Barreras para una alimentación saludable: un análisis cualitativo de las semánticas emergentes en las comunidades escolares de Ciudad Sur

La literatura ha hecho hincapié en la centralidad que cumplen los entornos alimentarios en las elecciones alimentarias y en el estado nutricional de la población. Objetivo: identificar las percepciones de padres, madres y apoderados, profesionales de establecimientos educacionales, funcionarios municipales, y feriantes pertenecientes a la zona sur de Santiago de Chile, respecto a las barreras y limitaciones de la puesta en práctica de una alimentación saludable en el ambiente alimentario escolar. Método: se realizaron seis grupos focales agrupando a 50 actores claves vinculados a los establecimientos educacionales de Ciudad Sur utilizando una muestra no probabilística. Se aplicó un análisis de contenido mediante la técnica de codificación temática buscando relevar los universos semánticos emergentes. Resultados: se identificaron nueve barreras, o semánticas, que caracterizan limitantes a la realización de la alimentación saludable en los entornos escolares desde la perspectiva de los participantes: la familia, kioscos escolares, la salida de los establecimientos escolares, gusto, determinantes socioeconómicos, política pública, falta de conocimiento, publicidad y disponibilidad de productos sin sellos. Conclusiones: las limitaciones asociadas al ambiente alimentario doméstico tienen una representación significativamente alta (47,9%) y contienen un carácter de responsabilización individual en su enunciación. Esta cultura explicativa es opuesta a la evidencia científica y académica respecto al funcionamiento de la conducta alimentaria, y a la centralidad de los ambientes alimentarios respecto a la facilitación u obstaculización del consumo de alimentos saludables o adecuados.

Literature has emphasized on food environments centrality in food choices and nutritional status. Objective: identify social perceptions of fathers, mothers and guardians, professionals from educational establishments, municipal officials, and stallholders belonging to the southern area of Santiago de Chile, regarding limitations of healthy diet implementation on school environments. Method: six focus groups were carried out grouping 50 key actors linked to educational establishments using a non-probabilistic sample. A content analysis was applied through thematic coding technique seeking to reveal emerging semantic universes. Results: Nine barriers, or semantics, were identified characterizing limitations to healthy eating habits in school environments: family, school kiosks, leaving school establishments, taste, socioeconomic determinants, public policy, lack of knowledge, publicity, and availability of products without seals. Conclusions: limitations associated with domestic food environment have a significantly high representation (47,9%) and contain an individualized responsibility feature. This explanatory culture is opposed to scientific and academic evidence regarding the functioning of eating behavior, and the centrality of food environments facilitating or hindering healthy food consumption.

Functional limitation among older adults in a rural area in South Kerala and its associated factors

Background: A person is said to have a functional limitation when he/she does not have the physical or cognitive ability to independently perform the routine activities of daily living. If recognized at an early stage, these can often be improved greatly, helping them regain their functional abilities and independence. Objective: The objective of the study was to determine the prevalence of functional limitations among older adults in a rural area in south Kerala. Materials and Methods: The cross-sectional study was conducted among older adults residing in the field practice area of a rural health training center of a medical college in south Kerala for 3 months from October 2019 to December 2019. Data were collected by interview of the participants by the investigator. The modified Barthel Index for activities of daily living was used to determine the prevalence of functional limitations. Results: The overall prevalence of functional limitations among older adults in a rural area in south Kerala was 35.9%. The most common functional limitation experienced by the participants was difficulty in climbing stairs. Functional limitation was found to be significantly associated with the age, socioeconomic status, and type of family of the participants. Conclusion: There is an urgent need to focus on the functional limitation among older adults, especially among the oldest old and those in lower socioeconomic status with emphasis on the need to strengthen the health‑care facilities for them, with respect to early identification and management of their functional limitations.

Exploring the Principles， Limitations， and Error-Correction Methods of Traditional Chinese Medicine's Empirical Thinking / 中医杂志

From the perspective of cybernetics， this study investigated the fundamental principles of empirical thinking in traditional Chinese medicine， encompassing six stages： experience input and storage， experience extraction and activation， experience combination and reconstruction， judgment and decision-making based on experience， and experience evaluation and feedback. The potential limitations of empirical thinking in clinical applications were analyzed， mainly manifested as “individuality”， “superficiality”， “conservatism”， “prioritizing commonality over individuality”， and “cognitive inertia”. To overcome these limitations， this paper also explored strategies and methods for clinical error-correction from four points： the integration of rational and empirical thinking， the reinforcement of feedback mechanisms and transcendent correction， the integration of individualization and quantity-quality balance， and the management and transference of tacit knowledge under empirical thinking.

Fatores desencadeantes para limitações sociais e saúde mental em diabéticos / Triggering factors for social limitations and mental health in diabetics / Factores desencadenantes de limitaciones sociales y salud mental en diabéticos

