COVID-19: Reducing the risk via diet and lifestyle / 中西医结合学报

This review shows that relatively simple changes to diet and lifestyle can significantly, and rapidly, reduce the risks associated with coronavirus disease 2019 (COVID-19) in terms of infection risk, severity of disease, and even disease-related mortality. A wide range of interventions including regular exercise, adequate sleep, plant-based diets, maintenance of healthy weight, dietary supplementation, and time in nature have each been shown to have beneficial effects for supporting more positive health outcomes with COVID-19, in addition to promoting better overall health. This paper brings together literature from these areas and presents the argument that non-pharmaceutical approaches should not be overlooked in our response to COVID-19. It is noted that, in several cases, interventions discussed result in risk reductions equivalent to, or even greater than, those associated with currently available vaccines. Where the balance of evidence suggests benefits, and the risk is minimal to none, it is suggested that communicating the power of individual actions to the public becomes morally imperative. Further, many lives could be saved, and many harms from the vaccine mandates avoided, if we were willing to embrace this lifestyle-centred approach in our efforts to deal with COVID-19.

Application of Sendai Framework for Disaster Risk Reduction in Food Security During Flood Disaster in Malaysia: A Narrative Review

@#Disaster risk reduction (DRR) plays essential roles in ensuring food security to avoid adverse social, economic and financial implications to the disaster victims. This article aims to review existing DRR strategies in food security during flood disasters and recommend strategies that can be adapted into policies in Malaysia according to the Sendai Framework. Sendai Framework provides comprehensive, globally recognized priority themes in DRR while highlighting governmental and stakeholders’ responsibility. A literature review was carried out by searching available published literatures from online databases and selected information used in this review is taken from articles, journals, reports, national reports, news, and thesis regarding the topic from November 2021 to January 2022. This review revealed that DRR strategies of food security during flood disasters in Malaysia lack one out of 14 work areas in four priorities in the Sendai Framework, which is the national-level risk and vulnerability assessment system and tools. This article proposed 19 recommendations to improve eight work areas across all four priority areas to enhance national food security during flood disasters.

Interpretations of the NCCN guidelines for breast cancer risk reduction (version 2023) / 中国胸心血管外科临床杂志

@#Breast cancer, the most common malignancy in the world, also causes the most death cases of women among malignancies. Breast cancer risk reduction guidelines (version 2023) was updated by National Comprehensive Cancer Network (NCCN). Based on high-level evidences from evidence-based medicine and the latest research progress, the guidelines provided standardized guidance for breast cancer risk assessment and risk reduction strategies for individuals without a history of invasive breast cancer or ductal carcinoma in situ, which has attracted widespread attention from clinicians worldwide. Breast cancer is also the most common malignancy in Chinese women, and the number of newly diagnosed breast cancer cases each year in China ranks first in the world due to the large population, so the breast cancer prevention has become a major public health challenge in China. Aimed to provide reference for breast cancer prevention in China, this article interpreted the guidelines (the new version) based on the characteristics of breast structure in Asian women and the epidemiological characteristics of breast cancer in China.

Jerarquización de zonas de atención prioritaria para la minimización del riesgo biológico en situación de crisis / Ordering areas for priority public health interventions during infectious disease outbreaks

RESUMEN Objetivo Proponer una herramienta para identificar sectores de población que requieren mayor atención por parte de autoridades locales o gubernamentales en situaciones de crisis biológica, considerando los factores que influyen en la adherencia a las normas de minimización de riesgos. Metodología Se implementó un algoritmo de ordenamiento, tomando como referencia las restricciones de julio del 2021 en Ecuador. El contexto del estudio se resume en siete sectores urbanos de la ciudad de Guayaquil, con una población caracterizada por un nivel de educación promedio por debajo de la educación secundaria superior (70%) y más del 50% entre 20-34 años, con alguna ocupación en el medio de una economía popular debilitada. Siete factores de riesgo fueron identificados después de un análisis estructural de la hipótesis de adherencia (x2/gl=3,6; CFI≥0,91; TLI≥0,90; RMSEA≤0,05), basado en una muestra aleatoria de n=515 adultos viviendo en las áreas afectadas. Resultados El seguimiento de las normas está influenciado por la percepción del clima de seguridad, el riesgo percibido y el entendimiento del riesgo. El umbral de ordenamiento (h) permite establecer relaciones unidireccionales entre variables. Conclusiones Los resultados muestran que Vergeles, Norte y Fertisa representan los sectores con mayor prioridad de atención en materia de salud pública {A4,A5,A6}>{A2}>{A3}>{A1}>{A7}. Se requiere identificar más factores para garantizar una diferenciación óptima.

