Manual de organización y funciones de la Dirección de la Cadena de Suministro / Organization and functions manual of Supply Chain Management

Como parte de la modernización de la administración pública y con el propósito de contar con un documento que regule y oriente el accionar a desarrollar por la Dirección de la Cadena de Suministros, se establece el presente "manual de organización y funciones", como un instrumento que servirá de apoyo gerencial y operativo tanto para la Dirección, como para otras instancias que requieran conocer el funcionamiento de la Dirección y los elementos orgánicos que se vinculan para contribuir a la consecución de objetivos y resultados esperados en el ámbito de los suministros para la salud, describiendo sus unidades y oficinas que enmarcan el trabajo administrativo y operativo que desarrollan

As part of the modernization of public administration and with the purpose of having a document that regulates and guides the actions to be carried out by the Supply Chain Management, this "organization and functions manual" is established as an instrument that will serve as managerial and operational support both for the Directorate and for other entities that require knowledge of the functioning of the Directorate and the organic elements that are linked to contribute to the achievement of objectives and expected results in the field of health supplies. , describing its units and offices that frame the administrative and operational work they carry out

Manual de procesos y procedimientos de atención integral en salud ambulatoria de mediana y alta complejidad / Manual of comprehensive care processes and procedures in ambulatory health of medium and high complexity

El presente manual de procesos y procedimientos documenta la atención integral ambulatoria de mediana y alta complejidad, como parte del proceso de atención en salud integral e integrada a la persona en el curso de vida con enfoque de atención primaria en salud, describe el sistema de operación de los establecimientos, mediante el enfoque por procesos, fomentando el desarrollo organizacional y el mejoramiento continuo. Establece las bases para la ejecución de los procesos y procedimientos, unificando criterios de contenido que permita la sistematización de las actividades y la definición de la metodología para efectuarlas. En el contenido de cada procedimiento se detalla la normativa legal y los registros para desarrollar cada una de sus actividades

This manual of processes and procedures documents comprehensive outpatient care of medium and high complexity, as part of the process of comprehensive and integrated health care for the person in the course of life with a focus on primary health care, describes the operation system of establishments, through the process approach, promoting organizational development and continuous improvement. Establishes the bases for the execution of processes and procedures, unifying content criteria that allows the systematization of activities and the definition of the methodology to carry them out. The content of each procedure details the legal regulations and records to carry out each of its activities

Manual de procesos y procedimientos de atención integral de habilitación y rehabilitación / Comprehensive Habilitation and Rehabilitation Process and Procedures Manual

El presente manual de procesos y procedimientos documenta la atención en salud integral de habilitación y rehabilitación, como parte del proceso de atención en salud integral e integrada a la persona en el curso de vida, detallando el método de operación de los establecimientos a través del enfoque por procesos que fomenta el desarrollo organizacional y el mejoramiento continuo. Establece las bases para la ejecución y estandarización de los procesos y procedimientos, unificando criterios de contenido que permita la sistematización de las actividades y la definición de la metodología para efectuarlas. En el contenido de cada procedimiento se detalla la normativa legal y los registros para desarrollar cada una de sus actividades

This manual of processes and procedures documents comprehensive habilitation and rehabilitation health care as part of the process of comprehensive and integrated health care for the person in the course of life, detailing the method of operation of establishments through the process approach that encourages organizational development and continuous improvement. It establishes the bases for the execution and standardization of processes and procedures, unifying content criteria that allow the systematization of activities and the definition of the methodology to carry them out. The content of each procedure details the legal regulations and registers for each of its activities

Manual para la aplicación del instrumento de evaluación del Modelo Maternidades Nacer Con Cariño / Handbook for the Implementation of the Maternal Care Model Assessment Tool

El Modelo de Maternidades Nacer con Cariño (MNCC) se basa en el derecho de todas las madres y sus hijos a recibir atención adecuada, independientemente de su cultura, condición socioeconómica o edad, promueve el respeto por las tradiciones culturales, preferencias y valores de las embarazadas, su situación familiar y estilo de vida; se esfuerza por garantizar el derecho de la persona recién nacida recibir atención en un ambiente de confianza y seguridad, así como lograr que las relaciones entre autoridades de la institución, equipo de salud, padres y familias sean respetuosas, cálidas, efectivas coordinadas

The Model of Maternities Born with Love (MNCC) is based on the right of all mothers and their children to receive adequate care, regardless of their culture, socio-economic status or age, promotes respect for cultural traditions, preferences and values of pregnant women, their family situation and lifestyle; strives to guarantee the right of the newborn person to receive care in an atmosphere of trust and security, as well as to ensure that relations between authorities of the institution, Health team, parents and families be respectful, warm, effective coordinated

Asociación entre condición física y fase angular en el adulto mayor: Un estudio piloto

