Cumplimiento diario del bundle ABCDEF de liberación de los pacientes de cuidados intensivos: estudio descriptivo retrospectivo / Daily compliance of the ABCDEF liberation bundle for patients in the intensive care unit: A retrospective descriptive study

Introducción La implementación del ABCDEF ha demostrado mejores resultados en los pacientes críticos. El objetivo de este trabajo es identificar el cumplimiento del registro diario del ABCDEF en una unidad de cuidados intensivos chilena. Métodos Estudio observacional retrospectivo de los registros clínicos electrónicos de profesionales de enfermería, kinesiología y medicina que trataron a pacientes mayores de 18 años, hospitalizados en una unidad de cuidados intensivos durante al menos 24 horas, con o sin requerimiento de ventilación mecánica. Se determinó el cumplimiento diario del considerando la presencia del registro en la ficha clínica de cada elemento: evaluación del dolor (elemento A), prueba de interrupción de la sedación (elemento B1) y ventilación espontánea (elemento B2), elección de la sedación (elemento C), evaluación del (elemento D), movilización temprana (elemento E) y empoderamiento de la familia (elemento F). Resultados Se obtuvieron 4165 elementos del registrados provenientes de enfermería (47%), kinesiología (44%) y medicina (7%), incluyendo 1134 días/paciente (133 pacientes). Los elementos E y C mostraron un cumplimiento del 67 y 40%, mientras que D, A, y B2 mostraron 24, 14 y 11%, respectivamente. Para B1 y F se obtuvo 0% de cumplimiento. El cumplimiento fue mayor en los pacientes sin ventilación mecánica para A y E, mientras que para D fue similar. Conclusiones La movilización temprana fue el elemento con mayor cumplimiento, mientras que las pruebas de interrupción de sedación y el empoderamiento de la familia tuvieron incumplimiento absoluto. Futuros estudios deberían explorar las razones que expliquen los diferentes grados de cumplimiento por elemento del en la práctica clínica.

Introduction Implementing the ABCDEF bundle has demonstrated improved outcomes in patients with critical illness. This study aims to describe the daily compliance of the ABCDEF bundle in a Chilean intensive care unit. Methods Retrospective observational study of electronic clinical records of nursing, physiotherapy, and medical professionals who cared for patients over 18 years of age, admitted to an intensive care unit for at least 24 hours, with or without mechanical ventilation. Daily bundle compliance was determined by considering the daily records for each element: Assess pain (element A), both spontaneous awakening trials (element B1) and spontaneous breathing trials (element B2), choice of sedation (element C), delirium assessment (element D), early mobilization (element E), and family engagement (element F). Results 4165 registered bundle elements were obtained from nursing (47%), physiotherapy (44%), and physicians (7%), including 1134 patient/days (from 133 patients). Elements E and C showed 67 and 40% compliance, while D, A, and B2 showed 24, 14 and 11%, respectively. For B1 and F, 0% compliance was achieved. Compliance was higher in patients without mechanical ventilation for A and E, while it was similar for D. Conclusions Early mobilization had the highest compliance, while spontaneous awakening trials and family engagement had absolute non-compliance. Future studies should explore the reasons for the different degrees of compliance per bundle element in clinical practice.

Impacto de la implementación de la estrategia multimodal de la OMS para mejorar la higiene de manos en una Unidad de Cuidados Intensivos / Impact on implementation of multimodal of World Health Organization strategies to improve hand hygiene in an Intensive Care Unit

INTRODUCCIÓN: La higiene de manos (HM) es la principal medida para disminuir las IAAS, las que en las Unidades de Cuidados Intensivos (UCI) presentan una alta prevalencia. En Chile no existe información sobre el impacto de la estrategia multimodal de la OMS para la HM en adultos. El objetivo fue evaluar el impacto de la implementación de la estrategia en una UPC. METODOLOGÍA: Estudio longitudinal con evaluación pre y post-intervención, entre los años 2018 y 2021, en la UCI del Hospital del Trabajador (HT), Santiago, Chile. La implementación se evaluó con pautas de cumplimiento de HM, consumo de jabón y productos en base alcohólica (PBA). El impacto se midió con las tasas de neumonía asociada a ventilación mecánica (NAVM), infecciones del torrente sanguíneo asociadas a CVC (ITS- CVC) y del tracto urinario por CUP (ITU-CUP), y la incidencia anual de dermatitis. RESULTADOS: El cumplimiento de pautas aumentó de 91 a 96% (p < 0,05). El consumo total de productos para la HM aumentó de 0,17 a 0,31 L/día/cama y de PBA en 10%. Las tasas de IAAS pre y post-intervención fueron para NAVM de 10,3 y 8,4; ITS-CVC de 0,8 y 1,5 e ITU-CUP de 4,2 y 5,3 por 1.000 días de exposición. La incidencia anual de dermatitis disminuyó en 30% (p < 0,05). CONCLUSIONES: La implementación de la estrategia multimodal se asoció a una disminución de las tasas de NAVM y de dermatitis en la UCI del HT.