Introdução:A Diabetes Mellitus é caracterizada como uma síndrome de múltiplas etiologias, que ocorre pela falta de insulina, ou resistência do organismo à mesma, estando relacionada à diversas complicações que demandam ao paciente adaptações no modo de viver e que podem ser geradores de sofrimento psicológico. Objetivo:Identificar os principais fatores desencadeantes para a ocorrência de limitações sociais e suas consequências na saúde mental de pacientes convivendo com diabetes. Metodologia:O estudo configura-se como revisão integrativa da literatura. Utilizou-se como critérios de inclusão: artigos completos, publicados de 2015 a 2020, nos idiomas inglês, português e espanhol. Foram excluídos: documentos de editoriais, revisões, resenhas, capítulos de livros e artigos que não atendessem ao objetivo proposto. A busca dos estudos se deu entre os meses de outubro a novembro de 2020 nas bases de dados: PubMed,CinahleEmbase. Foram utilizados descritores controlados identificados nos Descritores em CiênciasdaSaúde (DECs), Medical Subject Headings (MESH) e EMBASEEmtree, resultando em 2.063 estudos na identificação, passando por triagem e permanecendo 718, após a elegibilidade resultou em 12, dando origem a 9 estudos na amostra final. Resultados:A amostra final resultou na criação de eixos temáticos que trazem o aumento do sofrimento psicológico em pessoas com diabetes ocasionados pelas mudanças no estilo de vida, na falta de apoio familiar e social, na inatividade física, no impacto do gênero e da cultura, e no aumento dos sintomas de complicações e de comprometimento funcional, sendo desencadeantes para a ocorrência de limitações sociais. Conclusões:A diabetes e o seu tratamento geram limitações sociais na vida dos pacientes, pela necessidade de mudanças no estilo devida que demandam muita dedicação e tempo, tais fatores são considerados preditores para aumento dos riscos de sofrimento psicológico nesses pacientes (AU).

Introduction:Diabetes Mellitus is characterized by being a syndrome of multiple etiologies, which occurs due to the lack of insulin or the body's resistance to it, being related to various complications that require the patient to adapt their lifestyle and that can generate psychological suffering.Objective:Identify the main triggering factors for the occurrence of social limitations and their consequences on the mental health of patients living with diabetes.Method:This study is configured as an integrative review of the literature. The inclusion criteria were full articles, published from 2015 to 2020, in English, Portuguese and Spanish.Editorial documents, reviews, book chapters and articles that did not meet theproposed objective were excluded.The compilation of studies was carried out from October and November 2020 in the databases:PubMed, CinahlandEmbase. In addition, controlled descriptors identified in the Descriptors in Health Sciences (DECs), MESH and EMBASE Emtree were used, which resulted in 2,063 studies identified, submitted for selection, remaining 718, and 12 after the eligibility process, resulting in 9 studies in the final sample.Results:The final sample resulted in the creation of thematic axes that bring an increase in psychological suffering in people with diabetes caused by changes in their lifestyle, lack of family and social support, physical inactivity, impact of gender and culture, and the increase in symptoms of complications and functional impairment, triggering the occurrence of social limitations.Conclusion:Diabetes and its treatment generate social limitations in the lives of patients, due to the need for changes in their lifestyle that require a lot of dedication and time, such factors are considered predictors to increase the risks of psychological suffering in these patients (AU).

Introducción:La Diabetes Mellitus se caracteriza por ser un síndrome de múltiples etiologías, que se presenta por la falta de insulina o por la resistencia del organismo a esta, estando relacionada con diversas complicaciones que requieren del paciente adaptaciones ensumodo de vida y que pueden generar sufrimientopsicológico.Objetivo:Identificar los principales factores desencadenantes parala ocurrenciade limitaciones sociales y sus consecuencias enla salud mental de los pacientes que viven con diabetes.Metodología:Esteestudio se configura como una revisión integradora de la literatura. Se incluyeron: artículos completos, publicados de 2015 a 2020, en inglés, portugués y español.Se excluyeron: documentos editoriales, reseñas, capítulos de libros y artículos que no cumplieron con el objetivo propuesto.El compilado de estudiosse realizóde octubre y noviembre de 2020 en las bases de datos:Medline (PubMed®), CINAHL yEMBASE.Se utilizaron descriptores controlados identificados en los Descriptores enCiencias de la Salud (DECs), MESH y EMBASE Emtree, lo que resultó en 2.063 estudios identificados, sometidos a selección, quedando 718,y resultando, luego del procesode elegibilidad,en 12, dando lugar a 9 estudios en la muestrafinal. Resultados:La muestra final resultó en la creación de ejes temáticos que traen un aumento del sufrimiento psicológico en las personas con diabetes provocado por cambios en suestilo de vida, la falta de apoyo familiar y social, inactividad física, impacto del género y la cultura, y el aumento de los síntomas de complicaciones y deterioro funcional, desencadenando la ocurrencia de limitaciones sociales.Conclusiones:La diabetes y su tratamiento generan limitaciones sociales en la vida de los pacientes, debido a la necesidad de cambios en suestilo de vida que requieren mucha dedicación y tiempo, tales factores se consideran predictores para aumentar los riesgos de sufrimiento psicológico en estos pacientes (AU).

Estrategias y limitaciones de la consejería en salud de enfermería: una revisión integradora de literatura / Strategies and limitations of applying health counseling in nursing: an integrative literature review

Resumen: Objetivo: Identificar ámbitos de aplicación de consejería en salud de enfermería y sus limitaciones. Materiales y Métodos: Revisión integradora de literatura; la búsqueda de los estudios se realizó en las bases de datos: Web of Science, Scopus, PubMed, ClinicalKey, OVID, CINAHL y Proquest. Se localizaron artículos publicados en el período del 2012 al 2021, en idiomas: español, inglés y portugués, que incluían en el título y/o resumen alguno de los siguientes descriptores: "Nursing health counseling", "Health promotion", "Patient centered care", "Nurse-Patient relationships", con el operador booleano "AND". Resultados: Once artículos cumplieron los criterios de inclusión y fueron analizados. Se identificaron hallazgos clave y se formularon categorías y temas a través de los estudios. En los resultados se presentan dos categorías a) estrategias para brindar consejería de salud en enfermería y b) limitaciones de la consejería de salud en enfermería. Conclusiones: Los ámbitos de aplicación de la consejería de salud en enfermería son amplios dentro de la atención primaria de salud, tanto para la promoción de la salud, como para el autocuidado de personas con diversas patologías; en cuanto a limitaciones es necesario contar con personal de enfermería capacitado.

