La reproducibilidad de la alineación dental en medidas digitales y manuales

Introducción: La incorporación de modelos digitales ofrece al ortodoncista una alternativa a los modelos de estudio de yeso que se utilizan habitualmente. Estos son un componente estándar de los registros de ortodoncia y son fundamentales para el diagnóstico y la planificación del tratamiento. No obstante, es importante indagar sobre la confiabilidad de las nuevas tecnologías. Objetivo: Evaluar la reproducibilidad de las medidas digitales y manuales de alineación dental en modelos iniciales de pacientes de ortodoncia. Métodos: Se realizó un estudio de evaluación de tecnología diagnóstica, con 80 modelos de yeso, que fueron digitalizados con el escáner Ineos X5. Una vez obtenidos los modelos en yeso y sus imágenes digitales, el investigador que obtuvo el mejor resultado en la calibración inter e intra examinador realizó la medición de la alineación dental. Las medidas manuales se tomaron con un calibrador digital, y las digitales fueron tomadas en el software Nemocast. El análisis incluyó el cálculo del coeficiente de correlación intraclase (CCI) y los límites de acuerdo de Bland y Altman. Un valor de p < 0,05 fue considerado como estadísticamente significativo. Resultados: Los valores de CCI oscilaron entre 0,643 y 0,874. Más de la mitad de las mediciones obtuvieron valores de CCI superiores a 0,81, lo que se consideró una reproducibilidad "casi perfecta", según la interpretación sugerida por Landis y Koch. Se obtuvo un promedio de las diferencias entre -0,2 a -0,4, con límites de acuerdo estrechos. Conclusiones: Se encontró una reproducibilidad "casi perfecta" y un promedio de las diferencias cercano a cero entre las medidas manuales y digitales.

Introduction: The incorporation of digital models offers the orthodontist an alternative to the plaster study models that are commonly used. These are a standard component of orthodontic records and are critical to diagnosis and treatment planning. It is important to inquire about the reliability of new technologies. Objective: To evaluate the reproducibility of digital and manual measurements of dental alignment in initial models of orthodontic patients. Methods: A diagnostic technology evaluation study was carried out with 80 plaster models that were digitized with the Ineos X5 Scanner. Once the plaster models and digital images of them were obtained, the researcher who obtained the best result in the inter and intra examiner calibration performed the dental alignment measurement. Manual measurements were taken with a digital caliper, and digital ones were taken in the Nemocast software. The analysis included the calculation of the Intraclass Correlation Coefficient (ICC) and the Bland and Altman limits of agreement. A value of p <0.05 was considered statistically significant. Results: ICC values ​​ranged between 0.643 and 0.874, more than half of the measurements obtained ICC values ​​higher than 0.81, which was considered "almost perfect" reproducibility according to the interpretation suggested by Landis and Koch. Differences between -0.2 to -0.4 were averaged with narrow limits of agreement. Conclusions: An "almost perfect" reproducibility was found and an average of the differences close to zero between manual and digital measurements.

Evaluation of Head and Cervical Spine Posture after Therapy with Maxillary Protraction Appliances / Evaluación de la Postura de la Cabeza y la Columna Cervical Después de la Terapia con Aparatos de Protracción Maxilar

SUMMARY: The objective of this study was to evaluate the changes of head and cervical spine posture of skeletal class malocclusion in adolescent with maxillary protraction. Thirty cases of skeletal class malocclusion were randomly selected from the Stomatological Hospital of Shanxi Medical University. High-quality lateral cephalograms were collected including pre- and posttreatment to compare the changes of head and cervical spine posture. Data were processed using SPSS 26.0 statistical software. The paired-t test was used to compare pre- and posttreatment mean angular measurements.A significant difference in the SNA(p<0.001), SNB(p<0.01), and ANB(p<0.001) between T1 and T2 showed an improvement in the sagittal relationships. A significant change was observed in middle cervical spine posture, while upper cervical spine posture variables showed no significant difference after treatment. Skeletal class with maxillary protraction appliance not only led to the improvement of sagittal relationship, but also changed the middle cervical spine posture.

El objetivo de este estudio fue evaluar los cambios en la postura de la cabeza y la columna cervical debido a la maloclusión clase esquelética en adolescentes con protracción maxilar. Treinta casos de maloclusión de clase esquelética fueron seleccionados al azar del Hospital Estomatológico de la Universidad Médica de Shanxi. Se recogieron cefalogramas laterales de alta calidad, incluidos el tratamiento previo y posterior, para comparar los cambios en la postura de la cabeza y la columna cervical. Los datos se procesaron con el software estadístico SPSS 26.0. Se utilizó la prueba t pareada para comparar las medidas angulares medias antes y después del tratamiento. Una diferencia significativa en SNA (p <0,001), SNB (p <0,01) y ANB (p <0,001) entre T1 y T2 mostró una mejora en las relaciones sagitales. Se observó un cambio significativo en la postura de la columna cervical media, mientras que las variables de postura de la columna cervical superior no mostraron diferencias significativas después del tratamiento. La clase esquelética con aparato de protracción maxilar no solo condujo a la mejora de la relación sagital, sino que también cambió la postura de la columna cervical media.

Quantitative ultrasound biomicroscopy of iridocorneal angle

Background: Ultrasound biomicroscopy (UBM) is a high?resolution ultrasound technique, which allows noninvasive, in vivo imaging of the ocular anterior segment structures. Purpose: This video gives a description of the identification of the iridocorneal angle structures in the cross?sectional view in a radial scan through a typical ciliary process and a guide toward measuring the angle parameters. Synopsis: UBM provides two?dimensional, grayscale images of the iridocorneal angle. The real?time image is displayed on a video monitor and can be recorded for qualitative and quantitative analysis. The angle parameters can be measured by in?built calipers in the machine software and manipulated by the examiner. Highlights: This video demonstrates UBM caliper positions as displayed on the monitor and marked by the examiner for the measurement of various anterior segment parameters of the eye.

Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients

Aims: Cardiovascular disease (CVD) is the leading cause of death in dialysis patients as well as in kidney transplant recipients (KTx). Left ventricular hypertrophy (LVH) starts early during the course of chronic kidney disease and is a strong predictor of CVD. We hypothesised that kidney transplant is significantly associated with improvement in cardiovascular reserve. We conducted a prospective study to compare changes in CV before and after kidney transplantation in patients with ESRD who received KTx to control individuals who received PD but did not receive a KTx. Study Design: A Case-Control Study. Place and Duration of Study: Clinic for nephrology Clinical Center University of Sarajevo, Bosnia and Herzegovina. Methodology: In this case-control study, we included 50 KTx from the Kidney Transplant Outpatient Clinic for nephrology Clinical Center. For each 50 KTx, PD outpatients matched for gender and age were recruited. All patients underwent transthoracic echocardiography, and LV (left ventricular) mass (LVM), LV mass index (LVMi), and indices of cardiac function were measured. In the small subgroup of 18 KTx, we retrospectively assessed and compared the LVMI measurements, during dialysis and the post-transplant period. Results: The prevalence of LVH was 24% in KTx patients and 72% in PD patients (NS). KTx had significantly lower LVM, LVMi levels, E/A ratio, FS, and LA diameter compared with the PD group, while the EF and other echocardiographic parameters did not differ. In the subgroup of 18 KTx, LVMi levels after transplantation were significantly lower than dialysis LVMi levels. Conclusion: LVH is the most frequent cardiac abnormality at the time of kidney transplantation. After KTx, the reduction of LVH and diastolic dysfunction was significant. CV remodelling after successful KTx is related to better kidney function, and can explain better outcomes for patients with kidney transplants over patients on long-term dialysis.