ABSTRACT Objective To propose a tool to identify local communities that require public health work priority, taking into account factors that influence adherence to risk minimization guidelines, especially in lock-down environments and unconventional workplaces. Methodology An ordering algorithm, based on the theory of uncertainty, was applied to classify population zones exhibiting high levels of infection and non-compliance with regulations in Guayaquil, during the last 'weekend' lockdown episode in July 2021. Seven urban sectors showed the highest number of infections (more than 70% of the local population): Vergeles (A1), Samanes (A2), Socio Vivienda (A3), Guasmo Norte (A4), Fertisa (A5), Alborada (A6), Urdesa (A7). Seven risk factors were identified after a path analysis of compliance hypothesis (x2/gl=3,6; CFI≥0,91; TLI≥0,90, RMSEA≤0,05), based on a random sample of n=515 adults living in the affected areas. Results Adherence to norms is influenced by the safety climate, perceived risk and risk understanding. The ordering threshold (h) leaded unidirectional relationships between variables. Conclusions: Adding more factors are believed to increases the differentiation path. The results showed that Vergeles, Norte and Fertisa were the areas with the highest priority for public health care {A4,A5,A6}>{A2}>{A3}>{A1}>{A7}.

Produzindo dados e operando sistemas: o trabalhador do SUAS diante dos desastres socioambientais / Producing data and operating systems: the social worker in the face of socio-environmental disasters

Resumo: O artigo analisa os impactos socioterritoriais provocados por desastres com barragens à luz da Vigilância Socioassistencial. Adotou-se o método qualitativo, por meio de análise documental e técnica, de cidades impactadas por desastres com barragens de mineradoras em Minas Gerais (Brasil). Concluiu-se que as condições objetivas de respostas no campo da Assistência Social estão aquém dos preceitos internacionais de Gestão Integral de Riscos e de Desastres (GIRD), destacando foco para o aprimoramento específico para uma gestão planejada e compartilhada de Redução de Riscos de Desastres (RRD).

Abstract: The article analyzes the socio-territorial impacts caused by disasters with dams in the light of Social Assistance Surveillance. We adopted the qualitative method based on documental and technical analysis of cities impacted by disasters with mining dams in Minas Gerais/BR. We concluded that the objective conditions of answers in the field of Social Assistance fall short of the international precepts of Disaster Risk Management (DRM), highlighting a focus for specific improvement for a planned and shared management of Disaster Risk Reduction (DRR).

Al margen de los cuidados: experiencias de (des)protección sociosanitaria de trabajadoras del sexo en Oporto, Portugal / On the margins of care: sex workers' experiences of health and social (non-)protection in Oporto, Portugal

RESUMEN Teniendo en cuenta las marginaciones que recaen sobre la prostitución, analizamos los retos sociales y sanitarios que subyacen al ejercicio del trabajo sexual y la intervención realizada en este ámbito. Partimos de las experiencias y entendimientos de trabajadoras sexuales que ejercen su actividad en la ciudad de Oporto (Portugal), en un intento de comprender cuáles son las principales vulnerabilidades a las que se enfrentan y cómo viven la relación con los servicios del Estado y con la intervención sociosanitaria dirigida a ellas. La investigación de campo siguió un enfoque cualitativo basado en un estudio de caso de un proyecto de intervención. La recolección de datos se llevó a cabo, entre los meses de marzo y junio de 2019, mediante investigación documental, ejercicios de observación participante y entrevistas semiestructuradas al personal técnico y a seis trabajadoras sexuales. Como resultado de esta investigación, se ha constatado que las trabajadoras del sexo están sometidas a graves restricciones que limitan su recurso a las redes de apoyo informales y su acceso a los dispositivos de protección del Estado en términos de apoyo social y atención sanitaria. Es más, el proyecto de intervención de reducción de riesgos que apoya a estas mujeres, aunque valorado, asume un fuerte sesgo de prevención epidemiológica y favorece un enfoque individualista y asistencialista, dejando al descubierto otras vulnerabilidades sociales identificadas por ellas mismas.

ABSTRACT This article analyzes the social and health challenges linked to sex work and the interventions carried out within this arena, taking into consideration the ways in which prostitution is socially marginalized. Basing our analysis on the experiences and understandings of sex workers practicing in the city of Oporto (Portugal), we attempt to understand the main forms of vulnerability faced by this group, along with the ways in which they experience the relationship with State services and social and health interventions that target them. Qualitative field research was conducted involving a case study of an intervention project. Data collection was carried out from March to June 2019, and included documentary research, participant observation, and semi-structured interviews with project staff and six sex workers. Among the results of our study, we found that sex workers are subject to severe constraints, limiting their use of informal support networks and their access to State social protection and healthcare services. Moreover, although the intervention project based on harm reduction intended to support these women and was indeed valued, it had a strong epidemiological prevention bias favoring an individualistic and assistentialist approach, while failing to address other social vulnerabilities identified by the women themselves.

Mining dams disasters as systemic risks / Desastres em barragens de mineração como riscos sistêmicos

ABSTRACT: Between 2015 and 2019, Brazil recorded the two most serious disasters involving mining dams of the 21st century. The purpose of this article is to offer an understanding of these disasters as systemic risks. They involve from global and national processes related to social determinants that materialize in a complex system of dams distributed throughout the country with their intrinsic risks. When they occur, result in a set of impacts with potential damage and immediate effects combined with secondary and tertiary impacts that can trigger chain reactions, which promote risk factors of heterogeneous and complex occurrence. Approaching these events from the point of view of systemic risk allows for a broader understanding of both the singularity of each of these disasters and their multiple exposure, risk and disease processes, as well as the structural characteristics in which social, political processes and dynamics and economic factors reproduce in multiple territories a common pattern of disasters and their effects. We conclude that the promotion of population health and sustainable territories should guide the organization of production processes and not the opposite, with the externalization of human, environmental and social costs of mining and its disasters.