El diagnóstico por bioimpedancia (BIA) y el ángulo de fase (AnF), como indicador, permiten monitorear el estado físico, de salud y nutricional en adultos mayores. El objetivo de este estudio fue establecer la relación entre la condición física y valores de fase angular por bioimpedancia en un grupo de adultos mayores sedentarios. Participaron voluntariamente 24 adultos mayores sedentarios (21 mujeres y 3 hombres). A cada participante se les midió bioimpedancia, fuerza de presión manual y test de 6 minutos del Senior Fitness Test (SFT). Posteriormente se analizaron los resultados, correlacionando el ángulo de fase (AnF) y condición física cardiorrespiratoria según sexo y el AnF con la fuerza de presión manual. El 71% presentó una media de AnF por debajo de la referencia (4,5º ± 0,4), específicamente, el 67% de los hombres y el 62% de las mujeres. La correlación entre AnF y capacidad física cardiorrespiratoria arrojó un valor de R2= 0,50; p<0,0001. La asociación entre AnF y fuerza de presión manual fue de R2=0,35; p=0,0023. Se encontró una relación significativa entre una prueba de condición física cardiorrespiratoria y AnF y entre la fuerza de presión manual y AnF. Es de importancia clínica incluir parámetros objetivos de valoración celular en adultos mayores como el AnF.

The diagnosis by bioimpedance (BIA) and the phase angle (PhA) are indicators, that allow monitoring of the physical health and nutritional status of older adults. The objective of this study was to establish the relationship between physical fitness and phase angle values by bioimpedance in a group of sedentary older adults. 24 elderly sedentary volunteers participated (21 women and 3 men). Each participant underwent bioimpedance, manual dynamometry, and the 6-minute Senior Fitness Test (SFT). Subsequently, the results were analyzed, making a correlation between PhA and cardiorespiratory physical condition, another between PhA and cardiorespiratory physical condition according to sex and finally an association between PhA and handgrip strength. R71% presented a PhA mean below the reference (4.5º ± 0.4), specifically 67% of men and 62% of women. The correlation between PhA and cardiorespiratory fitness showed a value of R2= 0.50; p<0.0001. The association between PhA and handgrip strength was R2=0.35; p=0.0023. A significant relationship was found between a cardiorespiratory fitness test and PhA and between handgrip strength and PhA. It is of clinical importance to include objective cellular assessment parameters in older adults such as PhA.

O diagnóstico por bioimpedância (BIA) e ângulo de fase (AnF), como indicador, permitem monitorar o estado físico, de saúde e nutricional de idosos. O objetivo deste estudo foi estabelecer a relação entre a condição física e os valores da fase angular por bioimpedância em um grupo de idosos sedentários. Participaram voluntariamente 24 idosos sedentários (21 mulheres e 3 homens). Cada participante foi medido bioimpedância, força de pressão manual e teste de 6 minutos do Senior Fitness Test (SFT). Posteriormente, os resultados foram analisados, correlacionando o ângulo de fase (AnF) e a condição física cardiorrespiratória de acordo com o sexo e o AnF com a força de pressão manual. 71% apresentaram média do LAn abaixo da referência (4,5º ± 0,4), sendo 67% dos homens e 62% das mulheres. A correlação entre o LAn e a aptidão cardiorrespiratória deu um valor de R2= 0,50; p<0,0001. A associação entre LAn e força de pressão manual foi R2=0,35; p=0,0023. Encontrou-se relação significativa entre teste de aptidão cardiorrespiratória e NF e entre força de pressão manual e NF. É de importância clínica incluir parâmetros objetivos de avaliação celular em adultos mais velhos, como AnF.

Untangle the relationship of muscle mass and bone mineral content on handgrip strength: Results of ELSA-Brasil / Desvendando a relação entre massa muscular e conteúdo mineral ósseo na força de preensão palmar: Resultados do ELSA-Brasil

Abstract The study aims to investigate the independent association of muscle mass (MM) and bone mineral content (BMC) in the performance of the handgrip strength (HGS) test and whether there is effect modification by sex and age. In 12,491 participants from the ELSA-Brasil we estimated the associations between MM, BMC and HGS using linear regression models. All the analyses were performed for total population, also stratified for sex and age. For total population an interaction term was included between each explanatory variable of interest with sex and age to verify the presence of effect modification. We observed that the higher quintiles of MM and BMC were associated to an increasing in the mean of HGS compared to the first quintile, with greater magnitudes in men compared to women, also adults compared to elderly. When we estimated the independent effect of each exposure of interest, MM showed stronger effect in HGS in women, men and adults then BMC. In conclusion, we observed that higher amounts of MM and BMC are associated with higher HGS, regardless of sociodemographic characteristics, health conditions and lifestyle, with this effect being greater in men and adults.