Morphometric measurements and carcass characteristics of Black Australorp, Naked Neck, and Rhode Island Red crossbreds under alternative production systems / Medições morfométricas e características de carcaça de Black Australorp, Naked Neck e Rhode Island Red crossbreds sob sistemas de produção alternativos

Abstract The present trial explained the effect of alternative production systems on growth, morphometric and carcass traits of four different chicken genotypes. The second generation of two genotypes RNN (Rhode Island Red × Naked Neck) and BNN (Black Australorp × Naked Neck) obtained by two self-crosses (RNN × RNN = RR and BNN × BNN = BB) and two reciprocal crosses (RNN × BNN = RB and BNN × RNN = BR) were evaluated in three alternative production systems (conventional cages, enriched cages, and aviary). At the 6th week of age after sexing, a total of 600 birds, comprising 150 from each crossbred with a total of 300 pullets and 300 cockerels were divided into conventional cages, enriched cages, and aviary systems having 200 birds in each.Birds were organized into 3×4 factorial arrangements under Completely Randomized Design (3 production systems × 4 genotypes × 2 sexes × 25 birds = 600 birds). Regarding genotypes, RB and BR males showed higher (p < 0.01) carcass yield, drumstick weight, breast weight, and thigh weight than BB and RR genotypes. Females of BR genotype showed higher (p < 0.01) breast weight, thigh weight and drumstick weight. As far as production systems are concerned, higher (p < 0.01) liver weight, heart weight, breast weight, intestinal weight, drumstick weight, and thigh weight were observed in the males reared in enriched cages compared with conventional cages and aviary system. Females reared in enriched cages showed higher (p < 0.01) heart weight, breast weight, intestinal weight, drumstick weight, and thigh weight when compared with those reared in conventional cages and aviary. It is concluded that chickens (both sexes) of BR and RB genotypes had better morphological measurements and carcass traits than those of RR and BB genotype chickens. Among alternative production systems, chickens reared in enriched cages had better traits than those of reared in conventional cages and aviary during the growing phase.

Resumo O presente estudo explicou o efeito de sistemas alternativos de produção sobre o crescimento, características morfométricas e carcaças de quatro genótipos de frango diferentes. A segunda geração de dois genótipos RNN (Rhode Island Red × Naked Neck) e BNN (Black Australorp × Naked Neck) obtida por duas autocruzes (RNN × RNN = RR e B ANN × BNN = BB) e duas cruzes recíprocas (RNN × BNN = RB e BNN × RNN = BR) foi avaliada em três sistemas de produção alternativos (gaiolas convencionais, gaiolas enriquecidas e aviário). Na 6ª semana de idade após o sexo, um total de 600 aves, compostas por 150 de cada raça cruzada com um total de 300 pullets e 300 galos, foi dividido em gaiolas convencionais, gaiolas enriquecidas e sistemas aviários com 200 aves em cada. As aves foram organizadas em 3×4 arranjos fatoriais sob projeto completamente randomizado (3 sistemas de produção × 4 genótipos × 2 sexos × 25 aves = 600 aves). Em relação aos genótipos, os machos RB e BR apresentaram maior rendimento de carcaça (p < 0,01), peso da baqueta, peso mamário e peso da coxa do que os genótipos BB e RR. As fêmeas do genótipo BR apresentaram maior (p < 0,01) peso mamário, peso da coxa e peso da baqueta. No que diz respeito aos sistemas de produção, maior (p < 0,01) peso hepático, peso cardíaco, peso mamário, peso intestinal, peso da baqueta e peso da coxa foram observados nos machos criados em gaiolas enriquecidas em comparação com gaiolas convencionais e sistema aviário. As fêmeas criadas em gaiolas enriquecidas apresentaram maior (p < 0,01) peso cardíaco, peso mamário, peso intestinal, peso da baqueta e peso da coxa quando comparadas com as criadas em gaiolas convencionais e aviárias. Conclui-se que as galinhas (ambos os sexos) dos genótipos BR e RB apresentaram melhores medidas morfológicas e traços de carcaça do que os de frangos genótipos RR e BB. Entre os sistemas de produção alternativos, as galinhas criadas em gaiolas enriquecidas tinham características melhores do que as criadas em gaiolas convencionais e aviárias durante a fase de cultivo.

Awareness and Preparedness of Fomite Transmission Among Malaysian Online Shoppers: A Cross-Sectional Survey

@#Introduction: COVID-19 outbreak is the greatest communicable disease that hit globally, caused by SARS-CoV-2 virus. Malaysia commenced a Movement Control Order (MCO) to contain the epidemic, and thereby altered consumer’s purchasing pattern drastically into online shopping, thus increase the demand of delivery services. The virus able to survive on surfaces up until 9 days depending on the type of surface. Nonetheless, the negligence of proper hygiene management among the vendor, the courier or the user can trigger fomite transmission. The aims of this study were to determine the level of awareness and readiness of fomite transmission caused by COVID-19 among Malaysian online shoppers by evaluating knowledge, precautionary measurements and psychological state. Methods: Convenience sampling method was used for data collection, and 416 respondents participated. The survey instrument comprised of 2 parts; socio-demographic characteristics and the second part consist of COVID-19 transmission as well as its survivability, precautions and psychological state during the outbreak. This was transferred to a Google form and the link was shared through social medias. Data were analysed using SPSS software v.23.0. Results: In spite of the fact that 88% of respondents worried about being infected with COVID-19 and well informed regarding fomite transmission, almost half of respondents (42.3%) did not sanitize their parcels received from outside. Conclusion: In light of this, health authorities should implement more campaigns to emphasize the utmost importance of disinfection of any foreign items by consumers and it is strongly believed that it will provide enhanced protection against fomite transmission.

Morphometric measurements and carcass characteristics of Black Australorp, Naked Neck, and Rhode Island Red crossbreds under alternative production systems / Medições morfométricas e características de carcaça de Black Australorp, Naked Neck e Rhode Island Red crossbreds sob sistemas de produção alternativos

The present trial explained the effect of alternative production systems on growth, morphometric and carcass traits of four different chicken genotypes. The second generation of two genotypes RNN (Rhode Island Red × Naked Neck) and BNN (Black Australorp × Naked Neck) obtained by two self-crosses (RNN × RNN = RR and BNN × BNN = BB) and two reciprocal crosses (RNN × BNN = RB and BNN × RNN = BR) were evaluated in three alternative production systems (conventional cages, enriched cages, and aviary). At the 6th week of age after sexing, a total of 600 birds, comprising 150 from each crossbred with a total of 300 pullets and 300 cockerels were divided into conventional cages, enriched cages, and aviary systems having 200 birds in each.Birds were organized into 3×4 factorial arrangements under Completely Randomized Design (3 production systems × 4 genotypes × 2 sexes × 25 birds = 600 birds). Regarding genotypes, RB and BR males showed higher (p < 0.01) carcass yield, drumstick weight, breast weight, and thigh weight than BB and RR genotypes. Females of BR genotype showed higher (p < 0.01) breast weight, thigh weight and drumstick weight. As far as production systems are concerned, higher (p < 0.01) liver weight, heart weight, breast weight, intestinal weight, drumstick weight, and thigh weight were observed in the males reared in enriched cages compared with conventional cages and aviary system. Females reared in enriched cages showed higher (p < 0.01) heart weight, breast weight, intestinal weight, drumstick weight, and thigh weight when compared with those reared in conventional cages and aviary. It is concluded that chickens (both sexes) of BR and RB genotypes had better morphological measurements and carcass traits than those of RR and BB genotype chickens. Among alternative production systems, chickens reared in enriched cages had better traits than those of reared in conventional cages and aviary during the growing phase.