RESUMO: Entre 2015 e 2019, o Brasil registrou os dois mais graves desastres envolvendo barragens de mineração do século XXI. O objetivo deste artigo é oferecer a compreensão desses desastres como riscos sistêmicos, que envolvem desde processos globais e nacionais relacionados aos determinantes sociais que se concretizam em um complexo sistema de barragens distribuídas pelo País com seus riscos intrínsecos. Quando ocorrem, resultam em um conjunto de impactos com potencial de danos e efeitos imediatos combinados com impactos secundários e terciários que podem desencadear reações em cadeia, promovendo fatores de riscos de ocorrência heterogênea e complexa. Abordar esses eventos com base no conceito de risco sistêmico permite uma compreensão mais ampla tanto da singularidade de cada um desses desastres e seus múltiplos processos de exposição, riscos e doenças, como também das características estruturais com que os processos e dinâmicas sociais, políticas e econômicas reproduzem, em múltiplos territórios, um padrão comum de desastres e seus efeitos. Concluímos que a promoção da saúde da população e de territórios sustentáveis deve orientar a organização dos processos produtivos e não o contrário, com a externalização dos custos humanos, ambientais e sociais da mineração e seus desastres.

Morfología inusual de raíz y canales del primer molar mandibular, como indicación de tomografía computarizada de haz cónico: A propósito de un caso endodóntico "fronterizo"

Resumen La Tomografía Computarizada de Haz Cónico (CBCT) representa una promisoria herramienta para la clínica odontológica. En Endodoncia, CBCT ofrece tridimensionalidad y resolución imagenológica, potenciando el diagnóstico de diferentes condiciones patológicas. Sin embargo, su limitación por sobreexposición a radiación, ha llevado a directrices que recomiendan cautela para su indicación. Se presenta un caso infrecuente de un molar mandibular con una sola raíz y canal, y las circunstancias de uso de CBCT. Mujer de 48 años es derivada para endodoncia del primer molar mandibular izquierdo permanente. El examen radiográfico preoperatorio demostró el hallazgo inusual de un canal centrado en una única raíz. Con la información apropiada y el consentimiento de la paciente, la indicación de CBCT favoreció su diagnóstico y tratamiento. CBCT no debería ser utilizada rutinariamente para estos fines, pero podría justificarse en casos "fronterizos". Se discuten su indicación e implementación clínica, siguiendo actuales recomendaciones y directrices.

Resumo A tomografia computadorizada de feixe cônico (TCFC) representa uma ferramenta promissora para a clínica odontológica. Na Endodontia, a CBCT oferece tridimensionalidade e resolução de imagem, potencializando o diagnóstico de diferentes condições patológicas. No entanto, sua limitação devido à superexposição à radiação levou a diretrizes que recomendam cautela em sua indicação. Um caso raro de um molar inferior com uma única raiz e canal é apresentado e as circunstâncias do uso da TCFC. Uma mulher de 48 anos é encaminhada para tratamento de canal para o primeiro molar inferior esquerdo permanente. O exame radiográfico pré-operatório demonstrou o achado incomum de um canal centrado em uma única raiz. Com as devidas informações e o consentimento do paciente, a indicação da TCFC favoreceu seu diagnóstico e tratamento. A CBCT não deve ser usada rotineiramente para esses fins, mas pode ser justificada em casos "fronteiriços". Sua indicação e implementação clínica são discutidas, seguindo as recomendações e diretrizes atuais.

Abstract Cone-beam computed tomography (CBCT) is a promising tool in dental practice. CBCT provides three-dimensional images and imaging resolution to be used in endodontics. This enhances the diagnosis of various pathologies. However, guidelines have recommended limiting its use due to overexposure to radiation. This article presents the rare case of a mandibular molar with a single root and canal that benefited from taking a CBCT. A 48-year-old woman is referred for endodontic treatment of the permanent left mandibular first molar. The preoperative radiographic examination showed an unusual canal centered along a single root. Taking a CBCT with the relevant information and the patient's consent improved her diagnosis and treatment. CBCTs should not be used routinely for these purposes but could be justified in "borderline" cases. This paper discusses its indication and clinical implementation following current recommendations and guidelines.

Reducing alcohol-related risks among adolescents: a feasibility study of the SHAHRP program in Brazilian schools / Redução de riscos relacionados ao uso de álcool entre adolescentes: um estudo de viabilidade do programa SHAHRP em escolas brasileiras

Abstract The SHAHRP program was effective reducing drinking and alcohol - harms in Australia, but cross-cultural adaptation is required before replication. This study aimed at assessing the feasibility of SHAHRP in Brazil focused on implementation and acceptability. A mixed-methodsdesign was used: quantitative for implementing the program and evaluation and qualitative for acceptability. The quantitative design was a pilot of a randomized controlled trial. Private schools were randomly divided into four intervention (n=160) and four control (n=188) schools. Student's mean age was 12.7 years. The fidelity of implementation and likely outcome measures were assessed. Qualitative data on acceptability were provided by students and teachers. The percentage of implementation varied from 62.5% to 87.5%. Behaviours such as alcohol-harms requires a larger cohort and longer follow-up to be adequately evaluated. The risk reduction approach and activities had good acceptability from students and teachers. Quantitative and qualitative outcomes on knowledge and decision-making indicated possible improvement in SHAHRP schools. The program is feasible and well accepted in a Brazilian setting, opening the way for a more comprehensive evaluation and dissemination.

