Current status and prospect of diagnosis and treatment of neonatal lactose intolerance / 重庆医学

Lactose intolerance refers to the poor absorption of lactose caused by insufficient number or low activity of lactase,which leads to one or more gastrointestinal symptoms.Newborns are mainly develop-mental and secondary lactase deficiency,with various clinical symptoms,which are easy to be missed and mis-diagnosed.Neonatal lactose intolerance is often diagnosed by fecal reducing sugar and pH determination and urinary galactose determination,but there are still many hospitals that have not carried out related inspection projects.Although there is currently a lack of specific guidelines for neonatal lactose intolerance,but in the context of promoting breastfeeding,reducing the abuse of special milk powder,and rational use of efficient,high-quality lactase is particularly important.In addition,a series of problems involved in the diagnosis and treatment of neonatal lactose intolerance in China need to be further explored.How to find a balance point in the treatment of lactose intolerance will be a direction for future research.

Two Cases of Insomnia Using the Kampo Medicine in which the Therapeutic Effect was Confirmed by Sleep test / 日本東洋医学雑誌

We report two cases in which insomnia successfully treated with sansoninto alone or in combination and the effectiveness could be objectively evaluated with the portable sleep test. Case 1 was 40-year-old man who had suffered from arousal during sleep and daytime fatigue for several years. After taking sansoninto with ninjinto, his symptoms improved. Case 2 was 60-year-old woman who had suffered from a lack of deep sleep and daytime sleepiness. After taking sansoninto, she could get a deep sleep and could have less daytime sleepiness. In this report, we present that portable sleep test conducted before and after treatment confirmed that sleep quality improved. Sansoninto is one of the curative medicines for insomnia, but we believe this is the first report showing objective therapeutic effects using portable sleep test.

Application of anti-idiotypic antibodies in antibody screening and crossmatch tests of patients treated with CD47 monoclonal antibody / 中国输血杂志

【Objective】 To perform pre-transfusion examination and major crossmatch test using CD47 anti-idiotypic antibody (CD47 AID) (method 1) and reagent lack of anti-IgG4 anti-human globulin(method 2) in patients treated with CD47 monoclonal antibodies, and evaluate the feasibility of method 1 by comparing the transfusion efficacy of patients after cross matching with two methods. 【Methods】 Post-drug samples were collected from 18 clinical subjects treated with CD47 monoclonal antibody in our hospital. Antibody screening and major crossmatch test were performed using method 1 and method 2, and the difference of ΔHb (post-transfusion Hb minus pre-transfusion Hb) was compared after transfusion. The differences in ΔHb after transfusion were analyzed between the test group using method 1 and the control group without CD47 monoclonal antibody using ordinary microcolumn gel method. 【Results】 There was no significant difference in ΔHb between the test group using method 1 and test group using method 2 (8.40±0.71 vs 7.36±0.94, P>0.05). No significant difference was noticed in ΔHb between the test group using method 1 and the control group without CD47 monoclonal antibody (8.40±0.71 vs 6.59±0.77, P>0.05). 【Conclusion】 In the test group, major crossmatch test with method 1 has the same transfusion efficacy as the test with method 2. Method 1 is simple and easy to operate, and the results are objective and accurate. It is recommended to use method 1 for pre-transfusion antibody screening and major crossmatch tests for patients using CD47 monoclonal antibody.

Uso de hierro intravenoso en el tratamiento de la anemia ferropénica en niños: a propósito de un caso / Use of intravenous iron for the treatment of iron deficiency anemia in children: clinical case study / Uso de ferro intravenoso no tratamento da anemia ferropriva em crianças: relato de caso

Introducción: el déficit de hierro es la causa más común de anemia debido a carencia nutricional. Su tratamiento consiste en proporcionar alimentos ricos en hierro biodisponible junto con la administración de hierro oral. En circunstancias definidas puede utilizarse el hierro intravenoso. Objetivo: describir el abordaje diagnóstico y terapéutico de un niño portador de anemia ferropénica severa secundaria a mala adherencia al hierro oral en el que se utilizó hierro intravenoso. Caso clínico: niño de 21 meses, raza blanca. Antecedente de anemia ferropénica severa, con repercusión hemodinámica que a los 14 meses requirió transfusión de sangre desplasmatizada. Sin controles de hemoglobina posteriores. Sin adherencia a profilaxis con hierro vía oral. Alto consumo de leche de vaca y bajo consumo de alimentos ricos en hierro. En el contexto de infección respiratoria aguda baja se constata anemia clínica con marcado decaimiento y anorexia, sin repercusión hemodinámica. Se confirma la anemia microcítica, hipocrómica severa, con ancho de distribución eritrocitaria elevado, con metabolismo de hierro alterado. Recibe hierro sacarato, intravenoso, por seis días con buena tolerancia y evolución. Discusión: se identificaron múltiples factores de riesgo para anemia ferropénica. La pobre respuesta al tratamiento con hierro oral debido a efectos adversos y olvidos de administración, junto al antecedente de anemia ferropénica severa, que requirió transfusión de sangre desplasmatizada, motivaron la indicación de hierro intravenoso. Su administración fue programada y monitorizada, sin complicaciones. Es necesario fortalecer la prevención en todos los controles pediátricos y abordar este problema de salud desde una mirada interdisciplinaria.