INTRODUCTION: Hand hygiene is the main measure to decrease infections related to healthcare and the Intensive Care Unit has a high prevalence. In Chile there aren't reports about the impact of the World Health Organization multimodal hand hygiene improvement strategy. AIM: To assess the implementation impact of this strategy at the ICU. METHODOLOGY: Longitudinal study with pre- and postintervention evaluation during the years 2018-2021 at ICU. The implementation was assessed against hand hygiene compliance guidelines, soap consumption and alcohol-based products. The impact was evaluated with the rates of ventilator-associated pneumonia (VAP), catheter related bloodstream infection (CRBSI) and catheter associated urinary tract infection (CAUTI) and the annual dermatitis incidence. RESULTS: The guidelines compliance increased from 91% to 96% (p < 0.05). The total product consumption increased from 0.17 to 0.31 Liters/day/bed. The use of alcohol-based products increased by 10%. HAI rates pre- and post-intervention were for VAP 10.3 and 8.4, CRBSI 0.8 and 1.5 and CAUTI 4.2 and 5.3. The annual dermatitis incidence decreased by 30.8% (p < 0.05). CONCLUSIONS: The strategy implementation benefited the decrease of VAP and the dermatitis prevention in ICU.

La superación del profesor de Educación Física para desarrollar la autodeterminación, en educandos con discapacidad intelectual

La superación continua de los profesores de Educación Física constituye una necesidad que ha transcendido diferentes generaciones de docentes, determinada por el desarrollo creciente de la ciencia y la técnica, las exigencias del tercer perfeccionamiento educacional cubano, las demandas en la preparación y capacitación del profesorado y la necesidad de su incidencia en la formación de un egresado apto y capaz de desarrollar no solo habilidades y capacidades físicas, sino también para la vida, que les permitan actuar en el medio social, familiar y laboral. El objetivo de esta investigación consistió en diseñar una estrategia pedagógica de superación para transformar los modos de actuación de los profesores de Educación Física, en la dirección del proceso de enseñanza-aprendizaje, en función del desarrollo de habilidades de autodeterminación en los educandos en situación de discapacidad intelectual. Los métodos investigativos utilizados en el orden teórico y empírico fueron el análisis y síntesis, el histórico-lógico, el inductivo-deductivo, la modelación y el sistémico-estructural-funcional; además de la entrevista, la observación, la encuesta, el análisis de documentos, el criterio de expertos y la triangulación múltiple, los que permitieron revelar las causales que inciden en el normal desarrollo de las habilidades de autodeterminación, así como elaborar la estrategia. Con su implementación se perfeccionó el desempeño profesional y personal de los profesores y los educandos, quienes egresaron con el empoderamiento de habilidades para la toma de decisiones, la realización de elecciones, la resolución de problemas y el establecimiento de metas y objetivos.

O aperfeiçoamento contínuo dos professores de Educação Física constitui uma necessidade que transcendeu as diferentes gerações de professores, determinada pelo crescente desenvolvimento da ciência e da tecnologia, pelas exigências do terceiro melhoramento educacional cubano, pelas exigências na preparação e formação de professores e pela necessidade de seu impacto na formação de um egresso qualificado, capaz de desenvolver não apenas competências e habilidades físicas, mas também para a vida, que lhe permitam atuar no ambiente social, familiar e de trabalho. Discapacidade intelectual. Os métodos investigativos utilizados na ordem teórica e empírica foram análise e síntese, histórico-lógico, indutivo-dedutivo, modelagem e sistêmico-estrutural-funcional; Além da entrevista, observação, inquérito, análise documental, peritagem e triangulação múltipla, que permitiram revelar as causas que afetam o normal desenvolvimento das competências de autodeterminação, bem como desenvolver a estratégia. Com a sua implementação melhorou-se o desempenho profissional e pessoal de professores e alunos, que se formaram com a capacitação de competências para tomar decisões, fazer escolhas, resolver problemas e estabelecer metas e objetivos.

The continuous improvement of Physical Education teachers constitutes a need that has transcended different generations of teachers, determined by the growing development of science and technology, the demands of the third Cuban educational improvement, the demands in the preparation and training of teachers and the need for its impact on the training of a qualified graduate capable of developing not only physical skills and abilities, but also for life, which allow them to act in the social, family and work environment. The objective of this research was to design a pedagogical improvement strategy to transform the modes of action of Physical Education teachers, in the direction of the teaching-learning process, based on the development of self-determination skills in students in situations of intellectual disability. The investigative methods used in the theoretical and empirical order were analysis and synthesis, historical-logical, inductive-deductive, modeling and systemic-structural-functional; In addition to the interview, observation, survey, document analysis, expert judgment and multiple triangulations, which allowed us to reveal the causes that affect the normal development of self-determination skills, as well as to develop the strategy. With its implementation, the professional and personal performance of teachers and students was improved, who graduated with the empowerment of skills for making decisions, making choices, solving problems and establishing goals and objectives.