Resumo O programa SHAHRP foi eficaz na Austrália, mas precisa de adaptação transcultural para replicação em outro país. Este estudo teve como objetivo avaliar a viabilidade do SHAHRP no Brasil com base na sua implementação e aceitação. Utilizou-se métodos mistos: quantitativo para a implementação do programa e da avaliação e qualitativo para aceitação. O desenho quantitativo foi o piloto de um estudo clínico randomizado. Participaram escolas particulares: quatro intervenções (n = 160) e quatro controles (n = 188). Os alunos tinham 12,7 anos em média. A fidelidade da implementação e possíveis medidas de resultados foram avaliadas. Os dados qualitativos sobre aceitação foram relatados por alunos e professores. A fidelidade de implementação variou de 62,5% a 87,5%. Comportamentos como danos causados ​​pelo uso de álcool precisam de uma amostra maior e de mais tempo para avaliação. A abordagem de redução de riscos e as atividades do programa foram bem aceitas por alunos e professores. Os resultados quantitativos e qualitativos sobre conhecimento e tomada de decisão indicaram possível melhora nas escolas-intervenção. O programa é viável e bem aceito no cenário brasileiro, abrindo caminho para avaliação e disseminação mais abrangentes.

Multilevel elements associated with HIV serosorting for sexual encounters: a scoping literature review / Elementos multinivel asociados a seroclasificación por VIH en encuentros sexuales: revisión de alcance de la literatura

Abstract A scoping literature review to identify the multilevel HIV serosorting related elements was developed. Articles from EBSCO, PubMed, PsyNET and Science Direct with serosort* or serosorting at the tittle or abstract, written in English or Spanish were included. No restriction in type of population or design were applied. 239 records were retrieved after duplicates removed, but 181 references were extracted for full-text review. Individual level: HIV knowledge, serostatus, risk perceptions, abilities to disclose and for condom use negotiation, motivations, use of drugs, stigma, attitudes toward condom use, and perceptions/beliefs about the HIV and related treatments, HIV infection rates/testing and behavioral factors. Interpersonal level: social networks, abilities (sexual behavior negotiation, and communication). Community level: stigma, social norms, access to HIV related services. Structural level: political context, HIV related funding and public policies. HIV Serosorting is not solely an interpersonal behavior it involves multilevel elements that must be acknowledged by professionals and stakeholders.

Resumen Se desarrolló una revisión de alcance de la literatura para identificar elementos multinivel relacionados a la seroclasificación de VIH. Se incluyeron artículos de EBSCO, PubMed y Science Direct con serosort* o serosorting en título o resumen, escritos en Inglés o Español. No se aplicaron restricciones por tipo de población y diseño. Después de remover duplicados, se recuperaron 239 records, solo 181 referencias se extrajeron para revisión a texto completo. Nivel individual: Conocimiento del VIH, seroestado, percepciones de riesgo, habilidades para develar el seroestado y negociar el condón, motivaciones, uso de drogas, estigma, actitudes sobre uso del condón, y percepciones/ creencias acerca del VIH y tratamientos, tasas de infección y tamizaje de VIH, factores conductuales. Nivel interpersonal: redes sociales, habilidades (negociación de la conducta sexual, y comunicación). Nivel comunitario: Estigma, normas sociales, acceso a servicios de VIH. Nivel estructural: contexto político, políticas públicas y financiamiento relacionado al VIH. La seroclasificación de VIH no es solamente una conducta interpersonal, incluye elementos multinivel que deben ser reconocidos por los profesionales de salud y tomadores de decisiones.

Practical exploration of constructing a new system of medical risk prevention and control based on the integration of medical and law / 中华医院管理杂志

Peking Union Medical College Hospital has carried out the practical exploration of a new system of medical risk prevention and control based on the integration of medical and law, broken the traditional practice of legal counsel only handling medical disputes after the event, explored the pre-management and control mode of medical risks. The hospital established a whole process medical risk management mode in which legal counsel, medical administrators and clinical medical staff cooperated and participated, further standardized the medical behavior, legal concept and legal practice awareness of medical personnel, realized standardized management and formed a long-term mechanism. It could not only effectively integrate the fragmented clinical legal service needs and extensively enhance the sense of occupational security of clinical medical staff, but also effectively improve the operation quality of medical safety indicators and promote the high-quality development of the hospital.

Hereditary breast cancer ­ what we have learned in the last decade

This literature review aims to inform and assist physicians and other health professionals in managing all information related to hereditary breast cancer, which is in constant and rapid growth, allowing for improvement in patient care and assistance. In addition, we seek to better identify which patients are eligible for the clinical criteria of association with risk of hereditary breast cancer, based on international recommendations and highlighting the main high and moderate penetrance genes that make up the multigenic panels for germline investigation in breast cancer, as well as the possibilities of clinical management that must be considered when complex decisions are required in clinical practice. Nowadays, there is more interest in population screening, in a greater supply of genetic tests, more genes included in multigene panels ­ allowing the search for genetic counseling ­, apart from the need for clinical-decision support.

