Análisis de las Intervenciones de Bebés de 9 Meses durante la Lectura Compartida / Analysis of the Interventions of 9 Month-old Babies during Shared Storybook Reading

Resumen La lectura compartida es frecuente en la infancia. Sin embargo, la participación de infantes menores de un año en esta actividad ha sido poco explorada. Este trabajo describe y analiza las intervenciones de bebés de 9 meses en la lectura conjunta materno-infantil en hogares argentinos. Transcribimos y analizamos filmaciones realizadas por 10 madres. Clasificamos las intervenciones en: acción responsiva o espontánea; vocalización responsiva o espontánea; acción responsiva + vocalización; acción espontánea + vocalización. Los bebés realizaron mayoritariamente acciones espontáneas (con o sin vocalizaciones). Luego, clasificamos las acciones (con o sin vocalizaciones) en: convencionales (pasar la página, señalar) o manipulativas (morder, sacudir los libros); otras no orientadas (tomar otro objeto, mirar fuera del escenario). Encontramos que las acciones fueron principalmente manipulativas. Finalmente, clasificamos las acciones en: inespecíficas (morder el libro, sacudirlo) u orientadas (intentar agarrar los objetos representados). Predominaron las acciones inespecíficas. Los hallazgos muestran bebés sensoriomotores en exploración. Sin embargo, algunas intervenciones revelaron también un incipiente desarrollo simbólico al usar los libros convencionalmente y reconocer las imágenes como objetos simbólicos. La lectura compartida es un escenario en el que se accede a diversos sistemas de representación (imágenes, números, letras), permitiendo desarrollar tempranamente un potencial simbólico en contextos sociales relevantes.

Abstract Shared reading is a significant and frequent activity in early childhood. However, the interventions in this kind of activities by babies and infants under one-year have been little explored. The main objective of this work was to describe 9-month-old babies' interventions in reading situations with their mothers at Argentinian homes. The focus of the analysis was babies' actions during reading with their mothers. Ten mothers filmed shared reading sessions with their babies. Then we transcribed and analyzed babies' interventions in three levels. First, we classified the interventions in: responsive action, spontaneous action, responsive vocalization, spontaneous vocalization, responsive action + vocalization, spontaneous action + vocalization. Isolated vocalizations were rare. The babies performed mostly spontaneous actions (with or without vocalizations). Responsive actions were less frequent (with or without vocalizations). Second, we classified babies' actions (with or without vocalizations) in 1-conventional, like turn the page, point to the book, put the book in reading position, 2-manipulative, like bite, shake, put the book in the mouth, open and close the book, try to grab/suck/ touch objects represented in pictures, 3- other actions- actions not oriented to books, like shake another object present in the interaction or looking to some object or person outside the scene. We found that babies' actions were mainly manipulative. Finally, we categorized manipulative actions in 1- unspecific actions, like bite, shake, put the book in the mouth, open and close the book, and 2- pictures-oriented ones, like try to grab, suck, touch objects present in pictures. Unspecific actions predominated. Findings show sensory motor babies in exploration. Nevertheless, the presence of conventional actions and picture-oriented actions are signs of an incipient symbolic development. That is, babies use books conventionally and recognize pictures as symbolic objects. In sum, shared reading is one of the richest scenarios for early symbolic development. In this context babies and children access to diverse representational systems (words, pictures, numbers, letters). This activity allows children to development their symbolic potential in relevant social contexts.

Estudo sobre o uso do Picture Archiving and Communication System (PACS) em um Hospital Universitário da cidade de Belo Horizonte, Minas Gerais, Brasil / A study on the use of the Picture Archiving and Communication System (PACS) at the Hospital the Federal University of Belo Horizonte city of Minas Gerais (HC-UFMG)

Estudo sobre o uso do Picture Archiving and Communication System (PACS) em um Hospital Universitário da Cidade de Belo Horizonte, Minas Gerais- Brasil. 2023. Trabalho de Conclusão de Curso (Mestrado Profissional em Trabalho e Gestão Participativa na Saúde) ­ Escola de Enfermagem da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil. No contexto hospitalar, os exames de imagem são fundamentais para subsidiar e qualificar a tomada de decisão clínica. A radiologia, enquanto especialidade da medicina, tem como objetivo auxiliar os profissionais solicitantes na tomada de decisão para o diagnóstico. A radiologia é essencial porque, em diversas situações, é dela que deriva o tratamento. No contexto do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), utiliza-se o sistema de arquivamento, comunicação de imagens médicas conhecido como- Picture Archiving and Communication System (PACS). Ele é usado no setor da radiologia, permitindo aos outros profissionais solicitantes o acesso e a análise das imagens médicas, de forma eficiente e segura. A pergunta que norteou este estudo foi: Quais as potencialidades e os desafios decorrentes do uso do PACS no setor de Radiologia do Hospital de Clínicas da Universidade Federal de Minas Gerais (HC-UFMG)? O objetivo da pesquisa foi analisar como foi a implantação e a implementação do uso do PACS no setor de radiologia do HC-UFMG. Trata-se de um estudo de natureza qualitativa, exploratória e descritiva. O cenário da pesquisa foi o setor de Radiologia do HC-UFMG. Os participantes foram nove médicos radiologistas do referido setor. Foi adotado como critério de inclusão: médicos radiologistas efetivos (médicos concursados e que não estavam em período de férias e ou afastados) que utilizavam o sistema PACS no setor da Radiologia do HC-UFMG. Como critérios de exclusão adotou-se: médicos que não compunham o quadro efetivo no setor, ou seja, que eram voluntários ou residentes; foram excluídos também dois médicos que estavam de férias e dois que estavam de licença formal durante o período da coleta de dados. A coleta de dados foi realizada por meio de entrevistas com roteiro semiestruturado e levantamento documental. Realizou-se a análise dos dados das entrevistas pela técnica de Análise de Conteúdo e, dos documentos, por análise documental. A pesquisa foi submetida ao Comitê de Ética em Pesquisa da Universidade Federal de Minas Gerais (COEP/UFMG) e aprovada pelo CAAE 67471123.0.0000.5149, após aprovação pelo Departamento de Gestão em Saúde e anuência da Gerência de Ensino e Pesquisa (GEP) do HC/UFMG. Os principais resultados indicam que o PACS é considerado uma ferramenta central e eficiente pelos radiologistas entrevistados, por facilitar o acesso e a visualização dos exames de imagem, agilizar a tomada de decisão clínica e contribuir para uma assistência mais coordenada e eficaz. Conclui-se que a relevância deste estudo se reflete na contribuição para a compreensão das potencialidades e desafios relacionados ao uso do PACS em um hospital universitário, fornecendo subsídios para aprimorar a gestão em saúde e a assistência aos pacientes. O produto técnico deste estudo é um relatório técnico, a ser apresentado à direção do HC/UFMG. Palavras-chave: Picture Archiving and Communication System (PACS). Tecnologia. Eficiência. Gestão em Saúde.