Resumo O estudo tem como objetivo investigar a associação independente da massa muscular (MM) e conteúdo mineral ósseo (CMO) na realização do teste de força de preensão manual (FPM) e se há modificação do efeito por sexo e idade. Em 12.491 participantes do ELSA-Brasil estimamos as associações entre MM, CMO e FPM usando modelos de regressão linear. Todas as análises foram realizadas para a população total, também estratificada por sexo e idade. Para a população total foi incluído um termo de interação entre cada variável explicativa de interesse com sexo e idade para verificar a presença de modificação de efeito. Observamos que os maiores quintis de MM e BMC estiveram associados a um aumento na média da FPM em relação ao primeiro quintil, com maiores magnitudes em homens em relação a mulheres, também em adultos em relação a idosos. Quando estimamos o efeito independente de cada exposição de interesse, MM mostrou efeito mais forte na FPM em mulheres, homens e adultos do que BMC. Em conclusão, observamos que maiores quantidades de MM e BMC estão associadas a maior FPM, independentemente das características sociodemográficas, condições de saúde e estilo de vida, sendo esse efeito maior em homens e adultos.

Evaluation of the Association Between Carrying Angle, Hand Grip Strength, Lateral Pinch Strength, and Hand Functional Index in Nursing Students / Evaluación de la Asociación entre el Ángulo de Carga, la Fuerza de Agarre de la Mano, la Fuerza de Pellizco Lateral y el Índice Funcional de la Mano en Estudiantes de Enfermería

SUMMARY: Health professionals especially nurses have ongoing contact with patients and they may have a high incidence of musculoskeletal problems. For this reason, grip strength and carrying angle are important parameters for all health professionals to succeed in their job and avoid injuries. It was aimed to determine the effects of the hand grip, and pinch strength, carrying angle of dominant, and non-dominant hands as well as the association of the hand functional index with morphometric measurements in 193 nursing students. The means of the carrying angle of dominant and non-dominant sides were 169.11±4.21° and 168.16±4.30°, respectively. The means of the dominant and, non-dominant sides of hand grip strength were 45.99±11.24 kg and 45.89±11.34 kg, respectively. The lateral pinch strength means were measured as 19.55±3.75 kg and 19.31±3.45 kg, respectively. This paper's findings may be important for some experts such as anatomists, clinicians, surgeons, forensic scientists, anthropologists, and nurses- healthcare professionals keep in touch with patients. Also, we believe that appropriate and effective knowledge of carrying angle, hand grip and lateral pinch strength has created an opportunity to research in terms of reducing work-related risk factors.

Los profesionales de la salud, especialmente las enfermeras, se mantienen en contacto con los pacientes y pueden tener una alta incidencia de problemas musculo-esqueléticos. En consecuencia, la fuerza de agarre y el ángulo de carga son parámetros importantes para que todos los profesionales de la salud tengan éxito en su trabajo y eviten las lesiones. El objetivo de este estudio fue determinar los efectos de la fuerza de prensión y pinzamiento de la mano, el ángulo de carga de las manos dominantes y no dominantes, así como la asociación del índice funcional de la mano con medidas morfométricas en 193 estudiantes de enfermería. Las medias del ángulo de carga de los lados dominante y no dominante fueron 169,11±4,21° y 168,16±4,30°, respectivamente. Las medias de los lados dominante y no dominante de la fuerza de prensión manual fueron 45,99 ± 11,24 kg y 45,89 ± 11,34 kg, respectivamente. La media de la fuerza de pellizco lateral se midió como 19,55 ± 3,75 kg y 19,31 ± 3,45 kg, respectivamente. Los hallazgos de este artículo pueden ser importantes para algunos expertos, como anatomistas, médicos clínicos, cirujanos, científicos forenses, antropólogos y enfermeras y profesionales de la salud que se mantienen en contacto con los pacientes. Además, creemos que el conocimiento apropiado y efectivo del ángulo de carga, el agarre de la mano y la fuerza de pellizco lateral ha creado una oportunidad para investigar en términos de reducción de los factores de riesgo relacionados con el trabajo.

Posterior capsular opacification and Nd:YAG capsulotomy rates in patients implanted with square-edged and non-square-edged intraocular lenses in manual small-incision cataract surgery: A randomized controlled study

Purpose: To study posterior capsular opacification (PCO) and neodymium?doped yttrium aluminum garnet (Nd:YAG) capsulotomy rates in patients implanted with square?edged and non?square?edged intraocular lenses (IOLs) in manual small?incision cataract surgery (MSICS). Setting: Tertiary eye care center. Design: Prospective, comparative, and randomized controlled study. Methods: This study included patients with senile cataracts scheduled for MSICS and IOL implantation. One eye of each patient was randomized to the implantation of square?edged (S group) or non?square?edged IOL (NSQ group). An independent observer analyzed PCO at 6, 12, 18, and 24 months under slit?lamp illumination. Results: A total of 104 eyes were included in this study. The mean age of the participants in the two groups was 63.2 (�2) years, and there were 65 (62.5%) men and 39 women (37.5%). The mean best?corrected visual acuity (BCVA) values at 6, 12, and 18 months were 0.157 (�10), 0.11 (�12), and 0.12 (�11), respectively, in the S group and 0.17 (�10), 0.17 (�12), and 0.20 (�17), respectively, in the NSQ group. At 12 (P = 0.03) and 18 months (P = 0.01) follow?up, the BCVA of the S group was significantly better than that of the NSQ group. Four eyes in the NSQ group and one eye in the S group required Nd:YAG. Conclusion: Evaluation of PCO and Nd:YAG capsulotomy rates showed that the 360� square of the posterior IOL edge plays a role in the prevention of PCO. Owing to the low cost of the material and the easy availability of IOLs manufactured from it, square?edged IOL has a definite role in the prevention of PCO in MSICS.

