que enxergar educação em saúde como um problema dos pacientes, a melhoria dessa educação depende principalmente da comunicação e educação efetiva dos profissionais em parceria com aqueles que apresentam doença renal. Para formuladores de políticas renais, educação em saúde é pré-requisito para que organizações migrem para uma cultura que coloque a pessoa no centro dos cuidados. A crescente capacidade e acesso à tecnologia oferecem novas oportunidades para melhorar educação e conscientização sobre doença renal para todas as partes interessadas. Avanços nas telecomunicações, incluindo redes sociais, podem ajudar a melhorar a educação de pessoas e provedores. O Dia Mundial do Rim declara 2022 como o ano da "Saúde dos Rins para Todos" promovendo trabalho em equipe global no avanço de estratégias para preencher a lacuna na educação e conhecimento em saúde renal. Organizações renais devem trabalhar para mudar a narrativa da educação em saúde como um problema de pacientes, para sendo responsabilidade dos profissionais e formuladores de políticas. Ao engajar-se e apoiar formulação de políticas centradas na saúde renal, planejamento de saúde comunitária e abordagens de educação em saúde para todos, comunidades renais esforçam-se para prevenir doenças renais e permitir viver bem com elas.

Há diferenças remuneratórias por gênero na magistratura brasileira? / ¿Existen diferencias salariales de género en el Poder Judicial brasileño? / Is there a gender pay gap in the Brazilian judiciary?

Resumo O propósito deste estudo é testar a hipótese de que há clara diferença entre as remunerações médias percebidas por juízes e juízas de 8 tribunais de justiça brasileiros. Por meio da técnica de matching, realizou-se um pareamento entre juízes e juízas condicionado ao cargo, ao tempo de magistratura, ao mês e ao ano da remuneração, bem como ao tribunal. As diferenças nas médias remuneratórias persistem mesmo após o pareamento, o que pode ser explicado pelos mediadores de gênero, que operam gerando melhores oportunidades para homens em desfavor das mulheres.

Resumen El objetivo de este estudio es probar la hipótesis de que existe una clara diferencia entre las remuneraciones promedio percibidas por los jueces de ocho tribunales de justicia brasileños. Mediante la técnica de matching se realizó un emparejamiento entre jueces y juezas condicionado al cargo, a la duración de la magistratura, al mes y año de remuneración y al tribunal. Las diferencias en los promedios salariales persisten incluso después del emparejamiento, lo que puede explicarse por los mediadores de género, que operan generando mejores oportunidades para los hombres en detrimento de las mujeres.

Abstract This study tests the hypothesis that there is a clear difference between the average salaries perceived by male judges and female judges in eight Brazilian courts of justice. Using propensity score matching, judges were paired according to position, length of service as a judge, and court. The differences in average salaries persist even after the matching, although to a lesser degree, which can be explained by gender mediators that operate by generating better opportunities for men than for women.

Practice of the construction of urban medical alliance in Huzhou city / 中华医院管理杂志

Promoting balanced distribution of medical resources and realizing high-quality sharing of basic medical services between urban and rural areas are an important part of common prosperity. Huzhou urban medical alliance was a new urban and rural of medical alliance mode based on level 4 vertical integration, which played an important role in the whole evolution process of the medical alliance. This medical alliance had not only broken through the " integration of counties" but also explored the " integration of cities" . It was a bridge connecting counties and cities, which was of great significance in narrowing the gap between urban and rural medical health services. The construction of urban medical alliance took digital transformation and systematic integration as two breakthroughs to comprehensively promote the upgrade of energy efficiency and benefit stacking of health governance. In 2021, the grass-roots medical utilization rate and county-level medical utilization rate were 72.7% and 90.6%. In 2020, the average hospitalization cost(8 726.7 yuan)and the average outpatient and emergency expenses(239.6 yuan)of public hospitals were 25.0% and 8.6% lower than the average level of Zhejiang Province, respectively. Although Huzhou city had broken through the restrictions of administrative divisions and actively promoted the construction of the medical alliance, and achieved phased results, there were still structural defects and institutional difficulties. In order to solve these problems, the author proposed to promote the improvement of governance structure and optimization of governance system through " three governance" and " three characteristics" , and then promote the high-quality development of urban medical alliances.

Practice of bridging the digital divide between doctors and patients from the perspective of digital governance / 中华医院管理杂志

At present, the implementation of Internet hospitals is still hampered by the double digital divide between doctors and patients. In order to develop Internet healthcare better, a Grade-A tertiary hospital has implemented digital governance for traditional healthcare system. The healthcare service chain has been reshaped by integrating online and offline health services and using multi-subject synergy and government-driven logic. Information barriers were broken down by strengthening hospital′s top-level design and implementing personalized follow-up visits for specialized diseases and live broadcast of health education. By establishing cross-regional specialist alliances and medical consortia oriented to patient needs, the time and space limitations of medical resources have been broken through. Digital governance practices have realized the two-way bridging of digital divide between doctors and patients, expanded the new mode of digital healthcare, and provided reference for the sustainable development of Internet hospitals.