A study on the use of the Picture Archiving and Communication System (PACS) at the Hospital the Federal University of Belo Horizonte city of Minas Gerais (HC-UFMG). 2023. Dissertation (Professional Master's in Work and Participatory Management in Health) - School of Nursing, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. In the hospital context, imaging tests are essential to support and qualify clinical decision- making. Radiology, as a specialty of medicine, aims to assist referring physicians in making diagnostic decisions. Radiology is essential because in several situations, treatment is derived from it. In the context of Hospital das Clínicas of the Federal University of Minas Gerais (HC- UFMG), we used the Picture Archiving and Communication System (PACS) for archiving and communication medical images. Which is used in the radiology sector and allows other requesting professionals to access and analyze medical images efficiently and securely. A question that guided this study was: What are the potentialities and challenges resulting from the use of the future Archiving and Communication System (PACS) in the Radiology sector Clinical Hospital of Federal University of Minas Gerais (HC-UFMG)? The purpose of the research was to analyze the potentialities and challenges resulting from the use of PACS in the radiology at HC-UFMG. This is qualitative, exploratory and descriptive. The research scenario was the Radiology sector of HC-UFMG. The participants were nine radiologists from that sector. The following inclusion criteria were adopted: effective radiologists (doctors who were on public service and who were not on vacation and/or away) who used the PACS system in the Radiology sector of HC-UFMG. As exclusion criteria it was adopted: physicians who did not make up the effective physicians in the sector, that is, who were volunteers or residents; were excluded also two doctors who were on vacation and two who were on formal leave during the period of data collection. Data collection was carried out through interviews with a script semi-structured and documentary survey. Data analysis of the interviews was carried out by the Content Analysis technique and documents by document analysis. The research was submitted to the Research Ethics Committee of the Federal University of Minas Gerais (COEP/UFMG) and approved by CAAE 67471123.0.0000.5149, after approval by Department of Health Management and approval of the Teaching and Research Management (GEP) of the HC-UFMG The main results indicate that the PACS is considered a tool central and efficient by the radiologist interviewed, as it facilitates access and visualization of imaging exams, streamline clinical decision-making and contribute to more coordinated and effective. It is concluded that the relevance of this study is reflected in the contribution to the understanding of the potentialities and challenges related to the use of PACS in a hospital university, providing subsidies to improve health management and assistance to patients. The technical product of this study is a technical report, to be presented to the management from HC-UFMG. Keywords: Picture Archiving and Communication System (PACS). Technology. Efficiency. Health management.

Application of education picture of standardized position in patients undergoing gastroscopy in awake state / 中华消化内镜杂志

To explore the effect of education picture of standardized position in patients undergoing gastroscopy in awake state, 80 patients who underwent gastroscopy in Beijing Friendship Hospital from April 2022 to May 2022 were prospectively selected and divided into two groups by random number method, with 40 cases in experimental group and 40 cases in control group. Patients in control group received traditional conduction before gastroscopy, while patients in experimental group received picture education with standardized position based on the traditional method. The time of position placement, the time of gastroscopy, patient satisfaction, operator satisfaction and the occurrence of related adverse reactions between the two groups were recorded and compared. The results showed that the time of body position placement was 38.70±3.09 seconds in the experimental group and 50.25±3.12 seconds in the control group with statistical difference ( t=-16.637, P<0.001). The time of gastroscopy in the experimental group was 11.63±1.51 min, while that in the control group was 15.53±1.69 min, with statistical difference ( t=-10.856, P<0.001). Patient satisfaction was 92.5% (37/40) in the experimental group and 65.0% (26/40) in the control group, and operator satisfaction was 90.0% (36/40) and 67.5% (27/40) in the experimental group and the control group, respectively. The differences were both statistically significant ( P=0.005, P=0.027). Postoperative nausea occurred in 1 case in the experimental group, while 9 cases in the control group ( P=0.014). Using education picture of standardized position in patients before undergoing gastroscopy can shorten the time of position placement and gastroscopy, improve the satisfaction of patients and physicians, and reduce the occurrence of adverse events.

Incidence and clinical characteristics of engraftment syndrome after syngeneic hematopoietic stem cell transplantation in patients with hematological diseases / 中华血液学杂志

Objective: To explore the incidence and clinical characteristics of engraftment syndrome (ES) after syngeneic hematopoietic stem cell transplantation (syn-HSCT) in patients with hematological diseases. Methods: The clinical data of 21 patients who received syn-HSCT at People's Hospital of Peking University from January 1994 to May 2018 were retrospectively analyzed. Results: Seven (33.3% ) of 21 patients developed ES. The onset of ES symptoms occurred at a median of 8 (range: 5-13) days after HSCT, and the diagnosis of ES occurred at a median of 10 (range: 7-14) days after HSCT. Steroids were administered immediately after the diagnosis of ES, the median time of symptom continuance was 2 (range: 1-5) days, and all patients showed complete resolution of ES symptoms. In the multivariate analysis, patients with acute myeloid leukemia and faster neutrophil reconstitution were the risk factors for ES (HR=15.298, 95% CI 1.486-157.501, P=0.022, and HR=17.459, 95% CI 1.776-171.687, P=0.014) . Meanwhile, there was no significant difference in the overall survival and disease-free survival between patients with ES and those without ES. Conclusion: A high incidence of ES was observed in syn-HSCT recipients. Moreover, the prognosis of ES was excellent.