O presente estudo explicou o efeito de sistemas alternativos de produção sobre o crescimento, características morfométricas e carcaças de quatro genótipos de frango diferentes. A segunda geração de dois genótipos RNN (Rhode Island Red × Naked Neck) e BNN (Black Australorp × Naked Neck) obtida por duas autocruzes (RNN × RNN = RR e B ANN × BNN = BB) e duas cruzes recíprocas (RNN × BNN = RB e BNN × RNN = BR) foi avaliada em três sistemas de produção alternativos (gaiolas convencionais, gaiolas enriquecidas e aviário). Na 6ª semana de idade após o sexo, um total de 600 aves, compostas por 150 de cada raça cruzada com um total de 300 pullets e 300 galos, foi dividido em gaiolas convencionais, gaiolas enriquecidas e sistemas aviários com 200 aves em cada. As aves foram organizadas em 3×4 arranjos fatoriais sob projeto completamente randomizado (3 sistemas de produção × 4 genótipos × 2 sexos × 25 aves = 600 aves). Em relação aos genótipos, os machos RB e BR apresentaram maior rendimento de carcaça (p < 0,01), peso da baqueta, peso mamário e peso da coxa do que os genótipos BB e RR. As fêmeas do genótipo BR apresentaram maior (p < 0,01) peso mamário, peso da coxa e peso da baqueta. No que diz respeito aos sistemas de produção, maior (p < 0,01) peso hepático, peso cardíaco, peso mamário, peso intestinal, peso da baqueta e peso da coxa foram observados nos machos criados em gaiolas enriquecidas em comparação com gaiolas convencionais e sistema aviário. As fêmeas criadas em gaiolas enriquecidas apresentaram maior (p < 0,01) peso cardíaco, peso mamário, peso intestinal, peso da baqueta e peso da coxa quando comparadas com as criadas em gaiolas convencionais e aviárias. Conclui-se que as galinhas (ambos os sexos) dos genótipos BR e RB apresentaram melhores medidas morfológicas e traços de carcaça do que os de frangos genótipos RR e BB. Entre os sistemas de produção alternativos, [...].

Morphometric measurements and carcass characteristics of Black Australorp, Naked Neck, and Rhode Island Red crossbreds under alternative production systems

Abstract The present trial explained the effect of alternative production systems on growth, morphometric and carcass traits of four different chicken genotypes. The second generation of two genotypes RNN (Rhode Island Red × Naked Neck) and BNN (Black Australorp × Naked Neck) obtained by two self-crosses (RNN × RNN = RR and BNN × BNN = BB) and two reciprocal crosses (RNN × BNN = RB and BNN × RNN = BR) were evaluated in three alternative production systems (conventional cages, enriched cages, and aviary). At the 6th week of age after sexing, a total of 600 birds, comprising 150 from each crossbred with a total of 300 pullets and 300 cockerels were divided into conventional cages, enriched cages, and aviary systems having 200 birds in each.Birds were organized into 3×4 factorial arrangements under Completely Randomized Design (3 production systems × 4 genotypes × 2 sexes × 25 birds = 600 birds). Regarding genotypes, RB and BR males showed higher (p 0.01) carcass yield, drumstick weight, breast weight, and thigh weight than BB and RR genotypes. Females of BR genotype showed higher (p 0.01) breast weight, thigh weight and drumstick weight. As far as production systems are concerned, higher (p 0.01) liver weight, heart weight, breast weight, intestinal weight, drumstick weight, and thigh weight were observed in the males reared in enriched cages compared with conventional cages and aviary system. Females reared in enriched cages showed higher (p 0.01) heart weight, breast weight, intestinal weight, drumstick weight, and thigh weight when compared with those reared in conventional cages and aviary. It is concluded that chickens (both sexes) of BR and RB genotypes had better morphological measurements and carcass traits than those of RR and BB genotype chickens. Among alternative production systems, chickens reared in enriched cages had better traits than those of reared in conventional cages and aviary during the growing phase.

Resumo O presente estudo explicou o efeito de sistemas alternativos de produção sobre o crescimento, características morfométricas e carcaças de quatro genótipos de frango diferentes. A segunda geração de dois genótipos RNN (Rhode Island Red × Naked Neck) e BNN (Black Australorp × Naked Neck) obtida por duas autocruzes (RNN × RNN = RR e B ANN × BNN = BB) e duas cruzes recíprocas (RNN × BNN = RB e BNN × RNN = BR) foi avaliada em três sistemas de produção alternativos (gaiolas convencionais, gaiolas enriquecidas e aviário). Na 6ª semana de idade após o sexo, um total de 600 aves, compostas por 150 de cada raça cruzada com um total de 300 pullets e 300 galos, foi dividido em gaiolas convencionais, gaiolas enriquecidas e sistemas aviários com 200 aves em cada. As aves foram organizadas em 3×4 arranjos fatoriais sob projeto completamente randomizado (3 sistemas de produção × 4 genótipos × 2 sexos × 25 aves = 600 aves). Em relação aos genótipos, os machos RB e BR apresentaram maior rendimento de carcaça (p 0,01), peso da baqueta, peso mamário e peso da coxa do que os genótipos BB e RR. As fêmeas do genótipo BR apresentaram maior (p 0,01) peso mamário, peso da coxa e peso da baqueta. No que diz respeito aos sistemas de produção, maior (p 0,01) peso hepático, peso cardíaco, peso mamário, peso intestinal, peso da baqueta e peso da coxa foram observados nos machos criados em gaiolas enriquecidas em comparação com gaiolas convencionais e sistema aviário. As fêmeas criadas em gaiolas enriquecidas apresentaram maior (p 0,01) peso cardíaco, peso mamário, peso intestinal, peso da baqueta e peso da coxa quando comparadas com as criadas em gaiolas convencionais e aviárias. Conclui-se que as galinhas (ambos os sexos) dos genótipos BR e RB apresentaram melhores medidas morfológicas e traços de carcaça do que os de frangos genótipos RR e BB. Entre os sistemas de produção alternativos, as galinhas criadas em gaiolas enriquecidas tinham características melhores do que as criadas em gaiolas convencionais e aviárias durante a fase de cultivo.