Roles for community health workers in diabetes prevention and management in low- and middle-income countries / O papel dos agentes comunitários de saúde na prevenção e manejo do diabetes em países de renda baixa e média / Roles de trabajadores comunitarios en salud para la prevención y gestión de la diabetes en países con medios y bajos ingresos

Diabetes prevalence is increasing worldwide, especially in low- and middle-income countries (LMIC), posing the need for improved detection and management strategies. Chronic disease models and lifestyle medicine provide structures for action. Community health workers (CHWs) can significantly contribute to chronic disease care if they are trained and integrated into low-resource health systems. Although most current CHWs worldwide are performing maternal/child health and infectious disease-related tasks, other programs involving CHWs for noncommunicable disease prevention and management are increasing. In this article, we discuss the advantages, challenges, and questions regarding possible roles assigned to CHWs in the prevention and management of diabetes. These roles include performing simple screening tests, implementing lifestyle/behavioral interventions, and connecting patients with alternatives to biomedicine. Specifically, CHWs can aid diabetes epidemiological surveillance by conducting risk score-based screening or capillary glucose testing, and they can facilitate diabetes self-management by delivering interventions described in the transcultural diabetes nutrition algorithm. Furthermore, while this role has not formally been assigned, CHWs can leverage their intimate knowledge of local practices to provide decision-making support to patients in environments with pluralistic health systems. Ethnocultural differences in CHW functions and transcultural adaptations of their roles in diabetes care should also be considered. In summary, CHWs can improve diabetes care by screening high-risk individuals and implementing lifestyle interventions, especially in LMIC.

A prevalência do diabetes está aumentando em nível global, sobretudo nos países de renda baixa e média, o que exige melhor detecção e manejo da doença. O modelo de doenças crônicas e a medicina de estilo de vida fornecem estruturas para a ação nesse sentido. Os agentes comunitários de saúde (ACS) podem contribuir de maneira significativa para a assistência às doenças crônicas, desde que sejam capacitados e integrados aos sistemas de saúde, que dispõem de recursos limitados. Embora a maioria dos ACS no mundo esteja desempenhando tarefas relacionadas à saúde materno-infantil e doenças infecciosas, estão crescendo outros programas que envolvem a prevenção e manejo das doenças não transmissíveis. O artigo discute as vantagens, desafios e questões relacionados aos possíveis papéis definidos para os ACS na prevenção e manejo do diabetes. Esses papéis incluem testes simples de triagem, implementação de intervenções comportamentais e de estilo de vida e recomendação de alternativas à biomedicina para os pacientes. Especificamente, os ACS podem auxiliar na vigilância epidemiológica do diabetes, realizando triagem baseada em pontuação de risco ou testagem de glicemia capilar, e podem facilitar o auto-manejo do diabetes através de intervenções baseadas no algoritmo nutricional transcultural do diabetes. Além disso, embora o papel não tenha sido definido formalmente, os ACS podem alavancar seu conhecimento íntimo das práticas locais para apoiar decisões pelos pacientes em contextos com sistemas de saúde pluralistas. Devem ser consideradas as diferenças etnoculturais nas funções dos ACS e nas adaptações transculturais de seus papéis durante a assistência ao diabetes. Em resumo, os ACS podem melhorar a assistência ao diabetes através da triagem e da implementação oportuna de intervenções de estilo de vida, principalmente nos países de renda baixa e média.

La prevalencia de diabetes está aumentando en todo el mundo, especialmente en los países de bajos y medios ingresos (LMIC por sus siglas en inglés), imponiendo la necesidad de una detección y gestión mejoradas. Un modelo de enfermedad crónica y la medicina del estilo de vida proporcionan estructuras para la acción. Los trabajadores comunitarios de salud (CHWs por sus siglas en inglés) pueden contribuir significativamente al cuidado de la enfermedad crónica, si son entrenados e integrados en sistemas con pocos recursos de salud. A pesar de que la mayoría de los actuales CHWs en todo el mundo están desarrollando tareas relacionadas con enfermedades infecciosas en la salud maternal/infantil, otros programas que implican a los CHWs para la prevención y gestión de enfermedades no comunicables están aumentando. En este artículo, discutimos las ventajas, desafíos, y preguntas respecto a los posibles roles asignados a los CHWs, en la prevención y gestión de la diabetes. Estos roles incluyen realizar simples pruebas de detección, implementando intervenciones de estilo de vida/comportamentales, y conectando pacientes con alternativas a la biomedicina. Específicamente, los CHWs pueden ayudar en la vigilancia epidemiológica de la diabetes, llevando a cabo pruebas de detección basadas en marcadores de riesgo o pruebas de glucosa capilares, y pueden facilitar el autocontrol de la diabetes proporcionando intervenciones descritas en el algoritmo transcultural de nutrición en diabetes. Asimismo, mientras este rol no se les haya asignado formalmente, los CHWs pueden potenciar su conocimiento profundo de prácticas locales para proporcionar apoyo en la toma de decisiones a pacientes en entornos con sistemas de salud plurales. Las diferencias etnoculturales en las funciones de los CHW y las adaptaciones transculturales de sus papeles en el cuidado de la diabetes deberían también ser consideradas. En resumen, los CHWs pueden mejorar el cuidado de la diabetes detectando e implementando oportunamente las intervenciones de estilo de vida, especialmente en LMIC.