Sistema de acciones para la mejora continua en el funcionamiento de colectivos de disciplina

Fundamento: la estructura y organización de los planes de estudio de la Educción Superior en Cuba demandan la búsqueda constante de alternativas que posibiliten perfeccionar el trabajo metodológico. Objetivo: elaborar un sistema de acciones que contribuya a mejorar el funcionamiento de los colectivos de disciplina. Métodos investigación de desarrollo con enfoque dialéctico materialista, realizada en la Universidad de Ciencias Médicas de Cienfuegos en el año 2022. Se aplicaron métodos en los niveles empíricos, teóricos y estadísticos matemáticos que en su conjunto permitieron dar salida al objetivo previsto. La propuesta se organizó en las etapas de diagnóstico, diseño y validación. Resultados identificadas potencialidades y limitaciones en el funcionamiento de los colectivos de disciplina en la institución, aspectos considerados al proponer acciones de planificación, organización, ejecución y control para la mejora continua, que particularizan aspectos para aquellos colectivos que se centran en la práctica laboral por constituir la educación en el trabajo principio y forma organizativa fundamental en la Educación Médica cubana. La validación de la propuesta realizada confirmó su valor, de manera que implementarla es el reto para continuar apostando por la calidad de los procesos en la universidad. Conclusiones las acciones propuestas se derivan del diagnóstico realizado y de manera integrada contribuyen a lograr mayor efectividad en la dirección de ese nivel organizativo para el trabajo metodológico en la institución y por tanto a su funcionamiento.

Foundation: The conformation and organization of the Higher Education study plans in Cuba demand the constant search for alternatives that make it possible to perfect the methodological work. Objective: develop a system of actions that contributes to improve the function of disciplinary groups. Methods: development research with a materialist dialectical approach, carried out at the Cienfuegos Medical Sciences University in 2022. Methods were applied at the empirical, theoretical and mathematical statistical levels that together allowed the intended objective to be achieved. The proposal was organized into the diagnosis, design and validation stages. Results: identified potentialities and limitations in the functioning of the disciplinary groups in the institution, aspects considered when proposing planning, organization, execution and control actions for continuous improvement, which particularize aspects for those groups that focus on work practice by constitute education at work as a fundamental principle and organizational form in Cuban Medical Education. The validation of the proposal confirmed its value, so implementing it is the challenge to continue betting on the quality of the processes at the university. Conclusions: the proposed actions are derived from the diagnosis carried out and in an integrated manner contribute to achieving greater effectiveness in the direction of that organizational level for the methodological work in the institution and therefore its operat.

Antibiotic stewardship and nosocomial infection prevention in critically ill patients: a quality improvement program

SUMMARY OBJECTIVE: The objective of this study was to evaluate the impact of the implementation of a bundle of interventions through a "Program for Antibiotic Management and Nosocomial Infection Prevention" in the intensive care unit on antibiotic and devices use and healthcare-associated infections. METHODS: This was a quasi-experimental study of consecutive series of cases in periods before and after the establishment of protocols and checklists for the use of antibiotics as well as other measures to prevent healthcare-associated infection as part of a quality improvement program. Antimicrobial consumption was assessed by the defined daily dose. RESULTS: A total of 1,056 and 1,323 admissions in the pre-intervention and post-intervention phases, respectively, were evaluated. The defined daily dose per 100 patient-day decreased from 89±8 to 77±11 (p=0.100), with a decrease in carbapenems, glycopeptides, polymyxins, penicillins, and cephalosporins. The rates of ventilator and central venous catheter use decreased from 52.8 to 44.1% and from 76 to 70%, respectively. The rates of healthcare-associated infection decreased from 19.2 to 15.5%. CONCLUSION: Quality improvement actions focused primarily on antimicrobial management and prevention of healthcare-associated infection are feasible and have the potential to decrease antibiotic use and healthcare-associated infection rates.

Improvement in the quality of pressure injury prevention in an intensive care unit / Mejora de la calidad de la prevención de lesiones por presión en una unidad de cuidados intensivos / Melhoria da qualidade da prevenção de lesão por pressão em uma unidade de terapia intensiva

ABSTRACT Objective: to assess the effect of implementing a quality improvement project on the process of pressure injury prevention in an adult Intensive Care Unit. Method: a quality improvement project for the pressure injury prevention process was carried out in an adult Intensive Care Unit of a public hospital from November 2022 to July 2023. It was developed following the steps of an improvement cycle. The quality level of pressure injury prevention was measured before and after the interventions, using six quality criteria. Data collection for the first assessment was conducted in March 2023, retrospectively, referring to November and December 2022 and January 2023. Quality reassessment occurred in July 2023, also retrospectively, referring to April, May, and June 2023. Interventions included changes in records related to assistance in pressure injury prevention and education/awareness of the team on pressure injury prevention. Results: the initial quality assessment showed that the compliance level of pressure injury prevention was low, with virtually all criteria showing rates below 50%. After the interventions, there was an increase in compliance with almost all criteria. Conclusion: the use of a quality improvement project enabled the improvement of the pressure injury prevention process and contributed to the scientific community by corroborating the effectiveness of these projects in implementing pressure injury prevention programs, as well as prompting reflection on the multifactorial nature involved in this preventive process.