Parasitosis intestinales y medidas antropométricas en preescolares del cantón de Portoviejo, Ecuador / Intestinal parasites and anthropometric measurements in preschoolers from the canton of Portoviejo, Ecuador

Las enteroparasitosis son un problema de salud pública a nivel global con mayor impacto en los países subdesarrollados asociadas a condiciones de vida inadecuadas. La población infantil es más suceptible para desarrollar sintomatología provocando cuadros disentéricos, vomitos, síndrome de mal absorción, lo que influye en deficiencia de nutrientes y vitaminas, como consecuencia retraso en el crecimiento, malnutrición, trastornos del desarrollo físico y cognitivo. Se realizó una investigación epidemiológica, de corte transversal para estimar la prevalencia de parásitos instestinales y las diferencias en relación a las medidas antropométricas, en 283 escolares de la Capital de la provincia de Manabí. Las variables peso, talla parada, circunferencia de brazo izquierdo, pliegues de tríceps y subescapular, índice de masa corporal, área magra y área grasa fueron seleccionadas para establecer la relación. El coproparasitológico se realizó con el método directo (solución salina 0,9% y Lugol) y Kato Katz. Los resultados mostraron 62,54% de prevalencia, sin distingo de sexo, ni edad. Blastocytis spp., la especie más frecuente, confirmándose el comportamiento epidemiológico a nivel mundial a expensa de los protozoarios, con presencia de especies comensales (E. nana) relacionada con el fecalismo. A pesar de la alta prevalencia, no se observó diferencia significativa entre variables antropométricas analizadas en los escolares parasitados y no parasitados. Se infiere que es debido al tipo de especies y la intensidad de la infestación. Se recomienda realizar campañas de educación sanitaria y promover hábitos de higiene, así como dirigir investigaciones para determinar el papel epidemiológico del agua de consumo y las enteroparasitosis(AU)

Enteroparasitosis is a global public health problem with the greatest impact in underdeveloped countries associated with inadequate living conditions. The child population is more susceptible to developing symptoms causing dysentery, vomiting, malabsorption syndrome, which influences nutrient and vitamin deficiency, resulting in growth retardation, malnutrition, physical and cognitive development disorders. A cross-sectional epidemiological investigation was carried out to estimate the prevalence of intestinal parasites and the differences in relation to anthropometric measurements, in 283 schoolchildren from the capital of the province of Manabí. The variables weight, standing height, left arm circumference, triceps and subscapular folds, body mass index, lean area, and fat area were selected to establish the relationship. Coproparasitology was performed with the direct method (saline solution 0.9% and Lugol) and Kato Katz. The results showed 62.54% prevalence, regardless of sex or age. Blastocytis spp., the most frequent species, confirming the epidemiological behavior worldwide at the expense of protozoa, with the presence of commensal species (E. nana) related to fecalism. Despite the high prevalence, no significant difference was observed between the anthropometric variables analyzed in parasitized and non-parasitized schoolchildren. It is inferred that it is due to the type of species and the intensity of the infestation. It is recommended to carry out health education campaigns and promote hygiene habits, as well as to conduct research to determine the epidemiological role of drinking water and enteroparasitosis(AU)

Alteración de la función pulmonar en vendedores informales de gasolina expuestos a sus vapores en Maicao, Colombia

Objetivo: Determinar los efectos de la exposición a vapores de gasolina sobre la función pulmonar en vendedores informales. Material y métodos: Estudio descriptivo de corte transversal realizado en expendedores informales de gasolina expuestos a sus vapores en el municipio de Maicao, Colombia. Se registraron datos sociodemográficos, se evaluó la función pulmonar por medio de espirometría, oximetría de pulso y, evaluación de la exposición a biomasa. Resultados: Se evaluaron 74 pacientes. El 87,8% eran de sexo masculino, encontrándose principalmente entre los 18 - 40 años (71,6%). El 21,6% (n=16) de la población reportó tener afecciones respiratorias, el 59,4% obtuvo un VEF1 <80% predicho, el 68,9% un FVC <80% predicho y, el 32,4% un VEF1/FVC <70% predicho. De aquellos que tuvieron espirometría anormal (n=45), el 62,2% reportó tener un tiempo de labor ≥ 5 años. Los síntomas reportados con mayor frecuencia fueron disfonía (14,8%), conjuntivitis (14,8%), epigastralgia (10,8%) y cefalea (9,45%). No se encontraron diferencias estadísticamente significativas entre la alteración de la espirometría y antecedentes, saturación de oxígeno medida y presencia de afección respiratoria. Conclusión: Este estudio encontró que un porcentaje representativo de vendedores informales de gasolina expuestos a vapores de combustibles en la frontera colombo-venezolana, presentaron alteración en la función pulmonar comprobado por espirometría anormal y, algunos reportaron sintomatología y afección respiratoria. Estos, son principalmente hombres, adultos jóvenes, con nivel socioeconómico y educacional bajo y, expuestos a diario de forma prolongada y por varios años, a gases derivados del manejo de combustibles fósiles.

SUMMARY Objective: To determine the effects of fuel vapor exposure on pulmonary function among informal sellers. Methods: Cross-sectional study carried-out among informal fuel sellers in Maicao, Colombia. Sociodemographic data were gathered as well as pulmonary function by spirometry, pulse oximetry and evaluation of biomass exposure. Results: 74 patients were evaluated; 87.8% were males, 71.6% of them had between 18 to 40 years of age; 21.6% (n=16) reported pulmonary diseases; 59.4% had a predicted FEV1 <80%; 68.9% had a predicted FVC <80% and 32.4% had a predicted FEV1/FVC < 70%. Among those who had abnormal spirometry, (n=45) 62.2% reported to had worked ≥5 years. The most common reported symptoms were dysphonia (14.8%), conjunctivitis (14.8), epigastric pain (10.8) and headache (9.45%). No statistically significant differences were found between spirometry alterations and history of p pulmonary diseases, mean oxygen saturations and presence of a respiratory disease. Conclusions: This study demonstrates that a significant proportion of informal fuel sellers exposed to fuel vapors in the Colombian-Venezuelan border had derangement of the pulmonary function measured by spirometry and that some of them reported symptoms and respiratory disease. Young male adults of low socioeconomic and educational levels with prolonged exposure to fuel vapors are mostly affected.

Tinnitus and Otosclerosis: An Exploratory Study about the Prevalence, Features and Impact in Daily Life

Abstract Introduction Tinnitus is experienced by a significant part of the patients suffering from otosclerosis. Objective To assess the prevalence of tinnitus in otosclerosis, its main features, and the impact on the daily life. Methods Patients diagnosed with otosclerosis in 2019 in a tertiary hospital were enrolled in the study. Demographic data were retrieved and, besides a regular audiometric evaluation, the patients underwent acuphenometry to assess the psychoacoustic measurements (pitch and loudness), and the Tinnitus Handicap Inventory (THI). Results In total, 66 patients fulfilled the inclusion criteria, with a female predominance (63.6%; n = 42), and a mean age of 48.7 years. The mean air-bone gap was of 26.3 dB. A total of 72.7% complained of tinnitus; it was mostly unilateral, identified in the low frequencies, namely 500 Hz, with median loudness of 7.5 dB. The median score on the THI score was of 37; most patients had a mild handicap (33.3%, n = 16), followed by those with a severe handicap (22.9%; n = 11). The female gender had a statistically significant association with the presence of tinnitus. The THI scores were higher in middle-aged patients (age groups: 40 to 49 and 50 to 59 years), which was statistically significant. No correlation was found between audiometry results and the prevalence of tinnitus or score on the THI. On the other hand, high-pitched tinnitus, compared to low pitched-tinnitus, was associated with larger air-bone gaps. Conclusion The prevalence of tinnitus in our population was in line with the prevalences reported in the literature. It caused a catastrophic handicap in 22.9% of the patients. High-pitched tinnitus was associated with higher handicap. Nonetheless, the existence of tinnitus and its severity were not associated with the degree of hearing loss.