Características clínicas del estado epiléptico en niños de un hospital de tercer nivel de Lima / Clinical characteristics of status epilepticus in children in a third level hospital of Lima

RESUMEN El estado epiléptico (EE) en niños exhibe altos niveles de morbi-mortalidad y ha sido poco estudiado en el Perú. Objetivo: Describir la frecuencia y características clínicas de niños con estado epiléptico, atendidos en el Hospital Cayetano Heredia de Lima. Material y métodos: Estudio retrospectivo y observacional, tipo serie de casos de niños menores de 14 años con diagnóstico de estado epiléptico, atendidos entre enero y diciembre de 2021. Resultados: Se registró EE en un 28,8% de todos los niños atendidos por crisis epilépticas durante el año 2021. Se incluyeron 23 niños que presentaron 46 EE, varones (73,9%), con una mediana de la edad de 2 años, diagnóstico subyacente de epilepsia o malformación cerebral (21,7%), atendidos en emergencia pediátrica (91%). El tipo semiológico predominante fue el EE motor generalizado (52,2%), con etiología sintomática remota (87%) y EEG registrado en un 63% de los casos, predominantemente de tipo normal (75,9%). La mediana de duración fue de 22 minutos, de resolución total, 7 minutos y resolución parcial, 2 minutos. Se empleó midazolam (78%) como primera línea de tratamiento y fenitoína (85%), como segunda línea. Conclusiones: El EE en niños fue una emergencia prevalente durante el año 2021. La mayoría fueron varones, cuya etiología predominante fue sintomática remota y el tipo semiológico más común fue el motor generalizado. Los niños fueron atendidos de acuerdo con las guías internacionales de manejo. Se insiste en la necesidad de un sistemático afronte de vigilancia epidemiológica.

SUMMARY Status Epilepticus (SE) in children exhibits high levels of morbidity and mortality and has been poorly studied in Perú. Objective: To describe the frequency and clinical characteristics of children with Status Epilepticus treated at Cayetano Heredia Hospital in Lima. Material and Methods: Retrospective and observational study, case series type, in children under 14 years of age, with Status Epilepticus treated between January and December of 2021. Results: SE was recorded in 28.8% of children with epileptic seizures seen during 2021. Twenty-three children presenting 46 SEs were included. The median age was 2 years, the majority (73,9%) being males, with diagnosis of epilepsy or brain malformation (21.7%) and treated in the pediatric emergency (91%). The predominant semiological pattern was of generalized motor type (52.2%), with remote symptomatic etiology (73.9%), and EEG recorded in a 63% of all cases, mainly reported as normal (75,9%). The median duration was 22 minutes of total resolution, 7 minutes, and of partial resolution, 2 minutes. Midazolam was used as the first line of treatment (78%), and phenytoin as the second line (85%). Conclusions: SE was a frequent condition observed in children throughout the year 2021. Most affected children were male, the predominant etiology was remote symptomatic, and the most common semiological type was the generalized motor. The children were treated according to international management guidelines. Asystematic epidemiological surveillance approach is highly encouraged.

Procesamiento emocional en niños y adolescentes según sexo / Emotional Processing in Children and Adolescents According to Sex

Resumen Objetivo: analizar el procesamiento emocional en niños, niñas y adolescentes argentinos de edad escolar según sexo. Método: estudio descriptivo-comparativo con un diseño ex post facto, transversal. Participaron en la investigación 67 mujeres y 74 varones escolarizados de entre 7 y 14 años dividido en tres franjas etarias. Para evaluar el procesamiento emocional se utilizaron las 60 imágenes específicas para niños y adolescentes del International Affective Picture System (IAPS), y para medir los juicios evaluativos se utilizó el Self Assessment Manikin (SAM). Resultados: la distribución de las imágenes muestra una correlación moderada negativa entre dos dimensiones afectivas básicas del procesamiento emocional, la valencia afectiva y la activación fisiológica, con valores similares en ambos sexos. Las mujeres puntuaron más bajo que los varones en valencia y arousal, aunque sin diferencias estadísticamente significativas. Los varones evaluaron los estímulos aversivos con menor grado de activación y los estímulos agradables con mayor activación. En general, se observa mayor agrupamiento de las imágenes desagradables y neutras en las mujeres respecto de las de los varones. Conclusión: en ambos sexos se presentó una relación inversa entre valencia y arousal, evidenciada en mayor activación ante imágenes desagradables, lo cual demostraría una tendencia reaccionaron a las imágenes desagradables con mayor intensidad mientras que los varones, valoraron las imágenes agradables con mayor intensidad.

Abstract Objective: to analyze emotional processing in Argentine school-age children and adolescents according to sex. Method: descriptive-comparative study with an ex post facto, cross-sectional design. 67 girls and 74 schooled boys aged between 7 and 14, participated in the research divided into three age ranges. The 60 specific images for children and adolescents from the International Affective Picture System (IAPS) were used to assess emotional processing, and the Self-Assessment Manikin (SAM) was used to measure evaluative judgments. Results: the distribution of the images shows a moderate negative correlation between valence and arousal, with similar values in both sexes. Women scored lower in valence and arousal compared to men, although without statistically significant differences. The men evaluated the aversive stimuli with a lower degree of activation and the pleasant stimuli with greater activation. In general, a greater grouping of unpleasant and neutral images is observed in women compared to those of men. Conclusion: in both sexes there was an inverse relationship between valence and arousal, evidenced in greater activation in the face of unpleasant images, which would demonstrate an avoidance trend when arousal levels are high. Females reacted to unpleasant images with greater intensity while males rated pleasant images with higher degree.