Salpingectomía oportunista: patrones de práctica en un grupo de ginecólogos colombianos / Opportunistic Salpingectomy: patterns of practice in a group of colombian gynecologists

INTRODUCCIÓN Y OBJETIVOS: El cáncer de ovario es la neoplasia de origen ginecológico más letal y el 90% de los casos son de origen epitelial. Se ha postulado el origen del cáncer epitelial de ovario (CEO) en las fimbrias de las trompas de Falopio, por lo cual, se ha sugerido la realización de la salpingectomía oportunista como método de prevención primaria. La presente investigación tiene como objetivo determinar la frecuencia con que los ginecólogos adscritos a la Federación Colombiana de Ginecología y Obstetricia (FECOLSOG) incluyeron salpingectomías oportunistas en su práctica clínica durante los años 2017-2018. MÉTODOS: Se realizó una encuesta a los ginecólogos adscritos a la FECOLSOG. Las variables analizadas incluyeron características demográficas, práctica profesional, método de prevención primaria de cáncer de ovario en pacientes de bajo riesgo y la realización o no de la salpingectomía oportunista y sus respectivas razones. Las variables cualitativas se analizaron con frecuencias absolutas y relativas, mientras que las cuantitativas con medidas de tendencia central y desviaciones estándar con el software STATA 13. RESULTADOS: De 1765 ginecólogos contactados, 353 contestaron la encuesta (tasa de respuesta del 20%). El 62.5% de estos realizan salpingectomía oportunista en su práctica ginecológica y de estos, el 75.2% lo hizo para prevenir cáncer de ovario. Entre las razones manifestadas por los especialistas para no realizar salpingectomía oportunista, el 12.5% no la consideraba un factor de protección frente al cáncer de ovario y un 14.4% consideraba que incrementaba el riesgo de falla ovárica temprana y morbilidad asociada. CONCLUSIÓN: Aunque existen controversias en su realización, la salpingectomía oportunista muestra ser una conducta adoptada por ginecólogos adscritos a FECOLSOG. Se requieren investigaciones futuras para determinar la efectividad de la salpingectomía e implementar estrategias de prevención del cáncer epitelial de ovario.

INTRODUCTION AND OBJECTIVES: Ovarian cancer is the most lethal gynecological malignancy and 90% of cases are of epithelial origin. Recently, different investigations attribute their origin to the fimbriae of the fallopian tubes, reason why it has been suggested to perform elective salpingectomy for the prevention of high-grade adenocarcinoma, its most frequent histological variant. This research aims to determine the frequency with which gynecologists from the Colombian Federation of Gynecology and Obstetrics (FECOLSOG) included this procedure in their clinical practice during the years 2017-2018. METHODS: A survey was sent electronically to the gynecologists assigned to FECOLSOG on three different occasions with an interval of 15 days between them. The variables analyzed included demographic characteristics, professional practice, primary prevention method of Ovarian Cancer in low-risk patients and the performance or not of elective salpingectomy with their respective reasons. Qualitative variables were analyzed with absolute and relative frequencies, while quantitative variables with measures of central tendency and standard deviations with STATA 13 software. RESULTS: From 1765 gynecologists contacted at least once via email, 353 answered the survey, indicating a response rate of 20%. 62.5% perform elective salpingectomy in their gynecological practice and of these, 75.2% do so to prevent ovarian cancer. Among the reasons for not practicing salpingectomy, 12.5% ​​do not consider it a protective factor for ovarian cancer, and 14.4% believe that it increases the risk of early ovarian failure and morbidity. CONCLUSION: Elective salpingectomy is a promising procedure as a preventive measure against epithelial ovarian cancer. Although there are controversies regarding its performance, salpingectomy seems to be a common practice amongst gynecologists from FECOLSOG, and seems to have higher recurrence within this field. Future research is required to determine the effectiveness of salpingectomy and thus, implement the best strategies for ovarian cancer prevention.

Análise da percepção de risco dos estudantes participantes do Projeto Agente Mirim de Defesa Civil / Risk perception analysis of students participating in the Junior Civil Defense Agent

Atualmente, a Defesa Civil (DC) de Blumenau, em Santa Catarina, na Bacia Hidrográfica do Rio Itajaí (BHRI) realiza ações de educação ambiental para Gestão de Risco de Desastres (GRD) por meio de projetos, dentre eles o Agente Mirim de Defesa Civil (AMDC). O objetivo dessa pesquisa foi analisar como o projeto AMDCsubsidia a implementação da Lei Federal no. 12.608/2012, por meio da análise da percepção de risco dos estudantes durante sua participação. Para isso, foram utilizadas cinco ferramentas aplicadas em sete momentos no decorrer do ano letivo de 2016. Os resultados revelam que os estudantes ao ingressarem no projeto, trazem consigo conceitos básicos sobre ações de defesa civil e constroem novos conhecimentos sobre riscos de desastres. Conclui-se que as práticas educativas empregadas no projeto AMDC possibilitam a construção de conhecimentos, procedimentos e atitudes, capacitando os estudantes nos processos de prevenção, mitigação e preparação frentes aos riscos de desastres conforme enfatizado pela Lei Federal no. 12.608/2012.