RESUMEN Objetivo: evaluar el efecto de la implementación de un proyecto de mejora de la calidad en el proceso de prevención de lesiones por presión en una Unidad de Cuidados Intensivos para adultos. Método: se llevó a cabo un proyecto de mejora de la calidad del proceso de prevención de lesiones por presión en una Unidad de Cuidados Intensivos para adultos de un hospital público, entre noviembre de 2022 y julio de 2023. Este proyecto se desarrolló siguiendo las etapas de un ciclo de mejora. El nivel de calidad en la prevención de lesiones por presión se midió antes y después de las intervenciones, utilizando seis criterios de calidad. La recopilación de datos para la primera evaluación se realizó en marzo de 2023, retrospectivamente, para los meses de noviembre y diciembre de 2022 y enero de 2023. La reevaluación de la calidad se llevó a cabo en julio de 2023, también retrospectivamente, para los meses de abril, mayo y junio de 2023. Las intervenciones incluyeron cambios en los registros relacionados con la asistencia en la prevención de lesiones por presión y la educación/concientización del equipo sobre la prevención de lesiones por presión. Resultados: la evaluación inicial de la calidad mostró que el nivel de conformidad en la prevención de lesiones por presión era bajo, con casi todos los criterios presentando tasas inferiores al 50%. Después de las intervenciones, hubo un aumento en la conformidad en casi todos los criterios. Conclusión: el uso de un proyecto de mejora de la calidad permitió mejorar el proceso de prevención de lesiones por presión y contribuyó con la comunidad científica, al corroborar la eficacia de estos proyectos en la implementación de programas de prevención de lesiones por presión, así como para promover la reflexión sobre los múltiples factores involucrados en este proceso preventivo.

RESUMO Objetivo: Avaliar o efeito da implementação de um projeto de melhoria da qualidade no processo de prevenção de lesão por pressão numa Unidade de Terapia Intensiva adulto. Método: Projeto de melhoria da qualidade do processo de prevenção de lesão por pressão, realizado em uma Unidade de Terapia Intensiva adulto, de um hospital público, no período de novembro/2022 a julho/2023. Foi desenvolvido seguindo as etapas de um ciclo de melhoria. O nível de qualidade da prevenção de lesão por pressão foi medido antes e depois das intervenções, utilizando seis critérios de qualidade. A coleta de dados da primeira avaliação foi realizada em março/2023, de forma retrospectiva, referente aos meses de novembro e dezembro/2022 e janeiro/2023. A reavaliação de qualidade ocorreu em julho de 2023, também de forma retrospectiva, referente aos meses de abril, maio e junho/2023. As intervenções incluíram mudanças nos registros relacionados à assistência na prevenção de LP e educação/sensibilização da equipe sobre prevenção de lesão por pressão. Resultados: A avaliação inicial da qualidade mostrou que o nível de conformidade de prevenção de lesão por pressão era baixo, com praticamente todos os critérios apresentando taxas inferiores a 50%. Após as intervenções, houve aumento na conformidade de quase todos os critérios. Conclusão: A utilização de um projeto de melhoria de qualidade possibilitou a melhora do processo de prevenção de lesão por pressão e contribuiu com a comunidade científica, ao corroborar a eficácia destes projetos na implementação de programas de prevenção lesão por pressão, bem como incitou a reflexão acerca da multifatorialidade envolvida neste processo preventivo.

Educação permanente para qualidade e segurança do paciente em hospital acreditado / Educación permanente para calidad y seguridad del paciente en hospital acreditado / Permanent education for quality and patient safety in an accredited hospital

Resumo Objetivo Compreender os desafios enfrentados pela educação permanente para o alcance da melhoria da qualidade e da segurança do paciente em um hospital público submetido à acreditação hospitalar. Métodos Estudo descritivo, transversal e com abordagem qualitativa. Realizaram-se entrevistas semiestruturadas com 22 profissionais, durando, em média, 22 minutos, as quais posteriormente foram analisadas e interpretadas por meio da análise de conteúdo temática de Bardin. Adotaram-se os softwares Iramuteq para a análise de corpus textual, e o BioEstat 5.3, para análise do perfil dos participantes. A coleta de dados ocorreu em junho de 2022, após aprovação nos Comitês de Ética em Pesquisa. Resultados Aplicou-se a análise de classificação hierárquica descendente, gerada pelo Iramuteq. Obtiveram-se três categorias: Desafios da Educação Permanente mediante o Processo de Melhoria Contínua; Educação Permanente para a Promoção da Qualidade e da Segurança do Paciente no Contexto da Acreditação Hospitalar; e Estratégias Educativas para a Melhoria da Qualidade e da Segurança do Paciente. Conclusão Identificaram-se desafios inerentes às ações de educação permanente em saúde, tais como resistência à mudança de cultura, adesão às atividades, alta rotatividade de profissionais e dificuldade para liberação da equipe de enfermagem para participar das atividades relacionadas à demanda de trabalho.