Abstract: Objective: Identify the areas of application of nursing health counseling, and its limitations. Materials and Methods: Integrative literature review; the search of the studies was performed in the following databases: Web of Science, Scopus, PubMed, ClinicalKey, OVID, CINAHL, and Proquest. Articles that were published in the period from 2012 to 2021 were located in the following languages: Spanish, English, and Portuguese, which included in the title and/or abstract any of the following descriptors: "Nursing health counseling", "Health promotion", "Patient-Centered care", "Nurse-patient relationships", with the Boolean operator "AND". Results: Eleven articles met the inclusion criteria and were assessed. Key findings were identified and categorized into topics. In the results, two categories are shown: a) strategies to provide nursing health counseling and b) limitations of nursing health counseling. Conclusions: The application scope of nursing health counseling is broad within primary health care, both for the promotion of health and for the self-care of people with various pathologies; with respect to limitations, it is necessary to have trained nursing personnel.

Benefits, disadvantages and challenges of virtual conferencing in the COVID-19 era: Adjusting to the new normal

Objective: The COVID-19 pandemic has had tremendous effect on the medical and scientific community. Measures instituted to curb the spread of the disease such as physical distancing and ban on large gatherings have significantly altered conferencing activities of medical professional associations. With no end in sight to the pandemic, it is certain that medical professional associations may have to make do with purely virtual or hybrid conferencing for some time to come. The objective of this paper is to highlight the benefits, disadvantages and challenges of virtual conferencing Methods: We searched Pubmed, Embase, Scopus, and AJOL databases from January 1, 2021 to December 31, 2021 for publications describing the benefits, disadvantages and challenges of virtual conferencing during the pandemic. This, together with authors' experience formed the resource base for this work. Conclusion: We propose ways the scientific community in Nigeria can maximize the virtual conferencing while the pandemic lasts. We also advocate increased discussion about how to improve the virtual conferencing culture and the development of guidelines for purely virtual or hybrid scientific conferences

Objectif de l'étude: La pandémie de COVID-19 a eu un effet considérable sur la communauté médicale et scientifique. Les mesures instituées pour freiner la propagation de la maladie, telles que l'éloignement physique et l'interdiction des grands rassemblements, ont considérablement modifié les activités de conférence des associations professionnelles médicales. Sans fin en vue de la pandémie, il est certain que les associations professionnelles médicales devront se contenter de conférences purement virtuelles ou hybrides pendant un certain temps encore. L'objectif de cet article est de mettre en évidence les avantages, les inconvénients et les défis de la conférence virtuelle. Méthodes de l'étude : Nous avons effectué des recherches dans les bases de données Pubmed, Embase, Scopus et AJOL du 1er janvier 2021 au 31 décembre 2021 pour trouver des publications décrivant les avantages, les inconvénients et les défis des conférences virtuelles pendant la pandémie. Ceci, combiné à l'expérience des auteurs, a constitué la base de ressources pour ce travail. Conclusion : Nous proposons des moyens pour que la communauté scientifique du Nigéria puisse maximiser les conférences virtuelles pendant la durée de la pandémie. Nous préconisons également une discussion accrue sur la manière d'améliorer la culture des conférences virtuelles et l'élaboration de lignes directrices pour les conférences scientifiques purement virtuelles ou hybrides

Problems exposed in retrospective study of postoperative complications of rectal cancer and causal analysis / 中华胃肠外科杂志

Rectal cancer is a great threat to the health of the Chinese people. With the continuous improvement of surgical treatment level, complication as an important indicator to measure the safety of surgery has received increasing attention from clinicians both at home and abroad. Although there are many studies on postoperative complications of rectal cancer, the morbidity of complication reported by related studies varies greatly. An important reason occurs in the limitations of retrospective research, such as incomplete medical records, unclear diagnostic criteria for some complications, incomplete follow-up records after discharge, and poor communication mechanisms among MDT members. Starting from a retrospective study on postoperative complications of rectal cancer and finding out the defects and problems in the registration of complications in each center, then clarifying the definition of various postoperative complications, so as to establish a sound and standardized registration system, and carry out prospective research, this path could be a reliable method to obtain relatively accurate postoperative complications of rectal cancer.

Cognitive screening instruments for dementia: comparing metrics of test limitation / Instrumentos de rastreio cognitivo para a demência: comparação métrica da limitação dos testes

ABSTRACT Cognitive screening instruments (CSIs) for dementia and mild cognitive impairment are usually characterized in terms of measures of discrimination such as sensitivity, specificity, and likelihood ratios, but these CSIs also have limitations. Objective: The aim of this study was to calculate various measures of test limitation for commonly used CSIs, namely, misclassification rate (MR), net harm/net benefit ratio (H/B), and the likelihood to be diagnosed or misdiagnosed (LDM). Methods: Data from several previously reported pragmatic test accuracy studies of CSIs (Mini-Mental State Examination, the Montreal Cognitive Assessment, Mini-Addenbrooke's Cognitive Examination, Six-item Cognitive Impairment Test, informant Ascertain Dementia 8, Test Your Memory test, and Free-Cog) undertaken in a single clinic were reanalyzed to calculate and compare MR, H/B, and the LDM for each test. Results: Some CSIs with very high sensitivity but low specificity for dementia fared poorly on measures of limitation, with high MRs, low H/B, and low LDM; some had likelihoods favoring misdiagnosis over diagnosis. Tests with a better balance of sensitivity and specificity fared better on measures of limitation. Conclusions: When deciding which CSI to administer, measures of test limitation as well as measures of test discrimination should be considered. Identification of CSIs with high MR, low H/B, and low LDM, may have implications for their use in clinical practice.