Desempenho de adolescentes no discurso narrativo oral e fatores associados / Performance of adolescents in oral narrative discourse and associated factors

RESUMO Objetivo caracterizar o desempenho de adolescentes de 11 a 16 anos de idade, do 6º ao 9º ano do ensino fundamental no discurso narrativo oral, bem como verificar a influência do sexo, ano escolar, idade, desempenho em testes de linguagem oral, memória e nomeação de figuras. Método 100 adolescentes de ambos os sexos, cursando do sexto ao nono ano do ensino fundamental, sem queixa de distúrbio de linguagem e aprendizagem foram submetidos à avaliação do discurso narrativo oral (Bateria MAC), nomeação de figuras por confrontação visual (Teste de Nomeação de Boston), provas de linguagem oral e memória (NEUPSILIN). Considerou-se como variável resposta o desempenho no discurso narrativo (reconto parcial e integral e resposta a questões fechadas). Após análises univariadas, foram construídos modelos de Regressão Linear Múltipla. Resultados Apenas o desempenho geral na tarefa de nomeação foi considerado preditor do desempenho no discurso narrativo oral. Verificou-se associação diretamente proporcional entre as variáveis do discurso narrativo e da nomeação de figuras. A caracterização do desempenho dos adolescentes no reconto parcial e integral e na resposta às questões fechadas por idade, ano escolar e sexo será apresentada. Conclusão Na amostra estudada, os indivíduos foram capazes de compreender e de elaborar um discurso narrativo oral de forma semelhante a adultos com menor nível de escolaridade (de dois a sete anos). Dessa forma, a prova de discurso narrativo da Bateria MAC pode ser utilizada para a avaliação de adolescentes sem adaptações.

ABSTRACT Purpose to characterize the performance in oral narrative discourse of adolescents from 6 to 9 years of age from an elementary school, as well as to verify the influence of gender, school year, age, performance in oral language tests, memory, and appointment of figures. Methods 100 adolescents of both genders from the sixth to the ninth years of elementary school who did not have any language or learning disorders were evaluated for oral narrative discourse (MAC Battery), visual figure nomination (Boston Naming Test), oral language and memory (NEUPSILIN). Performance was considered as a response variable in narrative discourse (partial and complete retelling and the ability to answer questions). After univariate analysis, Multiple Linear Regression models were constructed. Results Only general performance in the naming task was considered as a predictor of performance in oral narrative discourse. A direct association between the variables of narrative discourse and the naming of figures was present. We show the characteristics of adolescents' performance in the partial and complete retelling and in the answers to the questions by age, school year and sex. Conclusion in the studied sample the participants (aged from two to seven years old) were able to understand and detail an oral narrative discourse similar to adults with a low educational level, consequently the MAC Battery narrative discourse test can be used to assess adolescents without any requirements for adaptation.

Construction and application of medical morphology online picture examination system / 中华医学教育探索杂志

At present, the experimental examination of medical morphology courses in most medical colleges and universities still adopt traditional specimen examination or PPT examination, and there are many disadvantages. This paper introduces how to build a system with B/S architecture based on the local area network, and how to set up an examination system to realize the functions of user management, online examination database updating, free examination paper formation, examination running and automatic marking. Through its application in Chengdu Medical College in recent years, the medical morphology online picture exam system has effectively promoted the reform of the examination methods, the style of study and the effect of experimental teaching. However, there are still some problems, such as high investment cost and limited examination room.

Review and Thinking on Forensic Pathological Changes of Coronavirus-Infected Diseases / 法医学杂志

Since the beginning of this century, three types of coronavirus have widely transmitted and caused severe diseases and deaths, which strongly indicates that severe infectious diseases caused by coronavirus infection are not accidental events. Coronavirus-infected diseases are mainly manifested by respiratory symptoms, with multiple organ dysfunctions. Precisely investigating the pathological process, characteristics and pathogenesis of coronavirus-infected diseases will be beneficial for us to understand clinical manifestations and provide targeted suggestions on prophylaxis and treatment. This paper briefly reviews the pathological findings of three known coronavirus-infected diseases, and attempts to construct the pathological spectrum of coronavirus-infected diseases, aiming to provide reference and thinking for autopsy, histopathological examination and animal infection model study of coronavirus-infected diseases.

La construcción de producciones orales en la infancia a partir de imágenes realistas y no realistas / The construction of oral productions in childhood from realistic and unrealistic images

Resumen El objetivo de este trabajo fue examinar la construcción de narrativas de ficción por parte de niños/as de 5 y 6 años de edad a partir de imágenes con distinto nivel de realismo. Analizamos 49 relatos, 24 realizados a partir de imágenes realistas y 25 a partir de imágenes no realistas. Primero clasificamos las producciones en narraciones, descripciones y otras producciones, y analizamos el ordenamiento de las imágenes. La mayoría de los niños/ as que participaron en la condición no-realista construyeron narraciones e identificaron una imagen para el comienzo y otra para el cierre; mientras que los que observaron imágenes realistas construyeron mayormente descripciones y no las organizaron en secuencias. Luego realizamos un análisis de datos textuales consignando: recuento de palabras y segmentos, y recuento de tipos de palabras y segmentos; glosario de palabras y segmentos ordenados según su frecuencia; y respuesta característica (la más significativa de cada grupo). No se encontraron diferencias en el número de palabras y la cantidad de tipos de palabras utilizadas en cada producción, pero sí en las palabras características y en las respuestas que caracterizaron a cada grupo. En las descripciones se utilizaron más sustantivos, mientras que en las narraciones se utilizaron verbos y conectores causales. La respuesta característica de la descripción consistió en una exposición acerca de cada una de las imágenes por separado. La narración presentó un conflicto o estado emocional, una resolución y un cierre. Los resultados muestran que los niños/ as construyeron distintas producciones (narraciones o descripciones) según el tipo de imágenes presentadas.

Abstract The aim of this paper was to examine the creation of fictional narratives by 5 and 6 year-old children from images with different levels of realism. We analyzed 49 stories, 24 from realistic images and 25 from unrealistic images. First, the productions were classified into narratives, descriptions and other productions, and analyzed the arrangement of the images. Most of the children who participated in the unrealistic condition created narratives and identified one image for the beginning and another for the ending; while those who observed realistic images mostly made descriptions and did not arrange them into sequences. It was analyzed: number of words and segments and number of kinds of words; glossaries and segments of words sorted by frequency; characteristic responses (the most significant of each group). No differences were found neither in the number of words nor in the number of different word types used in each production. However, differences were found in the characteristic words and in the complete responses that characterized each group. More nouns were used in the descriptions, while verbs and causal connectors were used in the narratives. The characteristic response of the description consisted in a presentation of the images separately. The narrative introduced a conflict or emotional state, a resolution and a closure. The results showed that the children developed different productions (narrations or descriptions) according to the type of images they were exposed.