Técnicas de Fisioterapia Respiratoria Manuales de Higiene Bronquial / Respiratory Physiotherapy Techniques Bronchial Hygiene Manuals

Este documento se enfoca en las técnicas manuales de fisioterapia respiratoria como una estrategia fundamental para la limpieza efectiva de las vías aéreas en pacientes con afecciones respiratorias. La fisioterapia respiratoria se ha establecido como un pilar crucial en la atención de individuos con trastornos pulmonares obstructivos y restrictivos, así como en situaciones clínicas que requieren la eliminación de secreciones pulmonares. Existe una variedad de técnicas manuales disponibles, como la percusión torácica, la vibración, el drenaje postural y la maniobra de tos asistida, con diferentes mecanismos de acción y fundamentos fisiológicos de su aplicación. Es importante considerar la personalización de estas técnicas según las necesidades individuales de cada paciente para brindar. Un tratamiento seguro y eficaz. En el siguiente artículo se revisarán los beneficios demostrados de la fisioterapia respiratoria en términos de mejora de la función pulmonar, la oxigenación y la calidad de vida de los pacientes. Cabe destacar la importancia de la fisioterapia respiratoria como un componente esencial en el manejo de las afecciones respiratorias y destacar la necesidad de continua de investigación y desarrollo de mejores prácticas en este campo, con el objetivo de mejorar la atención y los resultados clínicos en pacientes con problemas respiratorios.

This document focuses on manual respiratory physiotherapy techniques as a fundamental strategy for effective airway clearance in patients with respiratory conditions. Respiratory physiotherapy has established itself as a crucial pillar in the care of individuals with obstructive and restrictive pulmonary disorders, as well as in clinical situations that require the removal of pulmonary secretions. There are a variety of manual techniques available, such as chest percussion, vibration, postural drainage, and the assisted cough maneuver, with different mechanisms of action and physiological rationales for their application. It is important to consider customizing these techniques to the individual needs of each patient to provide. A safe and effective treatment. The following article will review the proven benefits of respiratory physiotherapy in terms of improving lung function, oxygenation and quality of life of patients. It is worth highlighting the importance of respiratory physiotherapy as an essential component in the management of respiratory conditions and highlighting the need for continuous research and development of best practices in this field, with the aim of improving care and clinical outcomes in patients with respiratory problems.

Manual de procesos y procedimientos para la gestión de la sangre, inmunohematología y hemoterapia / Manual of processes and procedures for blood management, immunohematology and hemotherapy

El presente manual de procesos y procedimientos documenta los servicios que se ofrecen en la atención al usuario interno y externo para la gestión de la sangre, inmunohematología y hemoterapia como parte del proceso de atención en salud integral e integrada a la persona en el curso de vida con enfoque de atención primaria en salud, describe el sistema de operación ofrecido en los establecimientos de salud, mediante el enfoque por procesos, fomentando así el desarrollo organizacional y el mejoramiento continuo para el cumplimiento de la misión institucional. Establece las bases para la ejecución de los procedimientos como parte de los procesos institucionales, unificando criterios de contenido que permite la sistematización de las actividades y la definición de la metodología para efectuarlas. Esta herramienta táctica y operativa, permite integrar las actividades y tareas de manera oportuna, para el logro de la prestación de servicios con calidad en los establecimientos de salud que lo necesiten, facilitando el cumplimiento de las normativas y lineamientos de programas especiales o por ciclo de vida vigentes en el Ministerio de Salud, así como la armonización con la sistematización y uso de herramientas tecnológicas que sea necesario implementar para volver más eficaz el trabajo del talento humano en salud

This manual of processes and procedures documents the services offered in the care of internal and external users for blood management, immunohematology and hemotherapy as part of the process of comprehensive and integrated health care for the person throughout the life course. With a focus on primary health care, it describes the operation system offered in health establishments, through the process approach, thus promoting organizational development and continuous improvement to fulfill the institutional mission. Establishes the bases for the execution of procedures as part of institutional processes, unifying content criteria that allows the systematization of activities and the definition of the methodology to carry them out. This tactical and operational tool allows the integration of activities and tasks in a timely manner, to achieve the provision of quality services in the health establishments that need it, facilitating compliance with the regulations and guidelines of special programs or by cycle of life in force in the Ministry of Health, as well as harmonization with the systematization and use of technological tools that need to be implemented to make the work of human talent in health more effective