RESUMO Os instrumentos de rastreio cognitivo (IRCs) para demência e comprometimento cognitivo leve são geralmente caracterizados em termos de medidas de discriminação, como sensibilidade, especificidade e razões de probabilidade, mas esses IRCs também têm limitações. Objetivo: Calcular várias medidas de limitação de testes para IRC comumente usados, a saber: taxa de classificação incorreta; relação entre dano líquido e benefício líquido; e probabilidade de diagnóstico ou diagnóstico incorreto. Métodos: Os dados de vários estudos de precisão de teste pragmático de IRC relatados anteriormente (MMSE, MoCA, MACE, 6CIT, AD8, TYM, Free-Cog) e realizados em uma única clínica foram reanalisados para calcular e comparar a taxa de classificação incorreta, o dano líquido para a relação de benefício líquido e a probabilidade de diagnóstico ou diagnóstico incorreto para cada teste. Resultados: Alguns IRC com sensibilidade muito alta, mas baixa especificidade para demência, tiveram desempenho ruim em medidas de limitação, com altas taxas de classificação incorreta, baixo prejuízo líquido para relações de benefício líquido e baixa probabilidade de diagnóstico ou diagnóstico incorreto; alguns tinham probabilidades de favorecer o diagnóstico incorreto ao invés do diagnóstico. Testes com melhor equilíbrio de sensibilidade e especificidade saíram-se melhor nas medidas de limitação. Conclusões: Ao decidir qual IRC administrar, as medidas de limitação, bem como as medidas de discriminação do teste, devem ser consideradas. A identificação de IRC com alta taxa de classificação incorreta, baixa relação de prejuízo e benefício e baixa probabilidade de diagnóstico ou diagnóstico incorreto pode ter implicações para seu uso na prática clínica.

Intervenções em Psicodrama: uma revisão sistemática / Psychodrama interventions: a systematic review / Intervenciones de psicodrama: una revisión sistemática

O Psicodrama busca conhecer a realidade apresentada, investigando a psique humana através da dramatização. Este estudo objetiva identificar intervenções em psicodrama, suas limitações e resultados. Nesta revisão sistemática da literatura, buscaram-se trabalhos publicados entre 2009 e 2019, no Portal de Periódicos da Capes. Dos 1403 estudos encontrados, 34 atenderam aos critérios de inclusão e exclusão. Após a análise dos artigos emergiram 11 categorias e eles foram agrupados por similaridade de assuntos ou público participante. O psicodrama se mostrou eficiente na maioria das intervenções, salientando sua flexibilidade e abrangência, permitindo mudanças significativas na vida dos participantes, reflexões sobre padrões comportamentais e autoconhecimento. As limitações encontradas ressaltam escassez de recursos, aparentemente financeiros, como questão comum a inúmeros artigos.

Psychodrama seeks to know the reality presented, investigating the human psyche through dramatization. This study aims to identify interventions in psychodrama, its limitations and results. This systematic review of the literature sought works published between 2009 and 2019, on the Portal de Periódicos da Capes. In 1403 studies found, 34 met the inclusion and exclusion criteria. After analyzing the articles, 11 categories emerged and they were grouped by similarity of subjects or participating public. Psychodrama proved to be efficient in most interventions, emphasizing its flexibility and comprehensiveness, allowing significant changes in the participants’ lives, reflections on behavioral patterns and self-knowledge. The limitations found underscore the scarcity of resources, apparently financial, as a common issue in numerous articles.

El psicodrama busca conocer la realidad presentada, investigando la psique humana a través de la dramatización. Este estudio tiene como objetivo identificar intervenciones en psicodrama, sus limitaciones y resultados. Esta revisión sistemática de la literatura buscó trabajos publicados entre 2009 y 2019, en el Portal de Periódicos da Capes. De los 1403 estudios encontrados, 34 cumplieron los criterios de inclusión y exclusión. Tras analizar los artículos surgieron 11 categorías y se agruparon por similitud de temas o público participante. El psicodrama demostró ser eficaz en la mayoría de las intervenciones, enfatizando su flexibilidad y amplitud, permitiendo cambios significativos en la vida de los participantes, reflexiones sobre patrones de comportamiento y autoconocimiento. Las limitaciones encontradas subrayan la escasez de recursos, aparentemente económicos, como tema común en numerosos artículos.

Opportunities and challenges of three-dimensional printing technology in pharmaceutical formulation development

Three-dimensional printing is a technology that prints the products layer-by-layer, in which materials are deposited according to the digital model designed by computer aided design (CAD) software. This technology has competitive advantages regarding product design complexity, product personalization, and on-demand manufacturing. The emergence of 3D technology provides innovative strategies and new ways to develop novel drug delivery systems. This review summarizes the application of 3D printing technologies in the pharmaceutical field, with an emphasis on the advantages of 3D printing technologies for achieving rapid drug delivery, personalized drug delivery, compound drug delivery and customized drug delivery. In addition, this article illustrates the limitations and challenges of 3D printing technologies in the field of pharmaceutical formulation development.

Serie de Redacción Científica: Estudio de Cohortes / Scientific Writing Series: Cohort studies

Objetivo. El estudio de cohortes es un diseño de tipo observacional. Este diseño solo incluye participantes que tienen el mismo riesgo de estar expuestos, para luego comparar quienes de los expuestos y no expuestos presentarán el desenlace de interés durante el mismo periodo de tiempo. La temporalidad entre la exposición y el resultado de interés en un estudio de cohorte está bien definida porque se tiene certeza de que la exposición antecede al resultado de interés. Los estudios de cohorte pueden ser prospectivos, retrospectivos o una combinación de ambos. Una de las principales ventajas es su naturaleza longitudinal, lo que permiten estimar la incidencia y el riesgo relativo como asociación de interés. Algunas variables pueden variar en el tiempo por lo que es importante, utilizar técnicas de modelamiento de datos avanzados como los modelos de efectos fijos y aleatorios

Objetive. The cohort study is an observational design. This only includes participants who have the same risk of being exposed, then compares who is exposed and unexposed presents the outcome of interest during the same period. The temporality between the exposure and the outcome of interest in a cohort study is well defined because it is certain that the exposure antecedent to the outcome of interest. Cohort studies can be prospective, retrospective, or a combination of both. One of the main advantages is its longitudinal nature, making it possible to estimate the incidence and relative risk as an association of interest. Some variables may vary over time, so it is essential to use advanced data modeling techniques such as fixed and random effects models.