Implementação do Pecs Associado ao Point-Of-View Video Modeling na Educação Infantil para Crianças com Autismo / Implementation of PECS Associated with Point-Of-View Video Modeling in Early Childhood Education for Children with Autism

RESUMO Este estudo teve por objetivo analisar os efeitos do Picture Exchange Communication System (PECS) associado ao Point-of-view Video Modeling (POVM) nas habilidades comunicativas de três crianças diagnosticadas com Transtorno do Espectro Autista (TEA) e Necessidades Complexas de Comunicação. Empregou-se o delineamento experimental de múltiplas sondagens combinado ao delineamento de tratamentos alternados, sendo o PECS associado ao POVM a variável independente e as habilidades de comunicação a variável dependente. Os dados foram analisados considerando aspectos como: a porcentagem de non-overlapping, a porcentagem de respostas corretas quanto ao desempenho dos participantes e os dados da escala Likert quanto à validade social. Os resultados mostraram que a partir do início da intervenção, os níveis e as tendências de seus dados mudaram, todos os participantes obtiveram o critério, atingindo o non-overlapping de 100%. Em todas as fases do PECS associado ao POVM, os participantes obtiveram porcentagem média acima de 90%. O estudo foi considerado pelos responsáveis, pelas estagiárias e pelas professoras como socialmente válido. Conclui-se que os participantes com TEA indicaram uma mudança após a intervenção, ao comparar a condição de linha de base com a intervenção e follow-up, demonstrando uma possibilidade em Comunicação Suplementar e/ou Alternativa para as crianças com TEA.

ABSTRACT This study aimed to analyze the effects of the Picture Exchange Communication System (PECS) associated to Point-of-view Video Modeling (POVM) in communicative skills of three children diagnosed with Autistic Spectrum Disorder (ASD) and Complex Communication Needs. The experimental design of multiple probe combined with the design the alternate treatments was used, being PECS associated to POVM the independent variable and the communication skills were the dependent variables. Data were analyzed considering aspects such as: the percentage of non-overlapping, participants' performance percentage of correct responses and Likert scale data on social validity. The results showed that from the beginning of the intervention, the data levels and trends changed, all the participants obtained the criterion, reaching 100% non-overlapping. In all phases of PECS associated to POVM the participants had an average percentage above 90%. The study was considered by those responsible for the child, the trainees and the teachers. It was concluded that the participants with ASD indicated a change after the intervention, when comparing baseline condition with intervention and follow-up, demonstrating a possibility in Augmentative and Alternative Communication for children with ASD.

La medicina militar cubana en la obra de un pintor / Cuban military medicine in the work of a painter

Introducción: La medicina militar se contextualiza al carácter histórico y social de cada época, fundamentándose al mismo tiempo en las tradiciones de cada país. Por eso, además de ser expresión simultánea de la ciencia médica y militar, es también reflejo de la cultura de cada nación. En el legado cultural del maestro Enrique García Cabrera hay una obra que tomó la medicina militar como tema de inspiración, plasmado en un mural decorativo. Objetivos: Mostrar la serie de pinturas que componen la admirable obra artística, con sus cinco pinturas al fresco cronológicamente ordenadas de modo que permiten recorrer etapas características de la medicina militar en Cuba, exaltando lo estético y patriótico de la obra. Métodos: Se emplean los métodos analítico-sintético, cronológico y el iconográfico-iconológico. Se hace referencia historiográfica al contexto que el autor representa en estas. Conclusiones: Los resultados de este trabajo ponen a disposición de la docencia un material para la apreciación artística, con una hermosa obra alegórica a la medicina militar cubana. Resultan útiles además como recurso didáctico para la el trabajo educativo dirigido a la formación cultural integral de los profesionales de la salud. Corresponde a la presente y futuras generaciones conservar y estudiar con mayor profundidad esta obra, como un homenaje a su autor y a los que han aportado al desarrollo de la medicina militar cubana(AU)

Introduction: The military medicine used to be adapted at the history and social life of each epoch. At the same time, it also lies over the traditions of the different countries. For the more to be expression at the same time of the medicine and the military sciences, it is also a reflex of the culture of each nation. Enrique Garcia Cabrera was a Cuban's painter who left us a group of attractive work that assumes the military medicine as the motivation, spotted on five esthetics and decorative pictures connected by common history. Objective: The present paper shows this group of pictures which form one composition about the military medicine in Cuba and its history showing in these splendid pictures its patriotic feeling. Methods: A bibliographic review was carried out. The analytical - synthetic, the historiography and chronological methods were used to data on the evolution of Cuban's military medicine in order to situate these pictures in their own historic context. Conclusions: These results contribute to enrich the historiography of Cuban's military medicine. In addition, the beautiful composition making by Enrique Garcia Cabrera offers a useful resource to the artistic appreciation teaching and it also can contribute to the education of the health professional just about integrity cultural. The present-day and future generation must guard and study deeply this composition made by Enrique Garcia Cabrera, in admiration of its author and too for all persons who have contributed to develop the Cuban's military medicine(AU)

Contribuições técnicas e socioculturais da prevenção quaternária para a atenção primária à saúde: caminhos e desafios / Technical and socio-cultural contributions of quaternary prevention for primary health care: paths and challenges / Contribuciones técnicas y socioculturales de prevención cuaternaria para la atención primaria de salud: caminos y desafíos