Resumen Objetivo Comprender los desafíos enfrentados por la educación permanente para lograr mejorar la calidad y la seguridad del paciente en un hospital público sometido a acreditación hospitalaria. Métodos Estudio descriptivo, transversal y con enfoque cualitativo. Se realizaron entrevistas semiestructuradas a 22 profesionales, con duración promedio de 22 minutos, que luego se analizaron e interpretaron mediante el análisis de contenido temático de Bardin. Se utilizaron los softwares Iramuteq para el análisis de corpus textual y BioEstat 5.3 para el análisis del perfil de los participantes. La recopilación de datos se llevó a cabo en junio de 2022, después de la aprobación de los Comités de Ética en Investigación. Resultados Se aplicó el análisis de clasificación jerárquica descendente, generado por Iramuteq. Se obtuvieron tres categorías: Desafíos de la educación permanente mediante el proceso de mejora continua, Educación permanente para la promoción de la calidad y de la seguridad del paciente en el contexto de la acreditación hospitalaria, y Estrategias educativas para la mejora de la calidad y la seguridad del paciente. Conclusión Se identificaron desafíos inherentes a las acciones de educación permanente en salud, tales como resistencia a cambios de cultura, adherencia a las actividades, alta rotación de profesionales y dificultad de autorizar al equipo de enfermería para participar en las actividades relacionadas con la demanda de trabajo.

Abstract Objective To understand the challenges faced in terms of permanent education in health, for achieving quality improvements and patient safety at a public hospital undergoing hospital accreditation. Methods This was a descriptive, cross-sectional study with a qualitative approach. Semi-structured interviews were conducted with 22 professionals, lasting an average of 22 minutes. The interviews were subsequently analyzed and interpreted using Bardin's thematic content analysis. The software Iramuteq was used to analyze the textual corpus, and BioEstat 5.3 was used to analyze the profile of the participants. The data collection took place in June 2022, following approval by the Research Ethics Committees. Results The descending hierarchical classification analysis, generated by Iramuteq, was applied, resulting in three categories: Challenges of Permanent Education through the Continuous Improvement Process, Permanent Education for the Promotion of Quality and Patient Safety in the Context of Hospital Accreditation, and Educational Strategies for Improving Quality and Patient Safety. Conclusion Challenges inherent to the actions of permanent education in health were identified, such as resistance to cultural change, adherence to activities, high turnover of professionals, and difficulty in releasing the nursing team to participate in activities, due to work demand.

Application of valve removal technique in improved endoscopic dacryocystorhinostomy / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of valve removal technology in improved endoscopic dacryocystorhinostomy.METHODS: Prospective randomized controlled study. A total of 92 patients(98 eyes)with nasolacrimal duct obstruction who underwent endoscopic dacryocystorhinostomy in our hospital from November 2020 to September 2022 were selected as the study subjects and they were randomly divided into group A(traditional group)and group B(improved group). The nasal mucosal flap was preserved after incision of the nasal mucosa in group A, the lacrimal sac flap and nasal mucosal flap were trimmed to an appropriate shape after the incision of the lacrimal sac, and the lacrimal sac flap the nasal mucosal flap were matched up. Group B made a “□” shaped incision on the nasal mucosa to remove the complete square nasal mucosa tissue. After the lacrimal sac was incised, the lacrimal sac mucosa was preserved as much as possible, and then the residual nasal mucosa was trimmed to make the lacrimal sac flap close to but not in contact with the residual nasal mucosa. Furthermore, the intraoperative bleeding volume and surgical duration of two groups of patients were recorded, and follow up until 3 mo postoperative. Nasal endoscopy and lacrimal duct flushing examinations were performed at 1 and 3 mo postoperative, respectively. The proliferation of granulation tissue within 5 mm of the ostial postoperative and the therapeutic effect were observed.RESULTS: At 3 mo postoperatively, 6 patients(7 eyes)who were lost to follow-up were excluded. A total of 44 eyes were included in group A, and 47 eyes were included in group B. The bleeding volume [27.00(22.00, 41.00)mL] and the surgical duration [35.00(33.00, 42.00)min] in group B were significantly lower than those in the group A(P&#x0026;#x003C;0.001). At 1 mo postoperatively, granulation tissue hyperplasia was observed within 5 mm of the ostial in 12 eyes of group A. In group B, granulation tissue hyperplasia was observed within 5 mm of the ostial in 1 eye. At 3 mo postoperatively, there were 9 eyes in group A with ostial adhesions but incomplete closure, and 2 eyes with complete closure; group B had 1 eye with mild adhesions at the ostial site and no ostial closure. The postoperative complications in the group B were significantly less than those in the group A(P&#x0026;#x003C;0.05), and the therapeutic effect was better than that in the group A(P&#x0026;#x003C;0.05).CONCLUSION: The application of valve removal technology in improving endoscopic dacryocystorhinostomy not only significantly reduces intraoperative bleeding and surgical duration, but also effectively reduces postoperative complications and improves surgical efficacy.

Research progress on dental materials for preventing root caries / 口腔疾病防治

@#The high incidence and untreated rate of root caries, a common and frequently occurring oral disease with challenging treatment in elderly individuals, is the main cause of tooth loss among elderly people, as rapid development results in pulpitis and periapical periodontitis or residual crown and root, which has been regarded as one of the common chronic oral diseases seriously affecting the quality of life of elderly people. Thus, early intervention and prevention are important. Traditional dental materials for preventing root caries have been widely used in clinical practice; however, they have the disadvantages of tooth coloring, remineralization and low sterilization efficiency. A series of new dental materials for preventing root caries have gradually become a research hotspot recently, which have the advantages of promoting the mineralization of deep dental tissue, prolonging the action time and enhancing adhesion. Future caries prevention materials should be designed according to the characteristics of root surface caries and the application population and should be developed toward simplicity, high efficiency and low toxicity. This review describes current research regarding anti-caries prevention material application, serving as a theoretical underpinning for the research of root caries prevention materials, which is important for both promotion in the effective prevention of root caries and improvement in the status of oral health and the quality of life among old people.