Limitaciones sociales en los derechos a la sexualidad de las personas con síndrome de Down / Limitações sociais nos direitos à sexualidade das pessoas com síndrome de Down / Social limitations in the sexuality rights of people with Down syndrome

Resumen La sexualidad es un proceso complejo, especialmente cuando se habla de personas con síndrome de Down. Por ello, el objetivo de este trabajo fue identificar las limitaciones sociales en el ejercicio de los derechos a la sexualidad de esta población. La revisión incluyó información de publicaciones de los años 2006 a 2019, de España, Argentina y Colombia. El análisis arrojó que entre las mayores limitaciones que condicionan la satisfacción de las necesidades afectivas y sexuales de las personas con síndrome de Down, se encuentran el trato infantil, la sobreprotección de sus familias, la reprensión y control excesivo, coerción de su autodeterminación y ausencia de una educación sexual; factores que limitan una inclusión real en la sociedad, pues consideran que son seres asexuados o por el contrario que su exacerbación sexual debe ser inhibida o controlada. Además, varios autores manifiestan que la educación para la sexualidad no se brinda desde la niñez, por miedo a despertar deseos que no se puedan controlar, situación que termina por coaccionar su desarrollo como persona, su inclusión social, el desarrollo de su calidad de vida y ser sujeto de derechos y deberes.

Resumo A sexualidade é um processo complexo, principalmente quando se fala de pessoas com síndrome de Down, portanto, o objetivo deste trabalho é identificar as limitações sociais no exercício dos direitos à sexualidade dessa população. A revisão inclui informações sobre publicações de 2006 a 2019, da Espanha, Argentina e Colômbia. A análise mostra que entre as principais limitações que condicionam a satisfação das necessidades emocionais e sexuais das pessoas com síndrome de Down, estão o tratamento infantil, superproteção de suas famílias, repressão e controle excessivo, coerção de sua autodeterminação e ausência de uma educação sexual; fatores que limitam uma inclusão real na sociedade, que os considera seres assexuais ou, pelo contrário, que sua exacerbação sexual deve ser inibida ou controlada. Além disso, vários autores afirmam que a educação para a sexualidade não é fornecida desde a infância, por medo de despertar desejos que não podem ser controlados, situação que acaba coagindo seu desenvolvimento como pessoa, sua inclusão social, o desenvolvimento de sua qualidade de vida e estar sujeito a direitos e deveres.

Abstract Sexuality is a complex process, especially when related to people with Down syndrome. This work identifies social limitations in this population's exercise of sexual rights. The review includes information from publications of the years 2006-2019 in Spain, Argentina and Colombia. The greatest constraints on the emotional and sexual needs of people with Down syndrome are their infantilization, overprotection from families, excessive repression and control, coercion of self-determination, and absence of sex education; factors that limit their real inclusion in society, which considers them asexual beings or that their sexual exacerbation must be inhibited or controlled. In addition, several authors state that sexual education is not provided, since childhood, for fear of arousing desires that cannot be controlled, a situation that ends up coercing their development as a person, their social inclusion, the development of a quality of life, and being subjects of rights and duties.

Valoración de limitaciones en reumatología. Herramientas más utilizadas en la práctica / Assessment of limitations in rheumatology. Tools most used in practice

Resumen Introducción: Las enfermedades reumáticas son patologías de alta prevalencia, impacto y repercusión, caracterizadas por dolor y limitación funcional. Para valorar la limitación, la historia clínica es el punto de partida, junto con las pruebas específicas necesarias, según el tipo de padecimiento. De forma complementaria, se recomienda el uso de herramientas clinimétricas. Objetivo: Comparar algunas herramientas o cuestionarios usados en las enfermedades reumáticas más prevalentes, revisando la bibliografía para destacar sus aportes y su utilidad en la labor del médico con finalidad clínica o pericial. Método: Se revisan las características básicas de los cuestionarios y herramientas más usadas en: osteoartritis, artritis reumatoide y artritis psoriásica, espondilitis anquilosante y lupus eritematoso sistémico. Se revisa en Medline la experiencia de los autores con algunos cuestionarios en función de la patología y de sus diversos usos. Resultados: Los cuestionarios se utilizan en su mayoría para la valoración de la calidad de vida, la discapacidad y la evolución clínico-terapéutica de los pacientes. No hay acuerdo entre los autores sobre si existe prioridad en el uso de algún cuestionario concreto por patología y se tiende a combinar varios. Los cuestionarios genéricos más utilizados son SF-36, NHP y EQ-5D. Por enfermedades: en artritis reumatoide, HAQy DAS28; en osteoartritis, WOMAC y Knoos; en Lupus, SLEDAI y BICLA, y en espondilitis, BASDAI y ASDAS. Conclusiones: En reumatología los cuestionarios son de uso habitual y resultan de utilidad de forma complementaria a la historia clínica y a las pruebas específicas. La elección por el profesional médico se basa en su experiencia y en la adecuación al objetivo buscado.