Introdução: No contexto do Sistema Único de Saúde, o conceito da prevenção quaternária adentra timidamente os níveis de atenção à saúde, no entanto, sofre expansão significativa no âmbito da atenção primária à saúde. Objetivo: Identificar por meio da sistematização de evidências científicas, as contribuições técnicas e socioculturais da prevenção quaternária no âmbito da atenção primária à saúde no Brasil. Métodos: Trata-se de uma revisão integrativa de estudos presentes nas bases de dados científicas da Scientific Electronic Library Online, Biblioteca Virtual em Saúde, biblioteca virtual da Comissão de Aperfeiçoamento de Pessoal do Nível Superior e MEDLINE via PubMed com a utilização dos descritores "prevenção quaternária" e "atenção primária à saúde", em inglês e português. Resultados: O corpus de análise foi composto por 22 artigos, sendo que a produção científica sobre o tema se deu de forma mais intensa a partir do ano de 2015 e, em sua maioria, possuíam como abordagem metodológica ensaios teóricos. Dentre as contribuições técnicas destacaram-se a introdução do ensino da prevenção quaternária de modo continuado aos graduandos e profissionais; a construção de protocolos e documentos de amparo profissional; a utilização de modelos explicativos dinâmicos na socialização do quadro clínico; a conduta profissional com os usuários e as contribuições socioculturais envolvendo mudanças na percepção profissional e comunitária sobre o fenômeno saúde-doença, assim como o incentivo a práticas de desmedicalização sociocultural em relação à dor, incapacidade, desconforto, envelhecimento, nascimento e morte. Conclusão: Apesar do reconhecimento das potencialidades da prevenção quaternária, faz-se necessário fortalecer estratégias que possibilitem o desenvolvimento de políticas públicas para fomentar e gerenciar alianças estratégicas com tomadores de decisão, profissionais de saúde e cidadãos, para fomentar a redução de diagnósticos e tratamentos excessivos, contribuindo com a qualidade do cuidado.

Introduction: In the context of the Unified Health System, the concept of quaternary prevention shyly enters the levels of health care, however, undergoes significant expansion in the scope of primary health care. Objective: To identify, through the systematization of scientific evidence, the technical and socio-cultural contributions of quaternary prevention within the scope of primary health care in Brazil. Methods: This is an integrative review of studies present in the scientific databases of the Scientific Electronic Library Online, Regional Portal of the Virtual Health Library of the Latin American and Caribbean Center on Health Sciences Information of the Pan American Health Organization, virtual library of the Higher Education Personnel Improvement Commission, and MEDLINE through PubMed using the descriptors "quaternary prevention" and "primary health care", in English and Portuguese. Results: The corpus of analysis consisted of 22 articles, and the scientific production on the topic took place more intensively from the year 2015 and, for the most part, had theoretical essays as methodological approach. Among the technical contributions, we highlight the introduction of teaching on quaternary prevention in a continuous way to undergraduates and professionals; the construction of protocols and documents of professional support; the use of dynamic explanatory models in the socialization of the clinical picture and professional conduct with users and socio-cultural contributions involve changes in the professional and community perception about the phenomenon of illness and health conception, as well as the incentive to practices of socio-cultural demedicalization in relation to pain, disability, discomfort, aging, birth, and death. Conclusion: Despite the recognition of the potential of quaternary prevention, it is necessary to strengthen strategies that enable the development of public policies to foster and manage strategic alliances with decision makers, health professionals and citizens, to promote the reduction of excessive diagnoses and treatments, contributing to the quality of care.

Introducción: En el contexto del Sistema Único de Salud, el concepto de prevención cuaternaria entra tímidamente en los niveles de atención de salud, sin embargo, experimenta una expansión significativa en el alcance de la Atención Primaria de Salud. Objetivo: Identificar, a través de la sistematización de evidencia científica, las contribuciones técnicas y socioculturales de la prevención cuaternaria en el ámbito de la Atención Primaria de Salud en Brasil. Métodos: Esta es una revisión integradora de estudios presentes en las bases de datos científicas de la Biblioteca Electrónica Científica en línea, Portal Regional de la Biblioteca Virtual en Salud del Centro Latinoamericano y del Caribe de Información en Ciencias de la Salud de la Organización Panamericana de la Salud, biblioteca virtual de la Comisión de Mejoramiento del Personal de Educación Superior y MEDLINE a través de PubMed utilizando los descriptores de prevención cuaternaria y atención primaria de salud, en inglés y portugués. Resultados: El corpus de análisis estuvo conformado por 22 artículos, siendo la producción científica sobre el tema más intensiva desde 2015 y, en su mayor parte, tuvo ensayos teóricos como abordaje metodológico. Entre los aportes técnicos, destacamos la implantación de la docencia en prevención cuaternaria de forma continua a estudiantes de pregrado y profesionales; construcción de protocolos y documentos de apoyo profesional, uso de modelos explicativos dinámicos en la socialización del cuadro clínico y conducta profesional con los usuarios y los aportes socioculturales implican cambios en la percepción profesional y comunitaria sobre el fenómeno de la enfermedad y la concepción de la salud, así como el incentivo a prácticas de desmedicalización sociocultural en relación al dolor, discapacidad, malestar, envejecimiento, nacimiento y muerte. Conclusión: A pesar del reconocimiento del potencial de la prevención cuaternaria, es necesario fortalecer estrategias que permitan el desarrollo de políticas públicas para fomentar y gestionar alianzas estratégicas con los tomadores de decisiones, profesionales de la salud y ciudadanos, para promover la reducción de diagnósticos y tratamientos excesivos, contribuyendo a la calidad de la atención.

Stimulation Mode and Model of Word-picture Language Task in Functional Magnetic Resonance Imaging Test for Post-stroke Aphasia (review) / 中国康复理论与实践

The cognitive neuroscience researches about post-stroke aphasia provide the interpretation of all aspects of linguistics. The word-picture research paradigm can be applied to assess different types of aphasia, in various ways of stimulation modes and models. It is more helpful combining functional magenetic resonance imaging to research the mechanism of brain damage and recovery objectively. The interactive application of language task and imaging has also become a new direction in the mechanism study of aphasia.