Manual de procesos y procedimientos de salud ambiental / Environmental Health Process and Procedures Manual

El presente manual de procesos y procedimientos documenta las principales actividades de atención integral en la vigilancia de la salud ambiental, como parte del proceso "Promoción de salud con participación social y multisectorial", en el cual se describe el sistema de operación desde los establecimientos de salud, mediante el enfoque por procesos, fomentando el desarrollo organizacional y el mejoramiento continuo para el cumplimiento de la misión institucional. Establece las bases para la ejecución de los procesos y procedimientos, unificando criterios de contenido que permite la sistematización de las actividades y la definición de la metodología para efectuarlas. Esta herramienta táctica y operativa, permite integrar las actividades y tareas de manera ágil, para el logro de la prestación de servicios que se ofrecen desde la vigilancia de la salud ambiental con calidad en los diferentes niveles de atención, facilitando el cumplimiento de las normativas y lineamientos de programas especiales vigentes en el Ministerio de Salud, así como la armonización con la sistematización y uso de herramientas tecnológicas que sea necesario implementar para volver más eficaz el trabajo del talento humano en salud

This manual of processes and procedures documents the main activities of comprehensive care in environmental health surveillance, as part of the process "Health promotion with social and multisectoral participation", in which the operation system is described from health establishments. health, through the process approach, promoting organizational development and continuous improvement to fulfill the institutional mission. Establishes the bases for the execution of processes and procedures, unifying content criteria that allows the systematization of activities and the definition of the methodology to carry them out. This tactical and operational tool allows activities and tasks to be integrated in an agile manner, to achieve the provision of services offered from environmental health surveillance with quality at different levels of care, facilitating compliance with regulations and guidelines of special programs in force in the Ministry of Health, as well as harmonization with the systematization and use of technological tools that need to be implemented to make the work of human talent in health more effective

Manual de organización y funciones de la Dirección del Sistema de Emergencias Médicas / Manual of organization and functions of the Directorate of the Medical Emergency System

El presente manual de organización y funciones, fue adecuado como un instrumento técnico que permita agilizar los procesos institucionales, evitando la duplicidad de funciones, delimitando las responsabilidades y estableciendo los canales de comunicación e información, contribuyendo además a la transparencia en la rendición de cuentas. Así como también, detalla la dependencia jerárquica, objetivos, estructura interna, funciones y relaciones de trabajo, asignadas a cada una de las unidades organizativas que conforman la Dirección del Sistema de Emergencias Médicas. Permitiendo así el eficiente y oportuno desarrollo de todas las actividades que realizan las unidades conformadas por la Dirección

The present manual of organization and functions was suitable as a technical tool for streamlining business processes, avoiding duplication of functions, delineating responsibilities and establishing communication and information channels, further contributing to transparency in accountability. It also details the hierarchical unit, objectives, internal structure, functions and working relations assigned to each of the organizational units that make up the Directorate of the Medical Emergency System. Thus allowing the efficient and timely development of all the activities carried out by the units formed by the Directorate

Manual de procesos y procedimientos misionales para proporcionar atenciones de salud integrales en emergencias médicas prehospitalarias / Manual of Missionary Processes and Procedures for Providing Comprehensive Health Care in Pre-Hospital Medical Emergencies

El presente manual de procesos y procedimientos documenta las principales actividades que se brindan en la atención de emergencia prehospitalaria como parte del proceso de atención integral e integrada a la persona en el curso de vida, desde el Sistema de Emergencias Médicas, (SEM). Describe el sistema de operación, mediante el enfoque por procesos para la gestión de la solicitud de la atención de la emergencia médica prehospitalaria y su respuesta oportuna, promoviendo la mejora continua, el desarrollo organizacional y el mejoramiento continuo para el cumplimiento de la misión institucional, establece las bases para la ejecución de los procesos y procedimientos, unificando criterios de contenido que permite la sistematización de las actividades y la definición de la metodología para efectuarlas. Permite integrar las actividades y tareas de manera ágil, para el logro de la prestación de servicios con calidad, facilitando el cumplimiento de las normativas por ciclo de vida vigentes en el Ministerio de Salud, así como la armonización con la sistematización y uso de herramientas tecnológicas que sea necesario implementar para volver más eficaz el trabajo del talento humano

This manual of processes and procedures documents the main activities that are provided in pre-hospital emergency care as part of the process of comprehensive and integrated care for the person in the course of life, from the Medical Emergency System (EMS). Describes the operating system, through the process approach to managing the request for pre-hospital medical emergency care and its timely response, promoting continuous improvement, organizational development and continuous improvement for the accomplishment of the institutional misión, establishes the basis for the execution of processes and procedures, unifying content criteria that allow the systematization of activities and the definition of the methodology for carrying them out. It makes it possible to integrate activities and tasks in an agile manner, in order to achieve quality service delivery, facilitating compliance with the life-cycle regulations in force in the Ministry of Health, as well as harmonization with the systematization and use of technological tools that need to be implemented to make the work of human talent more effective