Abstract Introduction: Rheumatic diseases are high prevalence, high impact and repercussion pathologies characterised by pain and functional limitation. To assess the limitation, the starting point is the clinical history, together with the specific tests required according to the type of condition. The use of complimentary clinometric tools is recommended. Objective: To compare some tools or questionnaires used in the most prevalent rheumatic diseases, and a review of the literature to highlight their contributions and usefulness in medical practice by the clinician or expert. Method: A review is made of the basic characteristics of the questionnaires and the most used tools in osteoarthritis, rheumatoid arthritis and psoriatic arthritis, ankylosing spondylitis and systemic lupus erythematosus. The experience of the authors is reviewed in Medline, with some questionnaires depending on the pathology and its various uses. Results: The questionnaires are used mainly to assess the quality of life, disability, and clinical-therapeutic evolution of patients. There is no agreement among the authors on whether there is a priority in the use of a specific questionnaire by pathology, and there is a tendency to combine several. The most commonly used generic questionnaires are SF-36, NHP and EQ-5D. For diseases: in rheumatoid arthritis, the HAQ and DAS28; in osteoarthritis, WOMAC and Knoos; in lupus, SLEDAI and BICLA; and in spondylitis, BASDAI and ASDAS. Conclusions: In rheumatology, questionnaires are commonly used, and are useful as a complement to the clinical history and specific tests. The choice by the medical professional is based on their experience and on the adaptation to the objective sought.

Development and challenges of gene editing technology / 生物工程学报

Gene editing is a technique for modifying gene fragments. The novel gene editing technology focuses on the field of artificial nuclease cleavage technology, mainly ZFN technology, TALEN technology, CRISPR technology and base editing technology. The continuous improvement of gene editing technology has promoted the rapid development of agriculture, animal husbandry and biomedicine, but at the same time, technical defects and ethical controversy have brought enormous challenges to its own development. This article will briefly discuss the development and challenges of gene editing technology, as well as the views at home and abroad, and hope to inspire readers to recognize gene editing technology.

Syllabus universitario actuante en ciencias pedagógicas potencialidades y limitaciones en la Universidad de Guyaquil / Syllabus university acting in Pedagogical Sciences potentialities and limitations at the University of Guayaquil / Universidade Syllabus atuando nas potencialidades e limitações das Ciências Pedagógicas na Universidade de Guayaquil

Resumen Introducción: El presente artículo está enfocado en la investigación acerca del syllabus universitario, conociendo su significado, importancia y limitaciones que se puedan encontrar dentro del syllabus que es considerado como una herramienta de planificación y organización de aspectos cognitivos, axiológicos, que se realizará en un tiempo determinado. Objetivo: Decidir cómo va a ser evaluado, de forma adecuada, su trabajo. Identificar y desarrollar diferentes recursos. Estructurar el trabajo activo de los estudiantes en su aprendizaje. Redactar su syllabus. Materiales y métodos: se adoptó una perspectiva metodológica cualitativa mixta, ya que se combinaron los componentes interpretativos con los cuantitativos en el mismo estudio con énfasis en el enfoque cualitativo. Resultados: El 100% sabe lo que significan los syllabus. La segunda pregunta: Según su criterio. Los syllabus se consideran como: Un programa detallado de una asignatura según el Gráfico 2 con un 72%, por otro lado, el 22% considera a los syllabus como una comunicación escrita entre el docente del curso y los alumnos, colegas y administradores. Conclusión: se determina que el syllabus universitario actuante en ciencias pedagógicas potencialidades y limitaciones en la universidad de Guayaquil pueden llegar a ser efectivas tomando en consideración las diferentes perspectivas de los docentes.

Abstract Introduction: The present article is focused in the research about the university syllabus, knowing its meaning, importance and limitations that can be found within the syllabus that is considered as a tool of planning and organization of cognitive, axiological aspects, that will be realized in a determined time. Objective: Decide how your work will be evaluated, in an appropriate manner. Identify and develop different resources. Structure the active work of students in their learning. Write your syllabus. Materials and methods: a mixed qualitative methodological perspective was adopted, since the interpretive components were combined with the quantitative ones in the same study with emphasis on the qualitative approach. Results: 100% know what syllabus means. The second question: According to your criteria. The syllabus are considered as: A detailed program of a subject according to Figure 2 with 72%, on the other hand, 22% consider the syllabus as a written communication between the teacher of the course and students, colleagues and administrators. Conclusion: it is determined that the university syllabus acting in pedagogical sciences potentialities and limitations at the University of Guayaquil can become effective taking into account the different perspectives of teachers. discharge vs. hydrostatic head / hole diameter ratio. Through comparisons with bibliographic sources. Conclusion. The values of discharge coefficients obtained in this investigation are valid according to the study flow conditions, these being of great contribution to these structures where holes are used such as desarenadores, catchments and drains.

Resumo Introdução: Este artigo centra-se na pesquisa sobre o currículo universitário, sabendo o seu significado, importância e limitações que podem ser encontrados no programa que é considerado como uma ferramenta para o planejamento e organização cognitiva, axiológica, a ser realizada em um determinado momento. Objetivo: Decida como seu trabalho será avaliado, de maneira apropriada. Identifique e desenvolva recursos diferentes. Estruturar o trabalho ativo dos alunos em sua aprendizagem. Escreva seu currículo. Materiais e métodos: adotou-se uma perspectiva metodológica qualitativa mista, uma vez que os componentes interpretativos foram combinados com os quantitativos no mesmo estudo, com ênfase na abordagem qualitativa. Resultados: 100% sabem o que significa syllabus. A segunda pergunta: de acordo com seus critérios. A estrutura curricular são considerados: um programa detalhado de um assunto de acordo com a Figura 2, com 72%, por outro lado, 22% consideraram o programa como um curso de escrita entre professores e alunos, colegas e administradores de comunicação. Conclusão: Está determinado que o programa universitário que atua nas potencialidades e limitações das ciências pedagógicas na Universidade de Guayaquil possa se tornar efetivo levando em conta as diferentes perspectivas dos professores: relação descarga x cabeça / diâmetro hidrostático. Através de comparações com fontes bibliográficas. Conclusão coeficientes de descarga valores obtidos nesta investigação são válidos como as condições de escoamento de estudo, sendo estas grande contribuição para essas estruturas onde furos como armadilhas de areia, depósitos e pias utilizados.