Introduction: iron deficiency is the most common cause of anemia due to nutritional deficiency. Its treatment consists of providing bioavailable iron rich food together with oral iron. In specific circumstances, intravenous iron may be used. Objective: of this study is to describe the diagnostic and therapeutic approach used with a child with severe iron deficiency anemia secondary to poor adherence to oral iron, in which intravenous iron was used. Clinical case: 21 month-old white patient. History of severe iron deficiency anemia, with hemodynamic repercussions that at 14 months of age required transfusion of deplasmatized blood. Without subsequent hemoglobin controls. No adherence to oral iron prophylaxis. High consumption of cow's milk and low of iron-rich foods. Within the context of acute lower respiratory infection, a clinical anemia with marked decline and anorexia were observed, without hemodynamic repercussions. Severe hypochromic microcytic anemia was confirmed, with an elevated erythrocyte distribution width and altered iron metabolism. He received iron saccharate, intravenously for 6 days with good tolerance and evolution. Discussion: multiple risk factors for iron deficiency anemia were identified. The poor response to treatment with oral iron resulting from adverse effects and lack of proper administration, together with a history of severe iron deficiency anemia, which required transfusion of deplasmatized blood, led to the prescription of intravenous iron. This administration was scheduled and monitored, occurring without complications. It is necessary to strengthen prevention of this condition in all pediatric check-ups and address this health problem from an interdisciplinary perspective.

Introdução: a deficiência de ferro é a causa mais comum de anemia por deficiência nutricional. Seu tratamento consiste no fornecimento de alimentos ricos em ferro biodisponível, juntamente com a administração de ferro por via oral. Em circunstâncias especificas, pode ser utilizado ferro intravenoso. Objetivo: descrever a abordagem diagnóstica e terapêutica de uma criança com anemia ferropriva grave secundária a sua má adesão ao ferro oral, e o uso de ferro intravenoso. Caso clínico: 21 meses, raça branca. História de anemia ferropriva grave, com repercussão hemodinâmica que requiriu de transfusão de sangue desplasmatizada aos 14 meses. Não houve nenhum controle de hemoglobina subsequente. Nenhuma adesão à profilaxia oral com ferro. Alto consumo de leite de vaca e baixo consumo de alimentos ricos em ferro. No contexto de infecção respiratória inferior aguda, observa-se anemia clínica com acentuado emagrecimento e anorexia, sem repercussões hemodinâmicas. É confirmada anemia microcítica e hipocrômica grave, com largura de distribuição eritrocitária elevada e metabolismo alterado do ferro. Recebeu sacarose férrica intravenosa por 6 dias com boa tolerância e evolução. Discussão: foram identificados múltiplos fatores de risco para anemia ferropriva. A má resposta ao tratamento com ferro oral devido aos efeitos adversos e ao esquecimento da administração, aliás da história de anemia ferropriva grave, que exigiu transfusão de sangue desplasmatizada, motivaram a indicação do ferro intravenoso. Sua administração foi programada e monitorada, e aconteceu sem intercorrências. É preciso fortalecer a prevenção em todos os controles pediátricos e abordar este problema de saúde numa persectiva interdisciplinar.

Anemia, deficiencia de hierro y factores asociados en niños cubanos de 6 a 59 meses

Introducción: La principal causa de anemia en los preescolares es la deficiencia dietética de hierro, pero existen otras condiciones asociadas y no evaluadas. Objetivo: Estimar la prevalencia de anemia y deficiencia de hierro en niños de 6 a 59 meses y su asociación con inflamación, sobrepeso global, ingestión de alimentos y nivel de instrucción materno. Métodos: Se realizó un estudio transversal nacional, con determinaciones de hemoglobina, ferritina, receptores de transferrina, proteína C reactiva y alfa-1 glicoproteína ácida. Se evaluó el estado nutricional, dieta y nivel de instrucción de la madre. Resultados: Se estudiaron 1417 niños. La prevalencia de anemia fue de un 22,5 %, la de deficiencia de hierro, de un 35,6 % y la de disfunción eritropoyética, de un 13,3 %; con inflamación 37,6 % y prevalencia de sobrepeso global 7,5 %. La anemia estuvo asociada al déficit de hierro OR = 2,07(1,45-2,97) y la inflamación OR = 2,01(1,45-2,78). No se encontraron asociaciones entre la anemia y el déficit de hierro con el sobrepeso global. El bajo consumo de huevos OR = 1,84 (IC95 %1,39-2,43), frutas OR = 1,73 (IC95 %1,29-2,34) y leguminosas OR = 1,68 (IC95 %1,25-2,25) resultaron ser un factor de riesgo de anemia. El análisis de regresión logística mostró que la anemia estaba asociada al grupo menor de 2 años, deficiencia de hierro, inflamación y bajo consumo de frutas; y el sobrepeso global fue un factor de protección. Conclusiones: La anemia y deficiencia de hierro clasifican como problemas de salud pública moderados asociados a la inflamación. El grupo menor de dos años y el bajo consumo de frutas resultó ser un factor de riesgo y el sobrepeso global resultó un factor de protección para la anemia.

Introduction: The main cause of anemia in preschoolers is dietary iron deficiency, nonetheless there are other associated and unevaluated conditions. Objective: To estimate the prevalence of anemia and iron deficiency in children aged 6 to 59 months and the association with inflammation, overall overweight, food intake and maternal educational level. Methods: A national cross-sectional study was carried out, with determinations of hemoglobin, ferritin, transferrin receptors, C-reactive protein and alpha-1 acid glycoprotein. The nutritional status, diet and educational level of the mother were evaluated. Results: One thousand four hundred and seventeen children were studied. The prevalence of anemia was 22.5%, 35.6% of iron deficiency, and 13.3% of erythropoietic dysfunction. 37.6% of cases presented inflammation and 7.5% presented global overweight prevalence. Anemia was associated with iron deficiency OR = 2.07(1.45-2.97) and inflammation OR = 2.01(1.45-2.78). No associations were found between anemia and iron deficiency with overall overweight. Low consumption of eggs OR = 1.84 (95% CI 1.39-2.43), fruits OR = 1.73 (95% CI 1.29-2.34) and legumes OR = 1.68 (CI 95% 1.25-2.25) were found to be a risk factor for anemia. The logistic regression analysis showed that anemia was associated with the group under two years of age. Conclusions: Anemia and iron deficiency classify as moderate public health problems associated with inflammation. The group under two years of age and low fruit consumption turned out to be a risk factor and overall overweight turned out to be a protective factor for anemia.