Plantilla para medir la cadera con desarrollo displásico en el lactante / Template for measuring the hip with dysplastic development in the breastfed baby

RESUMEN El éxito del tratamiento de la displasia del desarrollo de la cadera está íntimamente ligado a una intervención temprana, o sea, a un diagnóstico y tratamiento precoces y seguros. El estudio radiográfico tradicionalmente se ha sustentado en la medición de una serie de parámetros, la cual se realiza mediante el goniómetro, marcando directamente en la radiografía. Sin embargo, este procedimiento tiene sus desventajas. El presente estudio tiene como objetivo exponer las características de una plantilla para medir la cadera con desarrollo displásico en el lactante. Se explica cómo proceder con la herramienta propuesta; se argumentan sus posibilidades y metodología de aplicación, y se ilustra su factibilidad desde el punto de vista práctico. La plantilla permite evaluar la cadera del lactante, independientemente de la osificación del núcleo de la cabeza del fémur; así como determinar si la cadera es normal; y en caso de ser patológica, clasificarla en dependencia del grado de severidad de la afección.

ABSTRACT The success of developmental dysplasia of the hip treatment is closely linked to early intervention, that is, early and safe diagnosis and treatment. The radiographic study has traditionally been based on the measurement of a series of parameters, which is carried out using the goniometer, marking directly on the radiograph. However, this procedure has its disadvantage. The present study aims to expose the characteristics of a template to measure the hip with dysplastic development in infants. It explains how to proceed with the proposed tool; its possibilities and application methodology are argued, and its feasibility from a practical point of view is illustrated. The template allows evaluation of the infant's hip, regardless the femoral head nucleus ossification; as well as determines if the hip is normal; and if it is pathological, classifies it depending on the degree of severity of the condition.

Modificaciones de la punta nasal posterior a rinoplastia transcartilaginosa / Modifications of Nasal Tip After Transcartilaginous Rhinoplasty

Introducción: La reducción del ancho y definición de la punta nasal es uno de los objetivos principales de la rinoplastia estética. La vía endonasal, con incisión transcartilaginosa, se emplea principalmente cuando no hay alteraciones significativas en la estructura cartilaginosa de la punta nasal. Objetivo: Determinar los cambios morfológicos que se producen en la punta nasal, posterior a la rinoplastia transcartilaginosa. Métodos: Se realizó un estudio descriptivo, prospectivo, longitudinal en 15 pacientes con deformidad estética de la punta nasal, operados por rinoplastia transcartilaginosa en el Hospital "Hermanos Ameijeiras", entre el 2016 y el 2020. Las variables estudiadas fueron: ángulo nasolabial, ancho de la punta nasal, porciento de reducción del ancho de la punta nasal, relación longitud nasal-proyección de la punta nasal y estado de satisfacción de los pacientes. Resultados: Se produjo un estrechamiento de la punta nasal, de una media del ancho preoperatorio de 64,8 por ciento con relación a la base nasal, a una media del 60,1 por ciento para el posoperatorio, para una media del porciento de reducción del ancho de la punta nasal posoperatoria de 7,3 por ciento. En el resto de las variables estudiadas, aun cuando existieron cambios individuales, como grupo no hubo variación respecto al predominio de las categorías ideales. Conclusiones: Se produjeron modificaciones posoperatorias que tributaron en un refinamiento de la punta nasal, con un alto grado de satisfacción de los pacientes operados. Palabras clave: rinoplastia endonasal; modificación de la punta nasal; mediciones antropométricas(AU)

Introduction: The reduction of the width and definition of the nasal tip is one of the main objectives of aesthetic rhinoplasty. The endonasal route, with a transcartilaginous incision, is mainly used when there are no significant alterations in the cartilaginous structure of the nasal tip. Objective: To determine the morphological changes that occur in the nasal tip after transcartilaginous rhinoplasty. Methods: A descriptive, prospective, longitudinal study was carried out in 15 patients with aesthetic deformity of the nasal tip, who were operated by transcartilaginous rhinoplasty at Hermanos Ameijeiras Hospital, from 2016 to 2020. The variables studied were nasolabial angle, width of the nasal tip, percentage of reduction in the width of the nasal tip, relationship between the nasal length and the projection of the nasal tip, and the patients' satisfaction status. Results: There was a narrowing of the nasal tip, starting from a preoperative mean width of 64.8 percent in relation to the nasal base, to a postoperative mean of 60.1 percent, resulting in a mean percentage reduction in width of the postoperative nasal tip of 7.3 percent. No variation was observed regarding the predominance of the ideal categories in the rest of the variables studied, even when there were individual changes, as a group. Conclusions: Postoperative modifications were produced that contributed to a refinement of the nasal tip, with a high degree of satisfaction of the operated patients(AU)

Physicochemical and UV/VIS measurements of UHD solutionsof water, potentized water,and different potencies of organic substance

Conventional science regards the study of UHD (highly homeopathically potentized) solutions as pseudo-science. However, an increasing number of rigorous scientific investigations demonstrate differences in physicochemical and physical characteristics of such solutions. Strictly chemically regarded, they correspond to highly distilled water. Our research team developed a system of physicochemical and UV spectrographic measurements, whereby the differences may be consistently confirmed with high statistical significance.Methods:For measurement of the physicochemical parameters,we usedpH,electrical conductivity,and oxidation-reduction potential (ORP)sensors.For UV/VIS spectroscopymeasurements,we useda Macherey-Nagelspectrophotometer.For UHD research, we used two batches of substances: Russian (R) and Brazilian (B). In R, distilled water (W) was used for dilutions and potencies as follows: potentized water (W cH9), potentized dilution of antibodies to interferon-gamma (Abs IFNγ cH9), the same original substance in the form of a mixture of potencies (Abs IFNγ cH12, cH30, cH50, shortly Abs IFNγ mix). Furthermore, we prepared higher potencies of the substances (supplementary potentiation) in a specially prepared solution and measured their characteristics. In B, the solution was used for further dilutions and potencies as follows: potentized water (W cH1) and Glyphosate potencies (Gly cH6 => cH8, cH30 => cH 32, and cH200 => cH 202).For direct or post-hoc analysis, we used Wilcoxon signed-rank test, two-tailed.Results:UV-VIS spectroscopy (R): measurements of received liquids potentized for further cH1 show statistically significant differences between all substances, except between water W and W cH9 at 260 nm. Significant differences (p-values) were as follows: Abs IFNγ mixvs. W= 0.007; Abs IFNγ mixvs.W cH9=0.008; Abs IFNγ cH9vs. W=0.044; Abs IFNγ cH9vs.W cH9= 0.026; Abs IFNγ mixvs.W cH9= 0.007; W vs.W cH9= 0.506.Physicochemical measurements:R: measurementsdemonstrated statistical difference only in pH (Abs IFNγ mix towards all others). Significant differences (p-values) were as follows: Abs IFNγ mixvs. W=0.022; Abs IFNγ mixvs.W cH9=0.005; Abs IFNγ mixvs.Abs IFNγ cH9=0.025. After supplementarypotentiation, we obtained a more conspicuous picture with many statistical differences in conductivity and ORP, ranging from p= 0.001 to 0.046.A difference between water and potentized water has also been demonstrated.B: the measurements demonstrated statistical differences mainly in pH between Gly cH8 and the rest and between Gly cH202 and W cH1.Significant differences (p-values) were as follows:Gly cH8vs. Gly cH32 =0.027; Gly cH8vs. Gly cH202 = 0.011; Gly cH8vs. W cH1= 0.014; Gly cH202vs. W cH1= 0.034.Conclusion:UV/VIS at wavelength 260 nm Abs IFNγ mix discloses a pattern similar to exclusion zone (EZ)water at 270 nm.By additional potentiation and with physicochemical measurements, we obtained higher statistical differences than in the original dilutions.In contrast, UV/VIS spectroscopy showed more conspicuous results without additional potentiation. However, the very act of succussion becomes very distinct