Construction of Evidence Body for Revision of Safety Information on Package Inserts of Chinese Patent Medicines in Post-marketing： Taking Xiaoke'an Capsules as an Example / 中国实验方剂学杂志

ObjectiveTo construct the evidence body for revision of safety information on package inserts of Chinese patent medicines in post-marketing by taking Xiaoke'an capsules as an example， so as to provide reference for the revision of instructions of Chinese patent medicines in post-marketing. MethodThe construction of the evidence body was guided by the theory of traditional Chinese medicine（TCM） and the Technical Guiding Principles for Revision of Safety Information Items in Instructions for TCMs After Marketing， and 8 categories and 25 specific items were taken as the main body of the evidence body， and information inclusion， integration， screening and improvement were carried out， then expert demonstrations were conducted， and finally modifications were made based on the opinions of the Center for Drug Evaluation to complete the revision of the safety information in the instructions of Xiaoke'an capsules. Result［Adverse reactions］ of Xiaoke'an capsules was revised to "monitoring data show that the following adverse reactions can be seen with this product：individual hypoglycemic reaction reports". ［Contraindications］ was revised to "contraindicated for those allergic to this product and its ingredients". ［Precautions］ was revised to "（1）pregnant women should use with caution， （2）elderly people should consult a physician， （3）people with spleen deficiency and dampness， spleen and stomach deficiency and cold， or those who eat less and have diarrhea should use with caution， （4）this product contains ginseng， should not be taken at the same time with TCM prescriptions or patent medicines containing veratrum and Wulingzhi， （5）pay attention to monitoring blood sugar during medication， （6）if any other discomfort occurs during medication， you should seek medical attention in time". The warning was revised to "use with caution by pregnant women， and pay attention to regular monitoring of blood sugar". ConclusionIn accordance with the content and process of the evidence body for the revision of safety information in the instructions， the revision of the safety information in the instructions of Xiaoke'an capsules has been completed， providing a strong basis for the rational and safe use of medication in the clinic.

Disease burden due to PM2.5 pollution before and after air quality improvement in Shijiazhuang / 环境与职业医学

Background Air pollution has gradually become a major environmental and public health problem faced by countries around the world. Hazy weather not only affects the health of the population, but also poses a threat to social and public safety. China has successively promulgated policies such as the "Ten Articles on Atmosphere" and the Three-year action plan to fight air pollution, aiming to improve ambient air quality. It is clear that the Beijing-Tianjin-Hebei region has accomplished the set targets and improved air quality according to the environmental monitoring data of 2017. Objective To assess air quality improvements through the evaluation of the disease burden due to fine particulate matter (PM2.5) pollution in Shijiazhuang City before and after the air quality improvement from 2014 to 2021, including fatalities and health economic losses attributed to PM2.5 pollution. Methods Data on causes of death, PM2.5 concentrations, the number of permanent residents at the end of the year, gross regional product, and disposable income per capita in urban areas of Shijiazhuang were collected from 2014 to 2021. Total, non-accidental, circulatory, and respiratory deaths due to PM2.5 pollution were estimated by global exposure mortality models (GEMM). Health and economic losses due to selected diseases were calculated by value of statistical life (VOSL). Results During the study period, the average annual concentration of PM2.5 in Shijiazhuang was highest in 2014, and began to decline year by year in 2017, but all exceeded the current national limit of the second level of ambient air quality standards (35 μg·m−3). The total deaths, non-accidental deaths, circulatory disease deaths, and respiratory disease deaths attributed to PM2.5 pollution from 2014 to 2021 were 41326, 40246, 21792, and 5022, respectively; the associated health economic losses were 37.362, 36.369, 19.695, and 4.535 billion yuan, respectively. From the perspective of improved air quality, both the number of attributed deaths and health economic losses had declined in a volatile manner since 2017, with a significant decrease in 2019. If the average annual concentration of PM2.5 reached the second-level limit of China's ambient air quality standard (35 μg·m−3), the total deaths, non-accidental deaths, and deaths from circulatory diseases and respiratory diseases due to PM2.5 pollution would deducted by about 17000, 16000, 9000, and 2000, respectively; the corresponding health and economic losses would decreased by 15.201, 14.761, 7.959, and 1.859 billion yuan, respectively. If the average annual concentration of PM2.5 reached the latest PM2.5 air quality guidelines (5 μg·m−3) proposed by the World Health Organization, the total deaths, non-accidental deaths, circulatory disease deaths, and respiratory disease deaths due to PM2.5 pollution would deducted by 36000, 35000, 19000, and 4000, respectively, and the corresponding health and economic losses would reduced by 32.673, 31.796, 17.211, and 3.969 billion yuan, respectively. Conclusion PM2.5 pollution can lead to severe mortality burden and economic loss. Under the implementation of the State Council's "Ten Articles on Atmosphere" and the Three-year action plan to fight air pollution, Shijiazhuang's PM2.5 concentration and health economic losses have been significantly reduced, and further control of PM2.5 pollution can achieve greater health benefits and economic gains, affirming the positive results of local air pollution prevention work.