Observation of the curative effect of scleral suture fixation technique with four-loop foldable intraocular lens

The objective of the study was to evaluate the curative effect of a modified technique of scleral suture fixation with a four-loop foldable intraocular lens (IOL) for eye with inadequate capsule support. This was a retrospective study of 22 eyes with inadequate capsule support of 20 patients who underwent the scleral suture fixation technique with 9-0 polypropylene suture and foldable four-loop IOL implant. Preoperative and follow-up data were collected for all patients. The mean follow-up was 5.08 ± 0.48 months (range: 3–12 months). The mean pre- and postoperative log of minimum angle of resolution (logMAR) uncorrected distance visual acuity was 1.11 ± 0.32 versus 0.09 ± 0.09 (P < 0.001). The mean pre- and postoperative logMAR best corrected visual acuity was 0.37 ± 0.19 versus 0.08 ± 0.07 (P < 0.001). The intraocular pressure (IOP) increased briefly (range: 21–30 mmHg) in eight eyes on the first day postoperatively and returned to normal within 1 week. No IOP drops were used postoperatively. The IOP was 12–19.3 (13.72 ± 1.28) in this follow-up, which had no significant difference compared to the preoperative IOP (t = 0.34, P = 0.74). At this follow-up, there was no hyperemia, local hyperplasia, obvious scar, suture knots, or segment ends observed under the conjunctiva, as well as no pupil deformation or vitreous hemorrhage. The mean postoperative IOL decentration degree was 0.22 ± 0.08 mm. At the 7-day follow-up postoperatively, one side of the IOL was dislocated to the vitreous cavity in one case, which was resolved by reimplantation of a new IOL in time with the same technique. Scleral suture fixation technique of a four-loop foldable IOL was a feasible operation method for an eye with inadequate capsular support.

Expression profile in Leishmania major exposed to Staphylococcus aureus and group A beta-hemolytic Streptococcus

Background & objectives: The interaction of Leishmania spp. with microbiota inside the midgut vector has significant output in pathogenesis. This study aimed to identify the profile of Leishmania major gene expression of LACK, gp63, and hsp70 after exposure to Staphylococcus aureus and group A beta-hemolytic Streptococci (GABHS). Methods: Leishmania major (MRHO/IR/75/ER) promastigotes were exposed with S. aureus, with GABHS, and with both GABHS and S. aureus at 25°C for 72 h. The gene expression analysis of Lmgp63, Lmhsp70, and LmLACK was assessed using SYBR Green real-time PCR by ??Ct. All experiments were repeated in triplicate. Statistical analysis was done using two-way ANOVA. A P-value less than 0.05 was considered significant. Results: Lmgp63 was expressed in the group exposed to GABHS with 1.75-fold lower than the control group (p=0.000). The LmLACK had expression in both groups exposed with GABHS and GABHS with S. aureus with 2.8 and 1.33-fold more than the control group, respectively (p=0.000). The Lmhsp70 gene expression was reported in the group exposed with GABHS with relative quantification of 5.7-fold more than the control group. Interpretation & conclusion: This study showed that the important genes encoding LACK, gp63, and hsp70 changed their expression after exposure to the S. aureus and GABHS.

Two Cases of Globus Sensation Successfully Treated with Ryokeijutsukanto / 日本東洋医学雑誌

Hangekobokuto is often used for globus sensation. We herein describe two cases in which ryokeijutsukanto was effective for globus sensation, for which hangekobokuto was ineffective. Case 1 was a 28-year-old woman. She had been suffering from postprandial belching, fullness and stuffy throat for a year. She underwent examination, but could not find the cause of her symptoms and visited our department. She was prescribed hangekobokuto, but the feeling of stuffiness in her throat did not improve. Case 2 was a 50-year-old woman. She had been afflicted with a feeling of fullness in the ears, tinnitus, and pain in the back of the eyes for two weeks. She visited the otolaryngology department, but no abnormalities were found so she visited our department. She was prescribed kamishoyosan, and although her ear fullness and tinnitus improved by about 60%, she began to complain of dizziness and throat stuffiness. This did not improve even though she used hangekobokuto with kamishoyosan. In both cases, after changing treatment to ryokeijutsukanto, the symptoms were improved. For globus sensation, it is necessary to select Kampo medicines while paying attention to qi deficiency, qi depression, qi counter flow, static blood, liver depression, lack of fluid, fluid toxicity, and gastrointestinal disorders. We thought that ryokeijutsukanto could be a candidate.

A função da mancha no caso Hans: da falta à presença do objeto / La función de la mancha en el Juanito: de la falta a la presencia del objeto / The function of the stain in little Hans: from lack to presence of the object / La fonction de la tache dans le petit Hans: du manque à la présence de l'objet

O artigo desenvolve a hipótese de que o trabalho de releitura do caso Hans, realizado por Lacan no Seminário 4, A relação de objeto (1956-1957), antecipa a formulação do conceito de objeto a em seu ensino. Dois pontos cruciais em relação ao objeto são destacados em um trabalho de leitura próxima e atenta ao texto do Seminário. Nesse percurso, a introdução da falta de objeto, modulada pelas operações de privação, frustração e castração, se contrapõe à noção de uma certa presença do objeto. O artigo propõe que em sua teorização sobre a angústia do pequeno Hans, Lacan introduz a função da mancha operando como objeto a, situando-a como um resíduo impossível de ser simbolizado, a coisa preta na boca do cavalo, objeto da fobia de Hans