Manual de procesos y procedimientos para análisis clínicos de muestras biológicas / Manual of processes and procedures for clinical analysis of biological simples

El presente manual de procesos y procedimientos documenta las principales actividades de atención integral que se ofrecen al usuario interno y externo para el análisis clínico de muestras biológicas, como parte del proceso de atención en salud integral e integrada a la persona en el curso de vida, describe el sistema de operación de los servicios ofrecidos para el análisis clínico de estas muestras en los establecimientos de salud, mediante el enfoque por procesos, fomentando el desarrollo organizacional y el mejoramiento continuo para el cumplimiento de la misión institucional

This manual of processes and procedures documents the main comprehensive care activities offered to the internal and external user for the clinical analysis of biological samples, as part of the process of comprehensive and integrated health care for the person in the course of life, describes the system of operation of the services offered for the clinical analysis of these samples in health establishments, through the process approach, fostering organizational development and continuous improvement for the fulfilment of the institutional misión

Inpatient Decongestive Therapy for Lymphedema in Acute Postsurgical Head and Neck Cancer Patients

Abstract Introduction Head and neck lymphedema is an omnipresent morbidity related to head and neck cancer therapies. Studies on therapy for these patients in the acute postsurgical population have not been published to date. Objective To assess changes in the measurements of lymphedema in surgical head and neck cancer patients during the hospital stay with implementation of modified decongestive therapy (MDT). Methods Patients aged > 18 years undergoing neck dissection with or without primary-site resection or laryngectomy between 2016 and 2019 were included. Facial measurements were obtained prior to beginning MDT and again prior to discharge. A total facial composite measurement was calculated and used to assess change over time. Rates ≥ 2% of change were considered significant. Results A total of 38 patients were included (subsites: larynx = 27; thyroid =4; oral cavity = 3; and neck = 4). The mean number of days between surgery and the start of lymphedema therapy was 3.0 days. The mean number of days between measurements was 5.2 days. Reduction in the total composite score was observed in 37 (97%) patients, and 35 (92%) patients had a total composite reduction score > 2%. Tumor subsite and surgery type did not portend toward greater percent change, except for those patients treated with total laryngectomy, regional flap reconstruction, and neck dissection (p = 0.02). Conclusion Acute postsurgical inpatient MDT was associated with reduced total composite measurements in patients after head and neck surgery. As the first published study on lymphedema therapy in this acute postsurgical period, further prospective case-control studies are warranted to explore further benefits of acute therapy.

Associação entre força de preensão manual e ângulo de fase em idosos da Estratégia Saúde da Família: um estudo transversal / Association between handgrip strength and phase angle in older adults from the Family Health Strategy: a cross-sectional study

Introdução: a Força de Preensão Manual (FPM) é um indicador de saúde e funcionalidade do idoso, que diminui com o passar do tempo, impactada por aspectos como mudanças na composição corporal. Objetivo: investigar a associação entre o Ângulo de Fase Padronizado (AFP) e FPM em idosos comunitários da Atenção Primária à Saúde (APS). Metodologia: estudo transversal, com pessoas de 60 anos ou mais, atendidos na APS. A variável dependente foi a FPM medida com dinamômetro e a independente principal foi o AFP com base no sexo e faixa etária, calculado a partir do ângulo de fase obtido pela bioimpedância. Foi realizada a regressão logística com entrada por bloco, sendo incluídas no modelo as variáveis que apresentaram associação com nível crítico menor do que 10%. Resultados: dos 296 indivíduos avaliados, 28,0% exibiram baixa FPM e 15,9% apresentaram AFP < ­ 1,65°. As variáveis inseridas no modelo final de regressão logística, juntamente com o AFP, foram sexo, faixa etária, Índice de Massa Corporal (IMC) e Circunferência da Panturrilha (CP). A análise mostrou que o AFP < ­ 1,65° aumenta a chance do idoso apresentar baixa FPM, tanto na análise sem ajuste (OR = 2,71; IC 95% 1,43-5,15), quanto no modelo final (OR = 2,35; IC 95% 1,14-4,87). Conclusão: o AFP mostrou-se associado à FPM, independentemente da interação com sexo, faixa etária, IMC e CP. A sua utilização pode contribuir na avaliação de idosos, especialmente quando a aferição da FPM não for possível.