Prevalencia de afecciones musculoesqueléticas y factores asociados en adultos mayores en una Fundación de Duran / Prevalence of musculoskeletal conditions and associated factors in older adults in a Duran Foundation / Prevalência de condições musculoesqueléticas e fatores associados em idosos de uma Fundação Duran

Las afecciones musculoesqueléticas comprenden trastornos degenerativos que aparecen principalmente en personas de edad avanzada, deteriorando significativamente la salud, debido a que están relacionadas con dolor muscular u óseo, alteraciones del movimiento, mayor riesgo de caídas, fracturas y capacidad alterada para realizar las actividades del diario vivir. Objetivo. Determinar la prevalencia de afecciones musculo esqueléticas y factores asociados en el adulto mayor que asistieron a la Fundación. Metodología. Con enfoque cuantitativo, descriptivo, transversal, no experimental y retrospectivo. Los instrumentos a utilizar incluyeron el dinamómetro, índice de masa corporal y la antropometría. Resultados. se determinó que la prevalencia de las alteraciones musculoesqueléticas fue del 59%, de los cuales, la artrosis de rodilla fue la más común con una prevalencia del 90%, asociados con un índice de masa corporal elevado con un valor mayor a 25 kg/m2 y una fuerza muscular disminuida con un valor menor a 28.2 kg para los hombres y menor a 15.4 kg para las mujeres. En contraste, las medidas antropométricas fueron normales, con valores mayor o igual a 31 cm para la circunferencia de la pantorrilla y mayor o igual a 22 cm para la circunferencia del brazo. Conclusión. Existe una alta prevalencia de alteraciones musculoesqueléticas, El sobrepeso y la debilidad muscular fueron los únicos factores asociados.

Musculoskeletal disorders include degenerative disorders that appear mainly in elderly people, significantly deteriorating their health, because they are related to muscle or bone pain, movement disorders, increased risk of falls, fractures and impaired ability to perform daily activities. Objective. To determine the prevalence of musculoskeletal disorders and associated factors in older adults attending the Fundación. Methodology. With a quantitative, descriptive, cross-sectional, non-experimental and retrospective approach. The instruments to be used included the dynamometer, body mass index and anthropometry. Results. It was determined that the prevalence of musculoskeletal alterations was 59%, of which knee osteoarthritis was the most common with a prevalence of 90%, associated with an elevated body mass index with a value greater than 25 kg/m2 and decreased muscle strength with a value of less than 28.2 kg for men and less than 15.4 kg for women. In contrast, anthropometric measurements were normal, with values greater than or equal to 31 cm for calf circumference and greater than or equal to 22 cm for arm circumference. Conclusion. There is a high prevalence of musculoskeletal alterations. Overweight and muscle weakness were the only associated factors

As condições musculoesqueléticas compreendem desordens degenerativas que ocorrem principalmente em pessoas idosas, prejudicando significativamente a saúde, pois estão associadas a dores musculares ou nos ossos, comprometimento dos movimentos, aumento do risco de quedas, fraturas e incapacidade de realizar atividades da vida diária. Objetivo. Para determinar a prevalência de distúrbios musculoesqueléticos e fatores associados em adultos idosos que frequentam a Fundação. Metodologia. Com uma abordagem quantitativa, descritiva, transversal, não-experimental e retrospectiva. Os instrumentos utilizados incluíam o dinamômetro, o índice de massa corporal e a antropometria. Resultados. Foi determinado que a prevalência de distúrbios musculoesqueléticos foi de 59%, dos quais a osteoartrose do joelho foi a mais comum com uma prevalência de 90%, associada a um alto índice de massa corporal com um valor superior a 25 kg/m2 e uma diminuição da força muscular com um valor inferior a 28,2 kg para homens e inferior a 15,4 kg para mulheres. Em contraste, as medidas antropométricas foram normais, com valores maiores ou iguais a 31 cm para a circunferência da barriga da perna e maiores ou iguais a 22 cm para a circunferência do braço. Conclusão. Há uma alta prevalência de distúrbios musculoesqueléticos. O excesso de peso e a fraqueza muscular foram os únicos fatores associados.

Mensuração da atividade física e comportamento sedentário: uma análise baseada em grupos de pesquisa / Measurement of physical activity and sedentary behavior: a research group-based analysis

O presente estudo caracterizou os grupos de pesquisa brasileiros que possuem linhas de pesquisa voltadas à temática da mensuração da atividade física e/ou comportamento sedentário. Autores de artigos originais envolvendo desenvolvimento, adaptação, tradução e testagem de qualidade de medidas de instrumentos da atividade física/comportamento sedentário na população brasileira foram convidados a responder um instrumento online contendo 19 questões para a identificação de líderes e de características gerais dos grupos de pesquisa. Vinte e oito grupos de pesquisa foram identificados, sendo o pioneiro criado na década de 1970 e a maioria nas últimas duas décadas. Enquanto a região sudeste apresentou a maior concentração de grupos, foi identificada ausência de grupos nas regiões norte e centro-oeste. Os métodos de mensuração mais testados por estes grupos foram os subjetivos, predominantemente questionários (n = 24), seguidos pelos métodos objetivos por meio de acelerômetros (n = 18) e pedômetros (n = 9). Foram identificadas várias conexões (parcerias permanentes com outros grupos/instituições) em nível nacional e internacional, especialmente com países da América do Norte, Europa e Austrália. Espera-se que os resultados do presente estudo possam estimular ações colaborativas entre grupos e pesquisadores brasileiros com o intuito de reduzir desigualdades regionais e aprimorar a produção do conhecimento na área da mensuração da atividade física e do comportamento sedentário

The present study characterized the Brazilian research groups that have research lines focused on the meas-uring of physical activity and/or sedentary behavior. Authors of original articles that involved the devel-opment, adaptation, translation, and quality testing of measures of physical activity/sedentary behavior instruments in the Brazilian population were invited to answer an online instrument containing 19 questions to identify leaders and general characteristics of research groups. Twenty-eight research groups were identified, the pioneer being created in the 1970's and the majority in the last two decades. While the Southeast region had the highest concentration of groups, the absence of groups was identified in the North and Midwest regions. The measurement methods most tested by these groups were subjective, predominantly questionnaires (n = 24), followed by objective methods using accelerometers (n = 18) and pedometers (n = 9). Several connections (permanent partnerships with other groups/institutions) were identified at national and international levels, especially with countries in North America, Europe, and Australia. It is expected that the results of the present study can stimulate collaborative actions between Brazilian groups and re-searchers to reduce regional inequalities and improve the production of knowledge in the area of measuring physical activity and sedentary behavior