Currently the Civil Defense (CD) of Blumenau, Santa Catarina, in the Itajaíriver basin conducts environmental education actions for Disaster Risk Management (DRM) through projects, among them the "Junior Civil Defense Agent" (JCDA). The objective of this research was to analyze how the JCDA project subsidizes the implementation of Federal Law nº. 12.608/2012, by analyzing the students' perception of risk during their participation. To this end, five tools were applied at seven times during the 2016 school year. The results show that students entering the project bring with them basic concepts about civil defense actions and build new knowledge about disaster risks. It is concluded that the educational practices employed in the JCDA project enable the construction of knowledge, procedures and attitudes, enabling students in disaster prevention, mitigation and preparedness processes as emphasized by Federal Law nº. 12.608/2012.

Non-haemorrhagic causes of obstetrical intensive care unit admissions in tertiary care setting

Background: Management of critically ill obstetric patients involve intensive monitoring in intensive care unit. In present scenario there are significant number of obstetric patients with sepsis, tropical diseases and medical illness that require ICU care. The aim of this study was to evaluate in more detail the non-haemorrhagic causes of obstetric ICU admissions and to identify and adopt high risk strategies as prime learning objective.Methods: It is a prospective ongoing study conducted in 50 patients in SGRDUHS, Amritsar from December 2016 to October 2019, who were admitted in obstetric ICU, out of them 30 cases were attributed to non-haemorrhagic obstetric causes. All demographic parameters along with gestational age, diagnosis on admission, intervention done prior to shift to ICU and details of treatment given in ICU were evaluated. Patient outcome, review of mortality and area of improvement were also noted.Results: Majority of the patient (70.1%) were admitted in 3rd trimester. Obstetric sepsis (13.33%), infective diseases (16.66%), tropical conditions (16.66%), medical disorders (26.66%) and hypertensive disorders (26.66%) were the major causes of admission to obstetric ICU. There were 33.3% mortalities observed in present study and 40% were due to respiratory failure. In ICU mechanical ventilation was done in 63.3% cases and blood products were given in 33.3% of patients.Conclusions: A multidisciplinary approach is ideal to handle non-haemorrhagic situations especially related to medical disorders and tropical diseases. Review of the ICU admissions and periodic audit can improve management of morbidities as well as reduce maternal mortalities.

Mastectomía de reducción de riesgo: Experiencia del Centro Mamario del Hospital Universitario Austral / Risk reducing-mastectomy: Experience of the Hospital Universitario Austral Breast Center

Antecedentes: dada la mayor disponibilidad de estudios genéticos, en los últimos años se incrementaron significativamente las mastectomías de reducción de riesgo (MRR). Objetivo: analizar la experiencia institucional en MRR. Material y métodos: se tuvieron en cuenta las pacientes sanas sometidas a MRR bilateral simultánea y también las pacientes con antecedentes de cáncer de mama que luego fueron sometidas a MRR contralateral. No fueron tenidas en cuenta las mastectomías realizadas como tratamiento actual de un cáncer, pero sí la mastectomía contralateral. Resultados: se realizaron 70 MRR en 49 pacientes que cumplían con los criterios de inclusión para el análisis. La edad promedio fue de 44 años (rango 34-64). En 60 casos se conservó el complejo areola-pezón. En 50 casos, la reconstrucción mamaria fue con implante protésico directo. En 57 pacientes la incisión fue radiada en cuadrante superoexterno. En 57 casos no presentaron complicaciones y, de las restantessolo en 1 (1,4%) se perdió el implante. En un solo caso se detectó un carcinoma de mama oculto, y, en la evolución, una paciente desarrolló un carcinoma pequeño en la mama operada. Conclusión: la MRR es una alternativa válida y segura en mujeres con alto riesgo de cáncer de mama, pues logra disminuir en forma significativa la probabilidad de padecer la enfermedad, con buenos resultados estéticos y alto nivel de satisfacción.

Background: The number of risk-reducing mastectomies (RRM) has increased over the past years as genetic testing has become more readily available. Objective: The aim of this study was to analyze the experience of our institution with RRM. Material and methods: The analysis included healthy patients undergoing simultaneous bilateral RRM and those with a history of breast cancer who underwent contralateral RRM. Patients with mastectomies performed as treatment of breast cancer were not considered, but those with contralateral mastectomies were included. Results: Seventy RRM were performed in 49 patients who fulfilled the inclusion criteria for the analysis. Mean age was 44 years (range: 34-64). The nipple-areola complex was preserved in 60 cases. In 50 cases, a prosthesis was implanted for breast reconstruction during the same procedure. The breast was approach through a radial incision in the upper outer quadrant in 57 patients. Fifty-seven patients did not present complications, and in the rest of the cases the implant failed in only one (1.4%) case. An occult breast cancer was detected in only one patient. During follow-up, one patient developed a small carcinoma in the operated breast. Conclusion: RRM is a valid and safe option for women at high risk for breast cancer, since it significantly reduces the probability of developing the disease, with good aesthetic results and a high level of patient satisfaction.