Aseguramiento y control de la calidad de los datos en un estudio de cohorte en Colombia

Introducción: La calidad de los datos facilita garantizar la fiabilidad de los estudios observacionales. Objetivo: Describir el aseguramiento y el control de calidad para mantener la fiabilidad y la validez del dato en un estudio de cohorte. Métodos: Presentar el manejo de datos implementado dentro de un seguimiento de enfermos renales crónicos cuya exposición fue un programa de protección renal comparado con el tratamiento convencional y su asociación con desenlaces clínicos. Se evaluó el cambio en la frecuencia de errores después de implementar el plan y la reproducibilidad del ingreso de registros a las bases de datos. Resultados: Se documentó una disminución progresiva en los errores cometidos en la captación de datos. El valor de Kappa entre los recolectores de la información para las variables clínicas más importantes fue 0,960 para la depuración de creatinina 150 mg/dL; 0,730 para la alteración del sedimento urinario; 0,956 para la asignación de estadio al ingreso. Los coeficientes de correlación intraclase para la identificación de las cifras de presión arterial sistólica fue 0,996; para la de presión arterial diastólica 0,993 y para los niveles de creatinina sérica al diagnóstico 0,995. Discusión: La calidad de los datos comienza con el reconocimiento de los retos y dificultades que implica su responsable captación, de ahí el aporte de la estandarización de los procesos y el personal que los lleve a cabo en forma idónea. Estudios evidencian que muchos procesos de mejora surgen en el desarrollo de la investigación sin protocolos preestablecidos. Conclusión: La reducción en la proporción y el tipo de error durante el proceso de captación de datos se debe a su identificación temprana y la corrección de instructivos, del instrumento de control de diligenciamiento y de la capacitación continua del personal. El análisis mostró una buena concordancia interevaluador.

Introduction: Data quality makes it easier to ensure that observational studies are reliable. Objective: To describe assurance and quality control to maintain data reliability and validity in a cohort study. Methodology: We present the data management strategies implemented in a study that followed patients of chronic kidney disease who were in a renal protection program and compared them with those undergoing conventional treatment to observe its association with clinical outcomes. We assessed the changes in error frequency after implementing the plan along with the reproducibility of the strategies for entering records into the databases. Results: We documented a progressive decrease of data collection errors. The Kappa values among data collectors for the most important variables were: 0.960 for creatinine clearance 150 mg/dl; 0.730 for urinary sediment alteration and 0.956 for stage allocation upon admission. The intraclass correlation coefficient for the identification of systolic blood pressure was 0.996; for diastolic blood pressure, the coefficient was 0.993 and for serum creatinine levels at diagnosis, the value was 0.995. Discussion: Data quality begins with the recognition of the challenges and difficulties involved in responsible data collection, hence the contribution of standardized processes and personnel to carry them out in a suitable manner. Studies show that many improvement processes arise in the development of research without pre-established protocols. Conclusion: The reduction in error ratio and type during the data collection process are the result of the early identification of erroneously entered or missing data, the correction of the guidelines for completing forms as well as of the instruments for detecting errors and continuous training of the staff. The analysis showed good inter-rater reliability.

La superación del profesor de Cultura Física que atiende a trabajadores con discapacidad

Fomentar espacios de superación, para los profesores de Cultura Física que laboran en talleres especiales, constituye una condición primordial para apropiarse de conocimientos teórico-prácticos dirigidos a brindar un servicio de calidad, en la atención a los trabajadores con discapacidad. El objetivo del artículo consistió en diagnosticar la superación de los profesores de Cultura Física que dirigen la gimnasia profesional aplicada en trabajadores con discapacidad que asisten a los talleres especiales, en La Habana. Se realizó un estudio descriptivo de corte transversal no experimental que favoreció la identificación de la problemática pedagógica y científica del proceso de estudio, a partir de la aplicación de métodos empíricos como la revisión de documentos, la encuesta, la entrevista y la observación; esto permitió determinar las causas del fenómeno, para su caracterización y pronóstico. La investigación hizo evidente las principales dificultades en la atención a estos trabajadores y la necesidad de una superación especializada para la ampliación y perfeccionamiento de los conocimientos y habilidades de este profesional.

Promover espaços de aperfeiçoamento, para professores de Cultura Física que atuam em oficinas especiais, constitui condição primordial para a apropriação de conhecimentos teórico-práticos voltados à prestação de serviço de qualidade no atendimento ao trabalhador com deficiência. O objetivo do artigo foi diagnosticar o aperfeiçoamento dos professores de Cultura Física que dirigem a ginástica profissional aplicada aos trabalhadores com deficiência que frequentam oficinas especiais em Havana. Foi realizado um estudo descritivo transversal não experimental que favoreceu a identificação dos problemas pedagógicos e científicos do processo de estudo, baseado na aplicação de métodos empíricos como revisão documental, levantamento, entrevista e observação; Isto permitiu determinar as causas do fenômeno, para sua caracterização e prognóstico. A pesquisa evidenciou as principais dificuldades no atendimento a esses trabalhadores e a necessidade de formação especializada para ampliar e aprimorar os conhecimentos e habilidades desse profissional.