Gasto en atención primaria en salud en las Américas: medir lo que importa / Primary health care expenditure in the Americas: measuring what matters / Gasto em atenção primária à saúde nas Américas: calcular o que importa

RESUMEN En este informe especial se compara la medición del gasto en atención primaria en salud (APS) propuesta por la Organización para la Cooperación y el Desarrollo Económico (OCDE) y la Organización Mundial de la Salud (OMS) según el marco mundial para reportar gastos en salud (SHA 2011) en tres países de la región de las Américas. Hay divergencias conceptuales: 1) la operacionalización como atención básica, por OCDE, o primer contacto, por OMS; 2) la mayor amplitud de bienes y servicios en la definición de OMS (incluye medicamentos, administración y servicios preventivos colectivos); 3) la consideración únicamente de servicios en proveedores ambulatorios en OCDE. Los gastos en APS como el porcentaje del gasto corriente en salud (GCS) en 2017 para OMS y OCDE, serían: México (43,6% vs 15.1%); República Dominicana (41,1 vs 5,75%) y Costa Rica (31,4% vs 5,7%); superarían la meta del 30% del GCS en APS que propone el Pacto 30-30-30 de la Organización Panamericana de la Salud, con la definición de la OMS y estarían muy lejos de alcanzarla con la de la OCDE. La definición amplia de APS como primer contacto de OMS facilita la inclusión de servicios que reflejan la forma en que los países ofrecen atención a su población. Aun así, la OMS podría mejorar las descripciones de las categorías incluidas para fines de comparación internacional. Restringir la APS a proveedores ambulatorios como hace OCDE limita mucho la medición y excluye intervenciones intrínsecas al concepto de APS, como servicios colectivos de prevención. Como paso transitorio se recomienda a los países que monitoreen el financiamiento de la APS, explicitando qué incluyen en su definición. El SHA 2011 permite identificar y comparar estas diferencias.

ABSTRACT This special report compares the measurement of primary health care (PHC) expenditure proposed by the Organization for Economic Cooperation and Development (OECD) and by the World Health Organization (WHO), according to the global framework for reporting health expenditures (SHA 2011) in three countries in the Region of the Americas. There are conceptual differences: 1) operationalization as basic care, by OECD, versus first contact, by WHO; 2) a wider range of goods and services in the WHO definition (including medicines, administration, and collective preventive services); and 3) consideration only of services in outpatient providers by OECD. PHC expenditures as a percentage of current healthcare spending in 2017 for WHO and OECD: Mexico (43.6% vs. 15.1%); Dominican Republic (41.1% vs. 5.75%), and Costa Rica (31.4% vs. 5.7%). The 30% target for current healthcare spending on PHC proposed by Compact 30-30-30 (Pan American Health Organization) would be surpassed by the WHO definition, but it would be far from achieved by the OECD definition. The broad WHO definition of PHC as first contact facilitates inclusion of services that reflect the way countries provide care to their populations. Even so, WHO could improve its category descriptions for the purposes of international comparison. Restricting PHC to outpatient providers (as the OECD does) greatly limits measurement and excludes interventions intrinsic to the concept of PHC, such as collective preventive services. As a transitional step, we recommend that countries should monitor PHC funding and should explain what they include in their definition. SHA 2011 makes it possible to identify and compare these differences.

RESUMO Este informe especial apresenta uma comparação entre o cálculo do gasto em atenção primária à saúde (APS) conforme os métodos propostos pela Organização para a Cooperação e o Desenvolvimento Econômico (OCDE) e pela Organização Mundial da Saúde (OMS), segundo a metodologia System of Health Accounts (SHA 2011), em três países da Região das Américas. Observam-se divergências conceituais entre os métodos: 1) operacionalização do conceito como atenção básica pela OCDE ou primeiro contato pela OMS; 2) maior abrangência de bens e serviços de acordo com a definição da OMS (englobando medicamentos, administração e serviços de prevenção em âmbito coletivo) e 3) inclusão única de serviços ambulatoriais de acordo com a OCDE. Os gastos em APS como percentual do gasto corrente em saúde (GCS) em 2017, de acordo com os métodos propostos pela OMS e pela OCDE, foram: 43,6% vs. 15,1% no México; 41,1 vs. 5,75% na República Dominicana; e 31,4% vs. 5,7% na Costa Rica. Esses valores ultrapassam a meta de 30% do GCS em APS sugerida no Pacto 30.30.30 da Organização Pan-Americana da Saúde, com a definição proposta pela OMS, e essa meta estaria longe de ser alcançada com a definição proposta pela OCDE. A definição ampla de APS como primeiro contato que é proposta pela OMS permite incluir os diferentes serviços de atenção existentes nos países. No entanto, as categorias deveriam ser mais bem detalhadas para facilitar a comparação internacional. Por outro lado, a proposta da OECD restringe a APS aos prestadores de serviços ambulatoriais, o que limita muito o cálculo e exclui intervenções próprias do conceito de APS, como serviços de prevenção no âmbito coletivo. Numa etapa de transição, recomenda-se aos países monitorar o financiamento da APS, explicitando os itens incluídos na definição empregada. A metodologia SHA 2011 possibilita identificar e comparar essas diferenças.

Primary health care expenditure in the Americas: measuring what matters / Gasto en atención primaria en salud en las Américas: medir lo que importa / Gasto em atenção primária à saúde nas Américas: medir o que importa

ABSTRACT This special report compares the measurement of primary health care (PHC) expenditure proposed by the Organization for Economic Cooperation and Development (OECD) and by the World Health Organization (WHO), according to the global framework for reporting health expenditures (SHA 2011) in three countries in the Region of the Americas. There are conceptual differences: (1) operationalization as basic care, by OECD, versus first contact, by WHO; (2) a wider range of goods and services in the WHO definition (including medicines, administration, and collective preventive services); and (3) consideration only of services in outpatient providers by OECD. PHC expenditures as a percentage of current healthcare spending in 2017 for WHO and OECD: Mexico (43.6% vs. 15.1%); Dominican Republic (41.1% vs. 5.75%), and Costa Rica (31.4% vs. 5.7%). The broad WHO definition of PHC as first contact facilitates inclusion of services that reflect the way countries provide care to their populations. Even so, WHO could improve its category descriptions for the purposes of international comparison. Restricting PHC to outpatient providers (as the OECD does) greatly limits measurement and excludes interventions intrinsic to the concept of PHC, such as collective preventive services. As a transitional step, we recommend that countries should monitor PHC funding and should explain what they include in their definition. SHA 2011 makes it possible to identify and compare these differences.