Introduction: Handgrip Strength (HGS) is an indicator of health and functionality of the older adults, which decreases over time, impacted by aspects including changes in body composition. Objective: to investigate the association between the Standardized Phase Angle (SPA ) and HGS in community-dwelling older adults in Primary Health Care (PHC). Methodology: cross-sectional study, with people aged 60 or over, assisted in the PHC. The dependent variable was the HGS measured using a dynamometer. The main independent variable was the SPA based on gender and age range, calculated from the phase angle obtained by bioimpedance. Block-by-block logistic regression was performed, including variables that were associated with a critical level lower than 10% in the model. Results: of the 296 individuals assessed, 28.0% had low HGS and 15.9% had SPA < ­ 1.65°. The variables inserted in the final logistic regression model, together with the SPA , were gender, age group, Body Mass Index (BMI) and Calf Circumference (CC). The analysis showed that SPA < ­ 1.65° increases the chance of the older adults having low HGS, both in the unadjusted analysis (OR = 2.71; 95% CI 1.43-5.15) and in the final model (OR = 2.35; 95%CI 1.14-4.87). Conclusion: the SPA was associated with HGS, regardless of the interaction with sex, age group, BMI and CC. Its use can contribute to the evaluation of the older adults, especially when HGS measurement is not possible.

Evaluation of Root Canal Cleaning Efficacy of Selfadjusting Files, Protaper Rotary, and Manual K?Files in Primary Teeth ? An In vitro Comparative Study

Background: The success of pulpectomy depends on complete eradication of microbial load by cleaning and shaping the primary root canals that is difficult to achieve because of anatomical intricacy of primary pulp dentin complex. Numerous instruments were tried, however, they proved to be inadequate. Selfadjusting file (SAF) is a newer file system that facilitates less dentin removal with maximal cleansing of root canals. Aim: To evaluate and compare the in vitro root canal cleaning efficacy with SAF, Protaper Universal, and Hand K?files in primary teeth. Materials and Methods: Sixty extracted primary anterior teeth were randomly divided into three groups by lottery method. Access cavity was prepared, the canals were enlarged up to 20 K file, and an Indian ink was injected into each canal. Then the Group I (n = 20) was treated with SAF, Group II (n = 20) with Rotary Protaper Universal and Group III (n = 20) with Hand K?files and the root canal cleaning efficacy was evaluated based on the amount of Indian ink remaining in the canal walls under stereomicroscopy. Data were analyzed using Kruskal–Wallis one way ANOVA test and post hoc Tuckey test for intragroup and intergroup comparison, respectively. Results: A statistically highly significant difference was observed with SAF (mean = 1.5), Protaper (mean = 2.5), and Hand K?files (mean = 2.9). However, there was no significant difference in root canal cleaning efficacy with Protaper Universal and Hand K?files. Conclusion: The SAFs had shown superior cleaning efficacy compared with rotary Protaper Universal and manual K files.

Manual para la formación de facilitadoras de grupos de autoayuda de mujeres y adolescentes afectadas por diferentes tipos de violencia / Manual for the training of facilitators of self-help groups for women and adolescents affected by different types of violence

El Ministerio de Salud, comparte con otras instituciones del Estado y organizaciones de mujeres, la responsabilidad de asegurar que la atención a mujeres y adolescentes afectadas por los diferentes tipos de violencia, se realice bajo un enfoque integral con énfasis especial en lograr el empoderamiento de ellas mismas, por lo tanto, una respuesta efectiva para tal fin, en la consolidación e implementación de los grupos de autoayuda de mujeres y adolescentes (GAAMA) en la Redes Integrales e Integrada de Salud, es la elaboración del Manual para la formación de facilitadoras de grupos de autoayuda de mujeres y adolescentes que viven violencia de género, cuyo proceso de actualización inició convocando a facilitadoras de GAAMA con más de 10 años de experiencia, quienes compartieron su aprendizaje personal al facilitar el grupo, propiciando la definición de pautas claras para el fortalecimiento de los presentes lineamientos. El documento describe distintos métodos y conceptos para el desarrollo de aptitudes dentro del marco de aprendizaje, la socialización del presente Manual se ejecutará mediante talleres dirigidos al personal multidisciplinario de salud y de instituciones relacionadas con el abordaje integral de las mujeres y adolescentes afectadas por todas las formas de violencia. La metodología utilizada para la formación de facilitadoras de GAAMA, permite el desarrollo de habilidades para conocer el fenómeno de la violencia, con mayor énfasis la que afecta a las adolescentes y mujeres, manejo de grupos y el conocimiento del marco legal que apoya este abordaje. En este sentido, los GAAMA propician un espacio para socializar y sensibilizar sobre situaciones de violencia que les han afectado directamente e iniciar el proceso de ayuda a sí mismas y a la vez ayudar a otras mujeres y adolescentes

The Ministry of Health shares with other State institutions and women's organizations the responsibility of ensuring that care for women and adolescents affected by different types of violence is carried out under a comprehensive approach with special emphasis on achieving their empowerment. Therefore, an effective response to this end, in the consolidation and implementation of self-help groups for women and adolescents (GAAMA) in the Comprehensive and Integrated Health Networks, is the elaboration of the Manual for the training of facilitators of self-help groups of women and adolescents who experience gender violence, whose updating process began by calling on GAAMA facilitators with more than 10 years of experience, who shared their personal learning by facilitating the group, promoting the definition of clear guidelines for strengthening of these guidelines. The document describes different methods and concepts for the development of skills within the learning framework. The socialization of this Manual will be carried out through workshops aimed at multidisciplinary health personnel and institutions related to the comprehensive approach to women and adolescents affected by all forms of violence. The methodology used for the training of GAAMA facilitators allows the development of skills to understand the phenomenon of violence, with greater emphasis on violence that affects adolescents and women, group management, and knowledge of the legal framework that supports this approach. In this sense, the GAAMA provide a space to socialize and raise awareness about situations of violence that have directly affected them and start the process of helping themselves and at the same time helping other women and adolescents