El artículo desarrolla la hipótesis de que la relectura del caso Juanito realizada por Lacan en el Seminario 4, La relación de objeto (1956-1957) presenta una primera versión del concepto de objeto a en su enseñanza. Del trabajo de lectura cercana del texto del Seminario se destacan dos puntos cruciales con relación al objeto. En este recorrido, la introducción de la falta de objeto, modulada por las operaciones de privación, frustración y castración, admite la noción paradójica de una cierta presencia del objeto. El artículo propone que, a partir del desarrollo de su teorización sobre la angustia del Juanito, Lacan introduce la función de la mancha operando como objeto a, ubicándola como un residuo imposible de simbolizar, la cosa negra en la boca del caballo, objeto de la fobia de Juanito

The article develops the hypothesis that the re-reading of little Hans, carried out by Lacan in Seminar 4, The Object Relation (1956-1957), presents a primary version of the objet petit a in his teaching. In this course, two crucial points concerning the object are emphasized in a close reading of the Seminar's text. The introduction of the notion of lack of object, modulated by the operations of deprivation, frustration and castration, is then opposed to the notion of a certain presence of the object. The article proposes that with the development of a theorization on little Hans' anxiety, Lacan introduces the function of the stain working as na object a, a residue impossible to be symbolized, located in the black spot in the horse's mouth, object of Hans' phobia

L'article développe l'hypothèse qui la relecture du cas le petit Hans effectuée par Lacan dans le Séminaire 4, La relation d'objet(1956-1957) anticipe la formulation du concept d'objet (a) dans son enseignement. Deux points cruciaux par rapport à l'objet sont mis en évidence dans un travail de lecture attentive du texte du Séminaire. Dans ce parcours, l'introduction de la notion de manque d'objet, modulée par les opérations de privation, frustration et castration, s'oppose à la notion d'une certaine présence de l'objet. L'article soutient qui depuis sa théorisation sur l'angoisse du petit Hans, Lacan introduit la fonction de la tache comme un résidu impossible à symboliser, la chose noire dans la bouche du cheval, objet de la phobie de Hans. Et comme tel, la tache noire opère la fonction d'(a)

Effectiveness of Teaching Standardized Protocol on Safe Medication Administration Process Upon the Level of Knowledge among Nurses at a Tertiary Care Hospital, Chennai

Strategies to improve medication safety focused on acute care settings. Twenty-six studies and descriptions of quality improvement projects were identified. Strategies used to focus on recommendations to prevent medication errors at various stages, from a nationwide voluntary organization to improve safety of patients and empower education system of nurses and other health care providers in safe practices in health care system and vast growing technology.

A falta no Império da reivindicação / Le manque dans l'empire de la revendication / The lack in the claim's empire

Resumo: A psicanálise sustenta a falta como estrutural e essencial ao processo de subjetivação e à constituição do laço social. Tal postulação está presente ao longo de toda obra de Freud, bem como na de Lacan, o qual avança postulando três modalidades da falta: privação, frustração e castração. Da fundação da psicanálise aos dias atuais, porém, os contextos sociais se modificaram e autores de diversos campos da ciência vêm apontando um movimento dos sujeitos de rechaço à falta e nomeando-os como narcisistas. Tais autores, porém, talvez pela falta de um conhecimento rigoroso da teoria psicanalítica, não se aprofundam no esclarecimento de que registro da falta tratam e como de fato isso tem efeitos no campo da subjetivação. É, portanto, a esta investigação que nos dedicaremos neste artigo através de uma revisão bibliográfica de autores clássicos e contemporâneos da psicanálise. Veremos que o sujeito contemporâneo desmente a privação e, com isso, não avança consistentemente ao campo da castração, recuando e fixando-se na frustração, de modo que o narcisismo apontado por autores sociais se refere a um movimento defensivo de rejeição da condição subjetiva de falta-a-ser, a qual, porém, por estar inerentemente posta, gera efeitos de ressentimento

Le manque dans l'empire de la revendication: La psychanalyse soutient le manque comme structurel et essentiel au processus de subjectivation et à la constitution du lien social. Une telle postulation est présente tout au long de l'œuvre de Freud, ainsi que chez Lacan, qui avance en postulant trois modalités du manque : la privation, la frustration et la castration. Depuis la fondation de la psychanalyse jusqu'à nos jours, cependant, les contextes sociaux ont changé et les auteurs de différents domaines de la science ont résulté d'un mouvement de rejet du manque et de les nommer narcissiques. De tels auteurs, cependant, peut-être en raison du manque de connaissances rigoureuses de la théorie psychanalytique, n'entrent pas en profondeur dans la clarification de quel dossier de manque ils traitent et comment il a réellement des effets dans le domaine de la subjectivation. C'est donc à cette enquête que nous nous consacrerons dans cet article à travers une revue bibliographique des auteurs classiques et contemporains de la psychanalyse. Nous verrons que le sujet contemporain nie la privation et, par conséquent, n'avance pas systématiquement sur le terrain de la castration, reculant et se fixant sur la frustration, de sorte que le narcissisme pointé par les auteurs sociaux renvoie à un mouvement défensif de rejet de la condition de manque. -à-être, qui, cependant, parce qu'il est intrinsèquement fixé, génère des effets de ressentiment.

The lack in the claim's empire: Psychoanalysis supports the lack as structural and essential to the process of subjectivation and the constitution of the social bond. Such postulation is present throughout Freud's work, as well as in Lacan's, who advances postulating three modalities of lack: deprivation, frustration and castration. From the foundation of psychoanalysis to the present day, however, social contexts have changed and authors from different fields of science have resulted from a movement of rejecting the lack and naming them as narcissists. Such authors, however, perhaps due to the lack of a rigorous knowledge of psychoanalytic theory, do not go deep into clarifying what record of lack they deal with and how it actually has effects in the field of subjectivation. It is, therefore, to this investigation that we will dedicate ourselves in this article through a bibliographical review of classic and contemporary authors of psychoanalysis. We will see that the contemporary subject denies deprivation and, therefore, does not consistently advance to the field of castration, retreating and fixating on frustration, so that the narcissism pointed out by social authors refers to a defensive movement of rejection of the lack condition. -to-be, which, however, because it is inherently set, generates resentment effects.