RESUMEN En este informe especial se compara la medición del gasto en atención primaria en salud (APS) propuesta por la Organización para la Cooperación y el Desarrollo Económico (OCDE) y la Organización Mundial de la Salud (OMS) según el marco mundial para reportar gastos en salud (SHA 2011) en tres países de la región de las Américas. Hay divergencias conceptuales: 1) la operacionalización como atención básica, por OCDE, o primer contacto, por OMS; 2) la mayor amplitud de bienes y servicios en la definición de OMS (incluye medicamentos, administración y servicios preventivos colectivos); 3) la consideración únicamente de servicios en proveedores ambulatorios en OCDE. Los gastos en APS como el porcentaje del gasto corriente en salud (GCS) en 2017 para OMS y OCDE, serían: México (43,6% vs 15.1%); República Dominicana (41,1 vs 5,75%) y Costa Rica (31,4% vs 5,7%).La definición amplia de APS como primer contacto de OMS facilita la inclusión de servicios que reflejan la forma en que los países ofrecen atención a su población. Aun así, la OMS podría mejorar las descripciones de las categorías incluidas para fines de comparación internacional. Restringir la APS a proveedores ambulatorios como hace OCDE limita mucho la medición y excluye intervenciones intrínsecas al concepto de APS, como servicios colectivos de prevención. Como paso transitorio se recomienda a los países que monitoreen el financiamiento de la APS, explicitando qué incluyen en su definición. El SHA 2011 permite identificar y comparar estas diferencias.

RESUMO Este informe especial apresenta uma comparação entre a medida do gasto em atenção primária à saúde (APS) conforme as propostas da Organização para a Cooperação e o Desenvolvimento Econômico (OCDE) e da Organização Mundial da Saúde (OMS), usando a metodologia mundialmente aceita para reportar gastos em saúde - o System of Health Accounts (SHA 2011) - em três países da Região das Américas. Observam-se divergências conceituais entre os métodos: 1) operacionalização do conceito como atenção básica pela OCDE ou primeiro contato pela OMS; 2) maior abrangência de bens e serviços de acordo com a definição da OMS (englobando medicamentos, administração e serviços de prevenção em âmbito coletivo) e 3) inclusão exclusivamente de serviços ambulatoriais de acordo com a OCDE. Os gastos em APS como percentual do gasto corrente em saúde (GCS) em 2017, de acordo com os métodos propostos pela OMS e pela OCDE, foram: 43,6% vs. 15,1% no México; 41,1 vs. 5,75% na República Dominicana; e 31,4% vs. 5,7% na Costa Rica. A definição ampla de APS como primeiro contato proposta pela OMS permite incluir os diferentes arranjos de atenção existentes nos países. No entanto, as categorias deveriam ser mais bem detalhadas para facilitar a comparação internacional. Por outro lado, a proposta da OECD restringe a APS aos prestadores de serviços ambulatoriais, o que limita muito a medição e exclui intervenções próprias do conceito de APS, como serviços de prevenção no âmbito coletivo. Numa etapa de transição, recomenda-se aos países monitorar o financiamento da APS, explicitando os itens incluídos na definição empregada. A metodologia SHA 2011 possibilita identificar e comparar essas diferenças.

Gasto em atenção primária à saúde nas Américas: medir o que importa / Primary health care expenditure in the Americas: measuring what matters / Gasto en atención primaria en salud en las Américas: medir lo que importa

RESUMO Este informe especial apresenta uma comparação entre a medida do gasto em atenção primária à saúde (APS) conforme as propostas da Organização para a Cooperação e o Desenvolvimento Econômico (OCDE) e da Organização Mundial da Saúde (OMS), usando a metodologia mundialmente aceita para reportar gastos em saúde - o System of Health Accounts (SHA 2011) - em três países da Região das Américas. Observam-se divergências conceituais entre os métodos: 1) operacionalização do conceito como atenção básica pela OCDE ou primeiro contato pela OMS; 2) maior abrangência de bens e serviços de acordo com a definição da OMS (englobando medicamentos, administração e serviços de prevenção em âmbito coletivo) e 3) inclusão exclusivamente de serviços ambulatoriais de acordo com a OCDE. Os gastos em APS como percentual do gasto corrente em saúde (GCS) em 2017, de acordo com os métodos propostos pela OMS e pela OCDE, foram: 43,6% vs. 15,1% no México; 41,1 vs. 5,75% na República Dominicana; e 31,4% vs. 5,7% na Costa Rica. A definição ampla de APS como primeiro contato proposta pela OMS permite incluir os diferentes arranjos de atenção existentes nos países. No entanto, as categorias deveriam ser mais bem detalhadas para facilitar a comparação internacional. Por outro lado, a proposta da OECD restringe a APS aos prestadores de serviços ambulatoriais, o que limita muito a medição e exclui intervenções próprias do conceito de APS, como serviços de prevenção no âmbito coletivo. Numa etapa de transição, recomenda-se aos países monitorar o financiamento da APS, explicitando os itens incluídos na definição empregada. A metodologia SHA 2011 possibilita identificar e comparar essas diferenças.

ABSTRACT This special report compares the measurement of primary health care (PHC) expenditure proposed by the Organization for Economic Cooperation and Development (OECD) and by the World Health Organization (WHO), according to the global framework for reporting health expenditures (SHA 2011) in three countries in the Region of the Americas. There are conceptual differences: 1) operationalization as basic care, by OECD, versus first contact, by WHO; 2) a wider range of goods and services in the WHO definition (including medicines, administration, and collective preventive services); and 3) consideration only of services in outpatient providers by OECD. PHC expenditures as a percentage of current healthcare spending in 2017 for WHO and OECD: Mexico (43.6% vs. 15.1%); Dominican Republic (41.1% vs. 5.75%), and Costa Rica (31.4% vs. 5.7%). The broad WHO definition of PHC as first contact facilitates inclusion of services that reflect the way countries provide care to their populations. Even so, WHO could improve its category descriptions for the purposes of international comparison. Restricting PHC to outpatient providers (as the OECD does) greatly limits measurement and excludes interventions intrinsic to the concept of PHC, such as collective preventive services. As a transitional step, we recommend that countries should monitor PHC funding and should explain what they include in their definition. SHA 2011 makes it possible to identify and compare these differences.

RESUMEN En este informe especial se compara la medición del gasto en atención primaria en salud (APS) propuesta por la Organización para la Cooperación y el Desarrollo Económico (OCDE) y la Organización Mundial de la Salud (OMS) según el marco mundial para reportar gastos en salud (SHA 2011) en tres países de la región de las Américas. Hay divergencias conceptuales: 1) la operacionalización como atención básica, por OCDE, o primer contacto, por OMS; 2) la mayor amplitud de bienes y servicios en la definición de OMS (incluye medicamentos, administración y servicios preventivos colectivos); 3) la consideración únicamente de servicios en proveedores ambulatorios en OCDE. Los gastos en APS como el porcentaje del gasto corriente en salud (GCS) en 2017 para OMS y OCDE, serían: México (43,6% vs 15.1%); República Dominicana (41,1 vs 5,75%) y Costa Rica (31,4% vs 5,7%). La definición amplia de APS como primer contacto de OMS facilita la inclusión de servicios que reflejan la forma en que los países ofrecen atención a su población. Aun así, la OMS podría mejorar las descripciones de las categorías incluidas para fines de comparación internacional. Restringir la APS a proveedores ambulatorios como hace OCDE limita mucho la medición y excluye intervenciones intrínsecas al concepto de APS, como servicios colectivos de prevención. Como paso transitorio se recomienda a los países que monitoreen el financiamiento de la APS, explicitando qué incluyen en su definición. El SHA 2011 permite identificar y comparar estas diferencias.