Role and efficacy of picture archiving and communication system-assisted preoperative planning in total knee arthroplasty / 中国组织工程研究

BACKGROUND: In clinical application, Picture Archiving and Communication System gradually replaces the traditional preoperative planning mode of acetate template measurement on film, which can accurately obtain the parameters needed in the operation of total knee arthroplasty. OBJECTIVE: To evaluate the usage of Picture Archiving and Communication System in planning and assessment pre- and post-operatively in total knee arthroplasty. METHODS: Severe knee osteoarthritis patients who undertook total knee arthroplasty in Wuxi People's Hospital affiliated to Nanjing Medical University from March 2016 to March 2018 were included in the study. The patients were randomly divided into two groups. In the trial group (n=32), osteotomy was performed by Picture Archiving and Communication System, and then patients were implanted with knee prosthesis. In the control group (n=32), the osteotomy was performed according to the X-ray film, and then the artificial knee joint prosthesis was implanted. The trajectory of the tibia was tested during the operation. Anteroposterior and lateral X-ray films of the knee and the whole length films of the lower limbs were reexamined postoperatively. Tibial plateau inclination angle and valgus or varus angle were measured through Picture Archiving and Communication System. Recovery of lower limb alignment was assessed. Hospital for special surgery knee score on the affected side was analyzed to evaluate the recovery of joint function at postoperative 1, 3 and 12 months. This study was approved by the Ethics Committee of Wuxi People's Hospital affiliated to Nanjing Medical University. RESULTS AND CONCLUSION: (1) The satisfaction rate of lower limb alignment and the excellent and good rate of patellar movement trajectory were higher in the trial group than in the control group (100%, 91%; 100%, 94%, P 0. 05). (2) Hospital for special surgery knee score was higher in the trial group than in the control group at postoperative 1 and 3 months [(80. 5±9. 06), (74. 0±6. 42), P 0. 05). (3) No complications or adverse reactions related to implant occurred after operation. (4) Results indicated that personal osteotomy data can be obtained through Picture Archiving and Communication System in the total knee arthroplasty so as to improve the accuracy of osteotomy, better correct the lower limb alignment, obtain excellent patellar trajectory, and obtain better early curative effect of operation. The follow-up results within 1 year were satisfactory. The long-term effect remains to be further observed.

How to improve the quality of histological pictures in the manuscripts of Acupuncture Research / 针刺研究

Histological pictures are important parts of medical research articles, and a good histological picture not only visualizes the content of the article, but also makes it easier for readers to understand. With the rapid development of microscopic technology and image processing technology, journals have higher requirements for the quality of histological pictures and more strict requirements for the editing and annotation of pictures. Based on an analysis of the current status of histological pictures in the articles of Acupuncture Research, this article proposes our suggestions and Methods for rational use of histological pictures, so as to provide a reference for improving the quality of histological pictures in the articles published in Acupuncture Research.

Dermatomiositis juvenil. Sistematización de casos / Juvenile dermatomyositis. Case systematization

Introducción: La búsqueda bibliográfica realizada estableció una problemática a atender: la escasez de estudios de caso de dermatomiositis juvenil, por lo que la presente investigación pretende arrojar luz sobre esta patología, poco reflejada en la literatura médica. Nótese, además, que la sistematización puede servir de reservorio bibliográfico para estudios de posgrados de especialistas médicos. Dermatomiositis juvenil. Sistematización de casos: sistematizar y comparar 10 casos de dermatomiositis juvenil, publicados en las principales revistas médicas en cuanto a la edad del paciente, antecedentes de salud, cuadro clínico, resultados de complementarios, diagnóstico diferencial, manejo. Dermatomiositis juvenil. Sistematización de casos: hasta un 30 por ciento de los pacientes con dermatomiositis juvenil puede presentar calcinosis, especialmente en puntos de presión como codos, rodillas, dedos y glúteos. La calcinosis puede estar presente en el momento del diagnóstico, pero corrientemente se establece luego de 1 a 3 años y puede provocar la aparición de úlceras cutáneas, mengua de los rangos articulares, dolor e inflamación local. Alrededor del 10 por ciento de los pacientes con dermatomiositis juvenil puede presentar úlceras cutáneas. El estudio de su evolución suele anunciar un curso severo de la enfermedad con debilidad constante, calcinosis extensa y mala respuesta al tratamiento. Conclusiones: resulta importante sistematizar los estudios relacionados con casos de alteraciones dermatológicas de la dermatomiositis juvenil, ya que la enfermedad constituye una manifestación notable, tanto como marcador de actividad como de su daño derivado. Así también, pueden coadyuvar a lograr una percepción estadística más clara de la tasa de morbilidad y su consecuente relación con los pronósticos(AU)

Introduction: Literature search established a problem to be addressed: the scarcity of case studies of juvenile dermatomyositis, which is why this research aims to shed light on this pathology, little reflected in the medical literature. Note also that systematization can serve as a bibliographic reservoir for postgraduate studies of medical specialists. Dermatomiositis juvenil. Sistematización de casos: to systematize and compare 10 cases of juvenile dermatomyositis, published in the main medical journals regarding patient's age, health history, clinical picture, complementary results, differential diagnosis, management. Dermatomiositis juvenil. Sistematización de casos: up to 30 percent of patients with juvenile dermatomyositis can present calcinosis, especially in pressure points such as elbows, knees, fingers and buttocks. Calcinosis may be present at the time of diagnosis but is usually established after 1 to 3 years and may cause the appearance of skin ulcers, decreased joint ranges, pain and local inflammation. About 10 percent of patients with juvenile dermatomyositis may have skin ulcers. The study of its evolution usually announces a severe course of the disease with constant weakness, extensive calcinosis and poor response to treatment. Conclusions: it is important to systematize the studies related to cases of dermatological alterations of juvenile dermatomyositis, since the disease constitutes a remarkable manifestation, both as a marker of activity and of its derived damage. Likewise, they can help to achieve a clearer statistical perception of the morbidity rate and its consequent relationship with prognosis(AU)

Etiology of Pancytopenia and its Bone Marrow Picture

Introduction: Pancytopenia is an important clinicalhematological entity encountered in our day-to-day clinicalpractice. Pancytopenia may be a presentation of a widevariety of disorders, which primarily or secondarily affect thebone marrow. Study aimed to identify the etiology and bonemarrow morphology of pancytopenia patients.Material and methods: Total 30 non-malignant patientswho had pancytopenia were included in the study. Based onclinical findings bone marrow aspiration and trephine biopsywere carried out. All the bone marrow aspirate smears werestained with May-Grunwald Giemsa and trephine biopsieswere stained with and hematoxylin and eosin.Results: The majority of patients were from age group 29-38years (9 cases). Male to female ratio was 1.5:1. Commonestcomplaint presented was weakness in 28 cases followed byfever in 21 cases. Other presenting complaints were fatigue,breathlessness, icterus. Severe acute malnutrition was presentin 6 patients followed by malaria and dengue (5 cases each),Enteric fever in 2 patients. The most common cause ofPancytopenia was megaloblastic anaemia and was seen in 13cases. Bone marrow was hypercellular in all cases.Conclusion: Detailed physical examination; hematologicalinvestigations along with bone marrow aspiration andbone marrow biopsy wherever necessary in Pancytopenicpatients are helpful to diagnose or to rule out the causes ofPancytopenia.