De uma falta ontológica a uma política do tempo / From an ontological lack to a politics of time / D'un manque ontologique à une politique du temps / De una falta ontológica a una política del tiempo

Neste artigo os autores apresentam uma análise da dimensão temporal da concepção psicanalítica da falta-a-ser utilizando elementos da analítica existenciária presente em Ser e Tempo, de Heidegger. A partir disso, é discutida a função do corte, que revela o sujeito como descontinuidade no real, tal como foi proposto por Lacan no seminário O desejo e sua interpretação. Por fim, a categoria "corte" é proposta como o corolário técnico da proposição ontológica da falta-a-ser e o modo de operacionalizar a política da psicanálise em sua relação com a temporalidade do tratamento.

This article presents an analysis of the temporal dimension of a psychoanalytical concept called lack-of-being using elements of Heidegger's existential analysis he describes in Being and Time. Based on that, we discuss the function of the cut, which reveals the subject as discontinuity in the real, as proposed by Lacan in his seminar Desire and its interpretation. To conclude, the category of the cut is proposed as the technical corollary of the ontological proposition of lack-of-being and the way to operationalize the politics of psychoanalysis in its relation to the temporality of the treatment.

Cet article présente une analyse de la dimension temporelle de la conception psychanalytique du manque à être en utilisant des éléments de l'analyse existentielle que Heidegger décrit dans « Être et temps ¼. Ensuite, on discute la fonction de l' « après-coup ¼ qui permet de voir un sujet en tant que discontinuité dans le réel, comme l'a proposé Lacan dans son séminaire « Le désir et son interprétation ¼. Enfin, le concept d'après-coup est proposé comme corollaire technique de la proposition ontologique du manque à être et comme moyen de rendre opérationnelle la politique de la psychanalyse dans son rapport avec la temporalité du traitement.

En este artículo, los autores presentan un análisis de la dimensión temporal de la concepción psicoanalítica de la falta-en-ser, utilizando elementos del análisis existencial presente en Ser y Tiempo, de Heidegger. Desde este análisis, se discute la función del corte, categoría que revela al sujeto como discontinuidad en lo real, como lo propuso Lacan en el seminario El deseo y su interpretación. Para finalizar, los autores proponen el concepto de corte como el corolario técnico de la propuesta ontológica de la falta-en-ser y la forma de operacionalizar la política del psicoanálisis en su relación con la temporalidad de la cura.

How to use χ2 test correctly—— the goodness of fit tests and the implementation of the SAS software / 四川精神卫生

The purpose of this article was to introduce the goodness of fit test and its SAS implementation. The main contents included the following four aspects： ① Pearson΄s goodness of fit test； ② deviance or likelihood ratio goodness of fit test； ③ Hosmer-Lemeshow goodness of fit test； ④ goodness of fit test for the sparse data. In the aforementioned “fourth aspect”， there were six specific test approaches， namely “information matrix test” “information matrix diagonal test” “Osius-Rojek test” “unweighted residual sum of squares test” “Spiegelhalter test” and “Stukel test”. The paper implemented the four types of the goodness of fit tests mentioned above with the help of the SAS software through an example， explained the output results， and made statistical and professional conclusions.

Personalidade de insensibilidade e afetividade restrita em crianças vítimas de bullying / Callous-unemotional personality in children bullying victims / Personalidad de la insensibilidad y afectividad restringida en niños víctimas de bullying

A personalidade com insensibilidade e afetividade restrita (Callous-Unemotional personality) é bem investigada nos agressores de bullying, porém pouco se sabe sobre essa característica nas vítimas. O presente estudo objetivou avaliar a personalidade de insensibilidade e afetividade restrita em crianças que vivenciaram situações de bullying. Participaram da pesquisa 60 crianças do 6.º ano escolar divididas em grupos de agressores (n=15), vítimas (n=15), vítimas-agressores (n=15), e grupo controle (n=15). Foram aplicadas escalas de personalidade e de comportamento. Os resultados apontaram que as vítimas demonstraram um nível mais baixo de personalidade com insensibilidade e afetividade restrita se comparado aos outros grupos, apresentando também maior nível de comportamento pró-social. Torna-se, então, necessário investigar se níveis mais baixos deste traço de personalidade estão associados a maior passividade nas vítimas e, consequentemente, a uma maior probabilidade de serem alvo de bullying.

The Callous-Unemotional personality it is well examined among bullying aggressors, however little is known regarding this characteristic in victims. The present study aimed to investigate the insensibility and coldness in children living under bullying circumstances. Sixty children of the 6° school grade took part in the study, divided in groups of aggressors (n=15), victims (n=15), bully-victims (n=15), and a control group (n=15). Personality and behavior assessment scales were applied. Results revealed that victims showed a lower level of Callous-Unemotional personality compared to other groups, and also presented a higher level of pro-social behavior. It turns necessary to investigate if lower levels of those personality traits are associated to a higher passivity in victims and, consequently, to a greater probability of being target of bullying.