Why do we have so many molecules and biodiversity but so few antiparasite medicines? / Porqué tenemos tantas moléculas bioactivas y biodiversidad pero tan pocas medicinas antiparasitarias?

Natural products are isolated from biodiversity, that is, from plants, microorganisms, insects, and marine organisms; most of the biodiversity is found in about 10-12 countries located around the Equator. For a long time, people chose this option to alleviate diseases and the industry to discover new medicines; however, from the 70's onwards synthetic products have displaced them. Today there is a rebirth of natural products research and annually hundreds of new natural and synthetic bioactive molecules are reported in specialized journals. On the other hands, new drugs are continually required and especially there is a deficit of them to treat the so-called Neglected Diseases, which affect and threaten the health of billions of people in the world. These diseases paradoxically affect almost all megadiverse countries. Thus, the richest countries in biodiversity do not benefit from the use of natural products because research, development and production of new medicines are carried out in more technologically advanced countries. Why do we have so many molecules in biodiversity and journals but so few medicines? How could new antiparasite drugs be developed quickly and cheaply in the countries affected by Neglected Diseases? A feasible alternative is the Mining in Press, that is, the search of molecules in scientific literature. In this paper we analyze the reasons why these valuable substances have not become drugs and remain curiosities of laboratories and libraries, and the advantages of using this approach as a source of drugs or templates to other bioactive molecules.

Los productos naturales son aislados de la biodiversidad, es decir, de plantas, microorganismos y organismos marinos; gran parte de la biodiversidad se encuentra en cerca de 10-12 paises localizados alrededor del Ecuador. Por mucho tiempo, la gente ha seleccionado esta opción para aliviar sus enfermedades y la industria para descubrir nuevas medicinas; sin embargo, desde los años 70s los productos sintéticos los han desplazado. Hoy hay un renacimiento de la investigación de productos naturales y anualmente cientos de nuevas moléculas naturales y sintéticas bioactivas son reportados en las publicaciones especializadas. De otro lado, continuamente se requieren nuevas drogas y especialmente hay un déficit de ellas para tratar las llamadas Enfermedades Olvidadas, que afectan y amenazan la salud de miles de millones de personas en el mundo. Estas enfermedades paradójicamente afectan casi todos los países megadiversos. De esta manera, los países más ricos en biodiversidad no se benefician del uso de productos naturales, ya que la investigación, el desarrollo y la producción de nuevas medicinas se lleva a cabo en países tecnológicamente avanzados. Por qué tenemos tantas moléculas en la biodiversidad y en las publicaciones, pero tan pocas medicinas? Cómo podrían las drogas antiparasitarias ser desarrolladas de manera mas rápida y barata en los países afectados por las Enfermedades Olvidadas? Una posible alternativa es la Minería de las Publicaciones, es decir, la búsqueda de moléculas en la literatura científica. En este artículo nosotros analizamos las razones por la cuales esas valiosas sustancias no han llegado a ser drogas y permanecen como curiosidades de los laboratorios y bibliotecas, y las ventajas de usar esta aproximación como una fuente de drogas o modelos de otras moléculas bioactivas.

The "Degree of Inclusion" in Inclusive Education, Prerogative of Schools and Difficulties of Special Needs Educators

This article explores the current difficulties in the Special Needs field from the perspectives of variousstakeholders such as the schools, the Special Educators, the Special Needs students as well as the popularopinions and views about research and attempts to graphically represent the scenario for betterunderstanding. Large-scale disconnect between the actual receivers of Special Education-efforts, theSpecial Educators and the bureaucracy and media who are largely running after a fad without paying heedto actual in-field realizations and understandings, which in turn is causing more harm than good is beingseen. Special Needs Educators are being pressurized to give results in instances where it is quite difficult toget those results and in cases of failure, the blame is put on their capabilities.

Prescripción y adquisición de medicamentos y procedimientos: análisis de las limitaciones actuales en el ejercicio médico / Prescription and acquisition of medications and procedures: Analysis of current limitations in medical practice

Analizar el cumplimiento de la prescripción y de los procedimientos en los pacientes atendidos por un internista en la situación sanitaria venezolana actual y conocer el estado de insatisfacción de estos médicos ante las prescripciones realizadas. Método: Parte A: Dirigida a los pacientes y será un estudio de casos, descriptivo, prospectivo y transversal basado en una evaluación médica y una entrevista. Parte B: dirigido a los médicos: estudio descriptivo, prospectivo y transversal a través de una encuesta. Tratamiento estadístico: Descripción estadística con medidas de tendencia central y de proporción. Resultados: En la fase A se analizaron 422 pacientes. Los principales diagnósticos fueron Hipertensión Arterial (45.13% mujeres y 32.14%-), Diabetes Mellitus tipo 2 (32.74% mujeres y 18.37 % hombres) y Cardiopatía (19.03% mujeres y 16.33% Hom-bres). El 67.77% refería cumplimiento irregular o nulo y la principal causa fue la no disponibilidad del tratamiento en 62.13%. En la fase B: se analizaron 100 encuestas, donde se afirmó no contar con todos los implementos necesarios para el ejercicio profesional en el 80% de los que ejercían en instituciones públicas, y el 31 % en privadas, y el nivel de insatisfacción fue alto. Discusión: el acto médico del internista en el país está limitado por la imposibilidad de adquirir medicamentos y el ejercicio médico es generador de frustración y estrés(AU)