La otorrinolaringología y el riesgo de contraer el nuevo coronavirus humano COVID-19 / Otolaryngology and the risk of getting infected with de novel COVID - 19

La pandemia de enfermedad por coronavirus 2019 (COVID-19) ha producido cambios sin precedentes en la comunidad médica. Los médicos y trabajadores de la salud que realizan o participan en exámenes o procedimientos de cabeza y cuello y de la vía aérea son susceptibles en alto riesgo de adquirir la infección por COVID 19 debido a la alta exposición a aerosoles y contaminación por gotas. En la actualidad se carece de datos de riesgo específico de infección. Sin embargo, los otorrinolaringólogos y cirujanos de cabeza y cuello, junto con los oftalmólogos y los odontólogos, son los grupos de mayor riesgo dentro de los profesionales de la salud debido a las áreas que examinan. Este documento se desarrolla con base en pautas encontradas en la literatura disponible más reciente. Es seguro que serán modificadas según la experiencia de cada país.

The 2019 coronavirus disease (COVID-19) pandemic has produced unprecedented changes in the medical community. Physicians and healthcare workers who perform or participate in head and neck and airway examinations and procedures are at high risk of acquiring COVID 19 infection due to high exposure to aerosols and drop contamination. Currently there is not specific infection risk data available. However, otolaryngologists and head and neck surgeons, along with ophthalmologists and dentists, are the highest risk groups within healthcare professionals due to the areas they examine. This document is developed based on guidelines found in the most recent available literature that will most likely be modified according to the experience on the pandemic of each country.

Health belief model for coronavirus infection risk determinants / Modelo de crença em saúde para determinantes de risco para contaminação por coronavírus

ABSTRACT OBJECTIVE To use the advantages of a ratio scale with verbal anchors in order to measure the risk perception in the novel coronavirus infection, which causes covid-19, in a health belief model-based questionnaire, as well as its validity and reproducibility. METHOD We used the health belief model, which explores four dimensions: perceived susceptibility (five questions), perceived severity (five questions), perceived benefits (five questions), and perceived barriers (five questions). Additionally, we included a fifth dimension, called pro-health motivation (four questions). The questions composed an electronic questionnaire disseminated by social networks for an one-week period. Answers were quantitative values of subjective representations, obtained by a psychophysically constructed scale with verbal anchors ratio (CentiMax ® ). Mean time for total filling was 12 minutes (standard deviation = 1.6). RESULTS We obtained 277 complete responses to the form. One was excluded because it belonged to a participant under 18 years old. Reproducibility measures were significant for 22 of the 24 questions in our questionnaire (Cronbach's α = 0.883). Convergent validity was attested by Spearman-Brown's split half reliability coefficient (r = 0.882). Significant differences among groups were more intense in perceived susceptibility and severity dimensions, and less in perceived benefits and barriers. CONCLUSION Our health belief model-based questionnaire using quantitative measures enabled the confirmation of popular beliefs about covid-19 infection risks. The advantage in our approach lays in the possibility of quickly, directly and quantitatively identifying individual belief profiles for each dimension in the questionnaire, serving as a great ally for communication processes and public health education.

RESUMO OBJETIVO Neste estudo buscamos utilizar as vantagens de uma escala de razão por ancoragem verbal para medidas da percepção de risco de contágio pelo novo coronavírus, causador da covid-19, em um questionário baseado no modelo de crença em saúde, assim como avaliar sua validade e reprodutibilidade. MÉTODO Utilizamos o modelo de crença em saúde, o qual explora quatro dimensões: percepção individual de susceptibilidade percebida (cinco questões), severidade percebida (cinco questões), benefícios percebidos (cinco questões) e barreiras percebidas (cinco questões). Adicionalmente, incluímos uma quinta dimensão, a qual denominamos motivação pró-saúde (quatro questões). As questões definiram um questionário eletrônico que foi divulgado por redes sociais pelo período de uma semana. As respostas foram valores quantitativos de representações subjetivas, obtidas por meio de uma escala psicofísica de razão com ancoragem verbal (CentiMax ® ). O tempo médio total de preenchimento foi de 12 minutos (desvio-padrão = 1,6). RESULTADOS Obtivemos 277 respostas completas ao formulário. Uma foi excluída por se tratar de participante com menos de 18 anos de idade. Medidas de reprodutibilidade foram significantes para 22 das 24 questões de nosso questionário (α de Cronbach = 0,883). A validade convergente foi atestada pelo coeficiente de correlação de Spearman-Brown split half (r = 0,882). Diferenças significantes entre grupos foram encontradas mais intensamente nas dimensões susceptibilidade percebida e severidade percebida, e menos intensamente para benefícios percebidos e barreiras percebidas. CONCLUSÃO Nosso questionário baseado no modelo de crença em saúde utilizando medidas quantitativas permitiu evidenciar as crenças populares sobre os riscos de contágio por covid-19. A vantagem de nossa abordagem é a possibilidade de se identificar os perfis de crença individuais para cada dimensão do questionário de forma rápida, direta e quantitativa, podendo ser uma grande aliada em processos de comunicação e educação em saúde pública.