La personalidad con insensibilidad y afectividad restringida (Callous-Unemotional Personality) está bien investigada en agresores de bullying, pero poco se sabe sobre este rasgo en las víctimas. El presente estudio tuvo como objetivo evaluar la personalidad de insensibilidad y afectividad restringida en niños que experimentaron situaciones de bullying. Participaran de la investigación 60 niños del 6º año escolar divididos en grupos de agresores (n = 15), víctimas (n = 15), víctimas-agresores (n = 15) y grupo controle (n = 15). Se aplicaron escalas de personalidad y conducta. Los resultados mostraron que las víctimas mostraron un menor nivel de personalidad con insensibilidad y afectividad restringida en comparación con los otros grupos, además de presentar un mayor nivel de conducta prosocial. Entonces se hace necesario investigar si los niveles más bajos de este rasgo de personalidad están asociados con una mayor pasividad en las víctimas y, en consecuencia, a una mayor probabilidad de ser acosado.

Factores determinantes de salud que influyen en el abandono del programa de vacunación en niños de 12 a 23 meses de edad del centro de salud naranjal de la ciudad de naranjal 2018 / Determining health factors influencing the abandonment of the vaccination programme in children aged 12 to 23 months at the Naranjal health centre in the city of Naranjal 2018

La inmunización es un componente esencial de los derechos humanos, siendo un componente estratégico en materia de prevención entre los sistemas de salud a nivel mundial debido al alto beneficio que genera para las poblaciones y al mismo, la inmunización ha pasado a ocupar un lugar central como una de las fuerzas que impulsan las actividades encaminadas a alcanzar los Objetivos de Desarrollo del Milenio. La investigación abordo la temática sobre los determinantes que inciden en el abandono del sistema de vacunación por parte de las madres de familia de niños y niñas menores de 23 meses de edad. Objetivo: establecer los determinantes de salud que influyeron en el abandono del programa de vacunación en niños entre 12 y 23 meses de edad que acudieron al centro de Salud "Naranjal. Metodología: La investigación fue cuantitativa de diseño retrospectivo, de corte transversal de tipo descriptivo, para la obtención de los datos se elaboró una Ficha de observación validada por juicio de expertos en salud, calificando y aplicando criterios claros de validez, pertinencia y coherencia. El programa estadístico que se utilizó fue el IBM SPSS versión 22. Resultados: arrojaron que la falta de conocimiento sobre los beneficios y un escaso nivel de formación de las madres son los determinantes a que esta problemática se prolongó. Conclusión: se sugiere trabajar en planes de comunicación y concienciación para erradicar esta problemática que es el incumplimiento del esquema de vacunación(AU)

Immunization is an essential component of human rights, being a strategic component in terms of prevention among health systems worldwide due to the high benefit it generates for populations and at the same time, immunization has come to occupy a place central as one of the driving forces behind efforts to achieve the Millennium Development Goals. The research addressed the issue of the determinants that affect the abandonment of the vaccination system by mothers of children under 23 months of age. Objective: to establish the health determinants that influenced the abandonment of the vaccination program in children between 12 and 23 months of age who attended the "Naranjal. Methodology: The research was quantitative with a retrospective, cross-sectional, descriptive design. To obtain the data, an Observation Sheet validated by the judgment of health experts was prepared, qualifying and applying clear criteria of validity, relevance and coherence. The statistical program that was used was the IBM SPSS version 22. Results: they showed that the lack of knowledge about the benefits and a low level of training of the mothers are the determinants that this problem was prolonged. Conclusion: it is suggested to work on communication and awareness plans to eradicate this problem, which is non-compliance with the vaccination scheme(AU)

Covid-19 y responsabilidad civil médica: desafíos de una enfermedad desconocida que devino en pandemia / Covid-19 and medical liability: challenges of an unknown disease that became a pandemic / Covid-19 e responsabilidade civil médica: desafios de uma enfermidade desconhecida que se transformou em pandemia

Resumen La emergencia sanitaria provocada por el coronavirus evidencia que los regímenes de responsabilidad deben ser capaces de diferenciar los instrumentos conceptuales disponibles para lidiar con una enfermedad nueva que, además, devino en pandemia. Este trabajo postula que, tratándose de enfermedades nuevas, los principios de la responsabilidad por culpa evitarán que los prestadores médicos sean condenados por hechos o circunstancias que no se hubieran podido prever o evitar según el estado de los conocimientos de la ciencia. Además, en cuanto al problema de salud pública, todo juicio de responsabilidad deberá tomar en cuenta los cambios que se producirán en la lex artis médica, y diferenciar la eventual responsabilidad de los prestadores de salud de aquella que corresponda a la autoridad encargada de controlar los efectos de la pandemia.

Abstract The coronavirus health-emergency shows that liability schemes need to discriminate the conceptual instruments available to address a new disease that, additionally, has become a pandemic. This article argues that, regarding new diseases, a fault-based liability schemes prevents health providers from being held liable for consequences that could not have been foreseen or avoided according to the state of knowledge of science. Besides, regarding the public health problem, any liability judgment must take into account changes to the medical lex artis; distinguishing also the eventual liability of health providers from the one that belongs to the authority in charge of the response to the pandemic.

Resumo A emergência sanitária provocada pelo corona vírus evidencia que os regimes de responsabilidade devem ser capazes de diferenciar os instrumentos conceituais disponíveis para lidar com uma enfermidade nova que, além disto, se transformou em pandemia. Este trabalho postula que, tratando-se de enfermidades novas, os princípios de responsabilidade por culpa evitarão que os prestadores médicos sejam condenados por fatos ou circunstancias que não se podia prever ou evitar segundo o estado dos conhecimentos da ciência. Além disto, quanto ao problema de saúde pública, todo juízo de responsabilidade deverá ter em conta as mudanças que se produzirão na lex artis médica e diferenciar a eventual responsabilidade dos prestadores de saúde da que corresponda à autoridade encarregada de controlar os efeitos da pandemia.