A hospital based cross sectional study of clinical picture and spirometry pattern on interstitial lung diseases at a tertiary care centre

Background: Many of the ILDs are difficult to differentiate on clinical examination and history as they have similar clinical features. Symptom complex is not beyond that of respiratory symptoms. The objective was to study the clinical picture and spirometry pattern of the patients having interstitial lung disease.Methods: Hospital based cross sectional study was carried out among 73 cases of ILDs. Data related to history, clinical examination was recorded. Six minute walk test and spirometry was carried out. The data was analysed using proportions.Results: Incidence of Idiopathic pulmonary fibrosis (IPF) increased with age. Exertional dyspnea (100%) and cough (95.9%) were the commonest presenting symptoms amongst ILD patients. End inspiratory fine crackles (95.1%) and clubbing (67.1%) are the predominant clinical signs. Mean BMI of various ILDs patients were 24.86±8.2 Kg/m² in NSIP followed by 22.9±4.6 in sarcoidosis 21.9±6.4 and 20.8±3.94 in IPF and in Cryptogenic Organizing Pneumonias 19.34±1.8 Kg/M². Serum ACE level was raised in 69.2% patients of sarcoidosis. 81 % of patients could successfully perform 6 Minute Walk Test. Among those who could perform, average desaturation was 8.11% in sarcoidosis, 7.52% in IPF, 6.0% In Hypersensitivity Pneumonitis, 5.75% in NSIP and 4.75% in CTD associated ILDs patients. Raised C Reactive Protein label was consistent (45.2%) in ILDs, maximum in HP (63%) and 2 out of 3 patients with COP and 3 out of 5 patients of CTD associated ILDs. 17.8% cases had positive serum ANA, maximum in IPF.Conclusions: Idiopathic pulmonary fibrosis (IPF) was the commonest Interstitial Lung disease present in 39.7% of 73 cases followed by sarcoidosis in 17.9%, cases.

Conceptos y justificaciones brindadas por niños de 3 y 4 años antes y después de ser instruidos acerca de camuflaje animal / Which prey is the bird not going to eat? An analysis of the concepts and arguments provided by 3 and 4-year-old children to support their points of view

Las verbalizaciones que brindan los niños permiten que los adultos conozcamos sus aprendizajes y pensamientos. En esta investigación confluyen dos líneas de investigación: una centrada en el impacto de los libros de imágenes en el aprendizaje de conceptos y otra referida a las justificaciones en la infancia. Se presentan dos estudios cuasi-experimentales con diseño de preprueba y posprueba. En el marco de la lectura conjunta de un libro de imágenes se presentó a niños de 3 y 4 años de edad el concepto de camuflaje, con y sin la instrucción del adulto. Primero se analizaron las justificaciones que brindaron los niños para fundamentar sus respuestas, tanto antes como después de la lectura y luego, las categorías conceptuales a las que apelaron. Se observó que con instrucción los niños de 4 años, pero no los de 3, aprendieron el concepto, recurrieron al él para sustentar sus respuestas y complejizaron sus justificaciones con respecto a las que brindaron antes de la lectura. Por otro lado, los niños de 4 años que no recibieron instrucción, no aprendieron el concepto, ni apelaron a él para sustentar sus respuestas; además, no modificaron las justificaciones brindadas después de la lectura. Los resultados aportan sustento empírico respecto al entrelazamiento entre instrucción, aprendizaje de conceptos y justificaciones en la infancia.

Children's verbalizations provide a glimpse into their thoughts and learning processes. This research arises in the intersection of two fields: the impact of picture-books in conceptual and justification learning. Dialogic picture-book reading is a widespread practice between children and adults. The main goal of this research was to analyze the verbalizations children gave before and after the exposition to the concept of camouflage using a picture-book. We designed two studies using a quasi-experimental pre-test post-test approach. In Study 1 we compared two age group-children: 3- and 4-years-olds. Both groups were exposed to the concept of camouflage guided by the instruction of an adult using a picture-book. We considered camouflage as the ability of some animals to blend with the environment to avoid being seen by predators. By instruction, we meant the information given by the adult using examples of animals. The animals were shown in camouflaged and non-camouflaged settings and the adult explained which prey the predator could not eat based on the color of the animal and the background. The picture-book used was specially constructed for this research. It consisted of 10 pages; the first two showed a photograph of a predator (an eagle). The next eight pages showed four different preys depicted in camouflaged and no-camoulaged settings. In the pre-test and the post-test children were asked to choose which prey the depredator will not eat. Children also had to support their answers by explaining why the bird will not eat the chosen prey. We analyzed children's answers and the explanation that they gave before and after the exposition to the concept of camouflage with the picture-book. Additionally, we analyzed the justifications and the conceptual categories that children used to support their choices. The justifications were inspired in Migdalek's work (e.g. Migdalek, Rosemberg & Santibáñez, 2014). The conceptual categories were created inductively from the transcription of children's verbalizations. We found that the 4-years-olds learned the concept and support their choices appealing to the camouflage category; also, they provided complex justifications. As far as 3-years-olds, even though they received the same instruction, they did not learn the concept, neither improved their justifications. Given these results, we concluded that the observed differences in the performance are due to the children's age, since the instruction provided was the same for the two age groups. To specifically explore the impact of the instruction we designed a Study 2 in which we compared children's answers and their verbalizations in two groups of 4-year-old children. Four-years-old were exposed to the same picture-book with and without instruction. The procedure followed was the one described in Study 1. In the condition with out instruction, the experimenter presented the children the picture-book indicating which prey the depredator would not eat, but without explaining the reasons. We found out that the children that did not receive any instruction did not learn the conceptor used it to support their choices. Besides, this group did not improve their justifications. In contrast, the children that received instruction learned the concept and supported their choices using the camouflage category; in addition, they provided complex justifications. Overall, the results presented provided empirical data to highlight the close relationship between instruction, conceptual learning and justifying in children.