To analyze the fulfilment of prescriptions and medical procedures in patients treated by internists in the current Venezuelan health situation and learn about the level of dissatisfaction of these physicians with this situation. Methods: This study was done in two kinds of population: group A: a descriptive, prospective and cross-sectional case study based on a comprehensive medical evaluation and an interview. Group B: also, a descriptive, prospective and cross-sectional study, but through a survey on the physicians. Statistical treatment: Statistical description with measures of central tendency and proportion. Results: In phase A, 422 patients were analyzed. The main diagnoses were Arterial Hypertension (45.13% female and male 32.14%), Diabetes Mellitus type 2 (32.74% female and18.37% male) and Cardiopathy 19.03% female - and 16.33% male). The 67.77% reported irregular or null fulfillment and the reason was the lack of availability for purchase in 62.13%. In phase B: 100 surveys were analyzed,; 80% of those who work in public institutions eclared that not all the implements needed for their professional practice were available. This was true, also in 31% in private practice with a high the level of dissatisfaction. Discussion: the internist's medical act in the country is limited by the impossibility of acquiring medications and perform the right medical procedures. This situation generates in them feelings of frustration and stress(AU)

Limitations of endoscopic ultrasonography in diagnosis of gastric submucosal tumors / 中国内镜杂志

Objective To evaluate endoscopic ultrasonography (EUS) in diagnosis of gastric submucosal tumors (SMTs), and analyze the characteristics of gastric SMTs under EUS. Methods Clinical data of 614 patients with gastric SMTs, who were evaluated by EUS and underwent endoscopic submucosal dissection (ESD) from September 2008 to December 2016, were retrospectively analyzed. The golden standard for lession origins was the intraoperative diagnosis of ESD, and that for pathological types was the combination of postoperative pathological and immunohistochemical findings. The consistency of diagnosis of EUS was evaluated, and the characteristics of lesions under EUS were analyzed. Results The total consistency in diagnosing lesion origins was 91.25％ between EUS and intraoperative results of ESD, and the consistency in diagnosing lesion originated from the muscularis mucosa, submucosa and muscularis propria was 66.67％, 80.85％ and 94.50％, respectively. The total consistency in pathological types was 65.99％ between EUS and postoperative pathological results, and the consistency of gastrointestinal stromal tumor (GIST), leiomyoma, ectopic pancreas and lipoma was 91.85％, 18.56％, 79.76％ and 90.70％, respectively. Conclusion EUS can initially determine the origins and types of gastric SMTs, providing a more accurate basis for endoscopic treatment, but there were some limitations on the diagnosis of leiomyoma and some rare lesions such as hamartoma, inflammatory fibrous polyps, carcinoid, fibroma, etc. Thus, if necessary, the lesion should be removed so as to make a definite diagnosis and prevent malignant change.

Diseño de una herramienta para la valoración y clasificación de la limitación en fibromyalgia / Design of a tool for the assessment and classification of fibromialgia limitation

Resumen Introducción: El síndrome fibromiálgico se caracteriza por dolor crónico asociado a sintomatología somática no específica y con las limitaciones asociadas a su impacto personal, social, laboral y económico. Su valoración se realiza de forma independiente, analizando sus aspectos clínicos, de severidad, los tratamientos y su efectividad, la repercusión en las actividades de la vida diaria y la repercusión o afectación laboral. La herramienta FM-Check es una escala subjetiva que puede ser de ayuda para valorar de forma conjunta todos estos aspectos y servir de apoyo al profesional en el seguimiento del paciente y facilitar la colaboración conjunta interprofesional. Método: Para elaborar la FM-Check se parte de la historia clínica en la que se definen las variables que se van a utilizar agrupándolas en 4 bloques a los que se asignan porcentajes de limitación para cada variable y cada bloque, para llegar a un porcentaje global de limitación en los roles de las personas. Resultados: La distribución de porcentajes por cada bloque es en máximos: 10% para aspectos personales, 55% para clínico-terapéuticos, 24% para laborales y 10% para repercusión en la vida diaria. En función del porcentaje global obtenido tras la valoración del paciente se asignan grados de limitación: grado 1 hasta un porcentaje global < 20%, grado 2 del 20-40%, grado 3 entre el 41-70% y grado 4 > 70%. Conclusión: FM-Check pretende facilitar la labor médica en la evolución del paciente y la toma de decisiones clínico-terapéuticas tras una valoración global de la limitación del paciente con fibromialgia, siguiendo una metodología unificada que permita comparar resultados evolutivos individuales y la realización de estudios epidemiológicos colectivos.

Abstract Introduction: Fibromialgia syndrome is characterised by chronic pain associated with nonspecific somatic symptoms, and has a personal, social, occupational, and economic impact. The assessment is performed independently, by analysing the clinical aspects, severity, therapies, and their effectiveness, as well as the impact on daily life activities and its effect on employment. The FM-Check tool is a subjective scale that can be helpful in jointly assessing all these aspects, and provide professional support in monitoring the patient, as well as contribute to a multidisciplinary approach. Method: To develop FM-Check is developed by starting with the clinical history in which the variables that are going to be used are defined, and grouped into 4 blocks to which a percentage limitation rate is assigned for each variable and each block. An overall percentage limitation is then calculated for the activities in each person. Results: The distribution of assigned percentages was: a maximum of 10% for personal appearance, 55% for clinical-therapeutic aspects, 24% for work aspects, and 10% for impact on everyday life. The limitation levels were classified according to the overall percentage obtained after assessing the patient; grade 1: an overall percentage < 20%, grade 2: 20-40%, grade 3: 41-70%, and grade 4: > 70%. Conclusion: FM-Check aims to make it easier for the clinician to monitor the patient and making medical-therapeutic decisions after an overall assessment of the limitation of the fibromialgia patient. This achieved by following a unified methodology that can compare individual developmental outcomes, as well as for conducting joint epidemiological studies.