Factores de riesgo y prevalencia del síndrome de desgaste profesional (burnout) en médicos especialistas, Guadalajara, México. 2019 / Risk factors and prevalence of burnout syndrome in medical specialists. Guadalajara, México. 2019

Objetivo: Determinar prevalencia y factores asociados al riesgo del síndrome de desgaste profesional (burnout) en médicos especialistas. Material y métodos: Estudio observacional, descriptivo y transversal, participaron 182 médicos especialistas. Se realizaron estadísticas descriptivas e inferenciales con SPSS 15.0 y Epi-infoV6.1. Resultados: Respuesta del 81,3%. Se detectó burnout en 49,5%. Diferencias significativas: edad menor de 40 años; Menos de 15 años con pareja estable; Que trabajara la pareja; Antigüedad profesional menor a 10 años. Se mostró una correlación negativa entre agotamiento emocional y despersonalización; positiva con la falta de realización personal en el trabajo en presencia del síndrome. Conclusión: el burnout es frecuente (49,5%), perfil de riesgo: ser mujer; <40 años de edad; sin pareja estable y <15 años con ella; que trabaja la pareja; sin hijos; especialidad quirúrgica; <10 años de antigüedad profesional y en el puesto actual de trabajo; laborar en jornada acumulada; con tipo de contratación definitiva, no tener otro trabajo; jornada mayor a 4 horas. Las subescalas en promedio están cerca de la normalidad. Agotamiento emocional y despersonalización, se comportan como el síndrome. Correlación negativa entre agotamiento emocional y despersonalización y positiva con la falta de realización personal con burnout(AU)

Objective: To determine the prevalence and risk factors associated with burnout syndrome in medical specialists. Material and methods: An observational, descriptive and cross-sectional study was conducted among 182 participating medical specialists. Descriptive and inferential statistics were performed using SPSS 15.0 and EpiinfoV6.1. Results: We obtained a 81.3% response. Burnout was detected in 49.5% of respondents. Significant findings: respondents under 40 years of age; less than 15 years with a stable partner; had a working spouse; length of professional employment less than 10 years. We found a negative correlation between emotional exhaustion and depersonalization was evident, on the other hand, a positive correlation was evident between the lack of personal fulfillment at work and the presence of burnout. Conclusion: Burnout is frequent (49.5%).Risk factors include being a woman; being less than40 years old; having no stable partner and being together for less than15 years; that the couple works; childless; surgical specialty; less than 10 years of professional seniority and in the current job position; has a cumulative work day; having permanent recruitment, not having another job; and a work day greater than 4 hours. The subscales on average were close to normal. Emotional exhaustion and depersonalization mimic burnout. A negative correlation was evident between emotional exhaustion and depersonalization. A positive correlation was evident between the lack of personal fulfillment and burnout(AU)

Artropatías en el adulto mayor / Arthropathies in the elderly

Introducción: Los pacientes mayores de 65 años son la parte de la población más afectada por las enfermedades reumáticas. El diagnóstico reumatológico en los ancianos se complica por las manifestaciones clínicas que imitan los cambios relacionados con la edad. Objetivo: Sintetizar los aspectos generales del manejo clínico, el diagnóstico y la terapéutica de las principales enfermedades reumáticas inflamatorias y no inflamatorias en este subgrupo de población. Desarrollo: Los principales trastornos musculoesqueléticos no inflamatorios que afectan a los adultos mayores son la osteoartritis, la osteoporosis y el dolor de espalda, mientras que las artritis inflamatorias predominantes comprenden la artritis reumatoide, la artropatía cristalina, la polimialgia reumática y las formas inflamatorias de la osteoartritis. Conclusiones: Para el diagnóstico y la terapéutica de las principales enfermedades reumáticas (inflamatorias y no inflamatorias) en este subgrupo de población, es necesario el enfoque multidisciplinar(AU)

Introduction: It is recognized that patients older than 65 years are the part of the population most affected by rheumatic diseases. The rheumatological diagnosis in the elderly is complicated by clinical manifestations, which mimic the changes related to age. Objective: To synthesize the general aspects of clinical management, diagnosis and therapy of the main rheumatic diseases inflammatory and non-inflammatory in this subgroup of the population. Development: The main non-inflammatory musculoskeletal disorders that affect older adults are osteoarthritis, osteoporosis and back pain, while the predominant inflammatory arthritis include rheumatoid arthritis, crystalline arthropathy, polymyalgia rheumatica and the inflammatory forms of osteoarthritis. Conclusions: It is vital for academics to be involved in the rheumatological aspects of aging and call attention to the imperative that is to promote reflective discussion within community medicine to address the impact of musculoskeletal problems that affect function and mobility of the elderly and immune dysregulation in aging, among other issues(AU)

Nurses' perception on violence against children and adolescents by their companion in pediatric ward / Percepciones de las enfermeras sobre la violencia contra los niños y adolescentes ejercida por el acompañante dentro del sector pediátrico / Percepções do enfermeiro sobre violência contra criança e adolescente praticada pelo acompanhante na enfermaria pediátrica

ABSTRACT Objectives: to know the nurses' perception on violence against children by their companion in pediatric ward; describe the nurses' actions in this situation; analyze these actions in light of government policies; and know the organization and communication of the multidisciplinary team to face this phenomenon. Method: a descriptive qualitative research conducted through semi-structured interviews with nurses. Thematic analysis identified three categories: "A perception of violence"; "Actions and interventions performed by nurses"; and "Multidisciplinary team organization and communication". Results: nurses recognize the types of violence, but attaches greater severity to physical violence. The reported causes were children with difficult temperaments, transgenerational violence and hospitalization. The actions were dialogue, companion-child separation, registry and notification to the Guardianship Council. Poor communication from the multidisciplinary team and medical-centric organization have been reported.