Manual de organización y funciones de la Dirección Integral Materno Perinatal y Niñez / Manual of organization and functions of the Comprehensive Maternal Perinatal and Childhood Directorate

La Dirección Integral Materno Perinatal y Niñez, es la dependencia estratégica del Despacho Ministerial, que tiene entre sus propósitos contribuir a la transformación del modelo de atención materno infantil en El Salvador, a un modelo de atención centrado en la familia, así como supervisar la prestación de servicios y monitorear el cumplimiento de los lineamientos técnicos relacionados con la atención materno - infantil. Dicho modelo es un cambio de la cultura organizacional centrado en la mujer, en la familia, recién nacido, niñez y adolescencia con énfasis en la primera infancia; enfocado en la seguridad y en la prevención del error; orientado a las buenas prácticas y las intervenciones basadas en la evidencia científica; apoyado en el desarrollo de habilidades técnicas y en la capacitación continua; y afirmado en la responsabilidad, compromiso, comunicación y valores del equipo de salud. Le corresponde a esta dirección la actualización, innovación en salud, la definición y evaluación de indicadores y estándares nacionales en salud, en conjunto con todas las unidades relacionadas al curso de vida, los programas sanitarios y las dependencias del Derecho a la salud

The Comprehensive Maternal Perinatal and Childhood Directorate is the strategic unit of the Ministerial Office, which has among its purposes to contribute to the transformation of the maternal and child care model in El Salvador, to a family-centered care model, as well as to supervise the provision of services and monitor compliance with technical guidelines related to maternal and child care. This model is a change in the organizational culture focused on women, the family, the newborn, childhood and adolescence with an emphasis on early childhood; focused on security and error prevention; oriented to good practices and interventions based on scientific evidence; supported by the development of technical skills and continuous training; and affirmed in the responsibility, commitment, communication and values of the health team. This department is responsible for updating, innovation in health, the definition and evaluation of national health indicators and standards, in conjunction with all the units related to the life course, health programs and dependencies of the Right to Health

Manual de organización y funciones de la Dirección de Inmunizaciones / Manual of organization and functions of the Directorate of Immunizations

La Dirección de Inmunizaciones, es una dirección especializada del Ministerio de Salud de El Salvador, que tiene asignada la rectoría de todos los aspectos relacionados a la vacunación e inmunización de la población salvadoreña. Esta Dirección es el resultado de una acción conjunta entre los países de la Región de las Américas y de organismos internacionales como la Organización Mundial de la Salud (OMS), su interés es contribuir con acciones tendientes a lograr coberturas universales de vacunación, con el fin de disminuir las tasas de mortalidad y morbilidad causadas por las enfermedades inmunoprevenibles y está sujeta conforme a la Ley de Vacunas. En este sentido y para documentar la organización y funcionamiento de dicha Dirección, se ha elaborado el presente manual como un instrumento técnico normativo de gestión institucional, en el cual se integra la organización y funcionamiento de las diferentes dependencias que lo componen, se describen y establecen los objetivos generales y específicos, las relaciones de autoridad y dependencia de cada ambiente, así como las relaciones de trabajo internas y externas. Tiene el propósito de identificar con claridad las funciones de cada una de las áreas administrativas que la integran, evitar la duplicidad de funciones, conocer las líneas de comunicación y de mando; permitiendo así contar con un instrumento técnico administrativo integrado, que sirva de referencia y consulta a todo el personal laborando en la institución

The Immunization Directorate is a specialized department of the Ministry of Health of El Salvador, who is assigned the rectory of all aspects related to vaccination and immunization of the Salvadoran population. This Address is the result of an action collaboration between the countries of the Region of the Americas and international organizations such as the World Health Organization (WHO), its interest is to contribute with actions aimed at achieving universal vaccination coverage, in order to reduce the rates of mortality and morbidity caused by vaccine preventable diseases and is subject to according to the Vaccination Law. In this sense and to document the organization and operation of said Directorate, has prepared this manual as a regulatory technical management instrument institution, which integrates the organization and operation of the different dependencies that compose it, describe and establish the general objectives and specific, the relationships of authority and dependency of each environment, as well as the internal and external working relationships. Its purpose is to clearly identify the functions of each of the areas that integrate it, avoid duplication of functions, know the lines of communication and command; thus allowing to have a technical administrative instrument integrated, that serves as a reference and consults all the personnel working in the institution