RESUMEN Objetivos: conocer la percepción de las enfermeras sobre la violencia contra los niños y adolescentes ejercida por el acompañante dentro del sector pediátrico; describir las acciones de la enfermera en esta situación; analizar estas acciones a la luz de las políticas gubernamentales; y conocer la organización y comunicación del equipo multidisciplinario para enfrentar este fenómeno. Método: investigación descriptiva cualitativa, realizada mediante entrevista semiestructurada con enfermeras. El análisis temático identificó tres categorías: "La percepción de la violencia"; "Acciones e intervenciones realizadas por la enfermera"; y "Organización y comunicación del equipo multidisciplinario". Resultados: la enfermera reconoce los tipos de violencia, pero atribuye mayor severidad a la violencia física. Las causas informadas fueron: niños con temperamentos difíciles, violencia transgeneracional y hospitalización. Las acciones fueron: diálogo, separación de niños y compañeros, registro y notificación al Consejo Guardián. Se informó una comunicación deficiente por parte del equipo multiprofesional y la organización medicalocéntrica. Consideraciones finales: las políticas públicas están dirigidas hacia la violencia fuera de los entornos institucionales, por lo tanto, carecen de pautas para abordar situaciones presenciadas.

RESUMO Objetivos: conhecer a percepção dos enfermeiros sobre a violência contra a criança praticada pelo acompanhante na enfermaria pediátrica; descrever as ações do enfermeiro nesta situação; analisar essas ações à luz das políticas governamentais; e conhecer a organização e comunicação da equipe multidisciplinar no enfrentamento deste fenômeno. M étodo : pesquisa qualitativa descritiva, realizada mediante entrevista semiestruturada com enfermeiros. A análise temática identificou três categorias: "A percepção da violência"; "Ações e intervenções realizadas pelo enfermeiro"; e "Organização e Comunicação da equipe multidisciplinar". Resultados: o enfermeiro reconhece os tipos de violência, porém atribui maior gravidade à violência física. As causas relatadas foram: crianças com temperamentos difíceis, violência transgeracional e hospitalização. As ações foram: diálogo, separação acompanhante-criança, registro e notificação ao Conselho Tutelar. Foi relatada comunicação deficiente da equipe multiprofissional e organização medicalocêntrica. Considerações finais: as políticas públicas estão direcionadas à violência fora dos ambientes institucionais, consequentemente, carecem de diretrizes para abordagem de situações presenciadas.

Nurses perception on violence against children and adolescents by their companion in pediatric ward / Percepciones de las enfermeras sobre la violencia contra los niños y adolescentes ejercida por el acompañante dentro del sector pediátrico / Percepções do enfermeiro sobre violência contra criança e adolescente praticada pelo acompanhante na enfermaria pediátrica

ABSTRACT Objectives: to know the nurses' perception on violence against children by their companion in pediatric ward; describe the nurses' actions in this situation; analyze these actions in light of government policies; and know the organization and communication of the multidisciplinary team to face this phenomenon. Method: a descriptive qualitative research conducted through semi-structured interviews with nurses. Thematic analysis identified three categories: "A perception of violence"; "Actions and interventions performed by nurses"; and "Multidisciplinary team organization and communication". Results: nurses recognize the types of violence, but attaches greater severity to physical violence. The reported causes were children with difficult temperaments, transgenerational violence and hospitalization. The actions were dialogue, companion-child separation, registry and notification to the Guardianship Council. Poor communication from the multidisciplinary team and medical-centric organization have been reported.

RESUMEN Objetivos: conocer la percepción de las enfermeras sobre la violencia contra los niños y adolescentes ejercida por el acompañante dentro del sector pediátrico; describir las acciones de la enfermera en esta situación; analizar estas acciones a la luz de las políticas gubernamentales; y conocer la organización y comunicación del equipo multidisciplinario para enfrentar este fenómeno. Método: investigación descriptiva cualitativa, realizada mediante entrevista semiestructurada con enfermeras. El análisis temático identificó tres categorías: "La percepción de la violencia"; "Acciones e intervenciones realizadas por la enfermera"; y "Organización y comunicación del equipo multidisciplinario". Resultados: la enfermera reconoce los tipos de violencia, pero atribuye mayor severidad a la violencia física. Las causas informadas fueron: niños con temperamentos difíciles, violencia transgeneracional y hospitalización. Las acciones fueron: diálogo, separación de niños y compañeros, registro y notificación al Consejo Guardián. Se informó una comunicación deficiente por parte del equipo multiprofesional y la organización medicalocéntrica. Consideraciones finales: las políticas públicas están dirigidas hacia la violencia fuera de los entornos institucionales, por lo tanto, carecen de pautas para abordar situaciones presenciadas.

RESUMO Objetivos: conhecer a percepção dos enfermeiros sobre a violência contra a criança praticada pelo acompanhante na enfermaria pediátrica; descrever as ações do enfermeiro nesta situação; analisar essas ações à luz das políticas governamentais; e conhecer a organização e comunicação da equipe multidisciplinar no enfrentamento deste fenômeno. M étodo : pesquisa qualitativa descritiva, realizada mediante entrevista semiestruturada com enfermeiros. A análise temática identificou três categorias: "A percepção da violência"; "Ações e intervenções realizadas pelo enfermeiro"; e "Organização e Comunicação da equipe multidisciplinar". Resultados: o enfermeiro reconhece os tipos de violência, porém atribui maior gravidade à violência física. As causas relatadas foram: crianças com temperamentos difíceis, violência transgeracional e hospitalização. As ações foram: diálogo, separação acompanhante-criança, registro e notificação ao Conselho Tutelar. Foi relatada comunicação deficiente da equipe multiprofissional e organização medicalocêntrica. Considerações finais: as políticas públicas estão direcionadas à violência fora dos ambientes institucionais, consequentemente, carecem de diretrizes para abordagem de situações presenciadas.