Promoting spaces for improvement, for Physical Culture teachers who work in special workshops, constitutes a primary condition for appropriating theoretical-practical knowledge aimed at providing quality service in caring for workers with disabilities. The objective of the article was to diagnose the improvement of Physical Culture teachers who direct professional gymnastics applied to workers with disabilities who attend special workshops in Havana. A non-experimental cross-sectional descriptive study was carried out that favored the identification of the pedagogical and scientific problems of the study process, based on the application of empirical methods such as document review, survey, interview and observation; this allowed to determine the causes of the phenomenon, for its characterization and prognosis. The research made evident the main difficulties in caring for these workers and the need for specialized improvement to expand and improve the knowledge and skills of this professional.

Prevención de las hepatitis virales crónicas como contenido de la formación del especialista de Medicina General Integral

La superación profesional constituye un proceso permanente de la educación superior que garantiza la actualización y preparación de sus graduados para un ejercicio adecuado de sus desempeños en la práctica: en particular, en el ámbito de las ciencias médicas favorece la atención a las situaciones de salud que se presentan en la comunidad. El objetivo del presente trabajo está encaminado a exponer los fundamentos teóricos que sustentan el estudio del proceso de formación del residente de Medicina General Integral y la concreción del trabajo preventivo desde la comunidad. Se trata de un acercamiento inicial al proceso de formación de los especialistas de la Atención Primaria de Salud y la prevención de las hepatitis virales crónicas y como continuidad de las acciones de un proyecto de investigación, se acomete el abordaje actual en el período comprendido entre septiembre de 2022 a octubre de 2024, bajo el auspicio del Centro de Estudios de Ciencias de la Educación Enrique José Varona, de la Universidad Ignacio Agramonte Loynaz y el Centro de Desarrollo de las Ciencias Sociales y Humanísticas en Salud, de la Universidad de Ciencias Médicas, ambas instituciones pertenecientes a la provincia de Camagüey.

Professional improvement constitutes a permanent process of higher education that guarantees the updating and preparation of its graduates for an adequate exercise of their performances in practice: in particular, in the field of medical sciences, it favors attention to health situations that appear in the community. The objective of this work is aimed at exposing the theoretical foundations that support the study of the training process of the Comprehensive General Medicine resident and the concretion of preventive work from the community. This is an initial approach to the training process of Primary Health Care specialists and the prevention of chronic viral hepatitis and as a continuation of the actions of a research project, the current approach is undertaken in the period between September from 2022 to October 2024, under the auspices of the Enrique José Varona Center for the Study of Education Sciences, of the Ignacio Agramonte Loynaz University and the Center for the Development of Social and Humanistic Sciences in Health, of the University of Medical Sciences, both institutions belonging to the province of Camagüey.

Priorities and root cause analysis of quality and safety problems in chilean hospitals / Prioridades y análisis de las causas de los problemas de calidad y seguridad en hospitales chilenos

BACKGROUND: Quality improvement is an important component of hospital operations. AIM: To prioritise clinical quality and safety problems in Chilean hospitals according to their severity, frequency, and detectability. MATERIAL AND METHODS: The study was conducted between December 2018 and June 2019. To identify quality and safety problems, an exploratory study was conducted using an online survey aimed to those responsible for clinical quality and safety in Chilean hospitals. The survey was sent to 94 hospitals and completed by quality management personnel at 34 hospitals, yielding a total of 25 valid surveys for analysis. Based on the information gathered, a risk priority score was computed to rank the problems surveyed. Focus groups were held to find the root causes of the quality and safety problem with the highest risk priority score. RESULTS: The three highest risk priorities were:1 ineffective interprofessional communication,2 lack of leadership for addressing frequently recurring safety issues, and3 antimicrobial resistance due to inappropriate use of antibiotics. For the communication problem, the focus group found two main root causes: those due to personnel and those relating to the hospitals themselves. CONCLUSIONS: Hospitals can systematically use the proposed approach to categorize their main clinical quality and safety problems, analyze their causes, and then design solutions.

ANTECEDENTES: La mejora continua de la calidad es un componente importante en las actividades hospitalarias. OBJETIVO: Priorizar los problemas de calidad y seguridad en hospitales chilenos de acuerdo a su severidad, frecuencia y detectabilidad. MATERIAL Y MÉTODOS: Se efectuó un estudio exploratorio con una encuesta en línea para detectar problemas de calidad y seguridad, dirigida a quienes están a cargo de los problemas de calidad y seguridad en los hospitales. La encuesta fue enviada a 94 hospitales y respondida por los encargados de calidad y seguridad en 34 de ellos, lográndose 25 encuestas válidas para análisis. El estudio se llevó a cabo entre diciembre de 2018 y junio de 2019. Se diseñó una escala de prioridades de riesgo para determinar la importancia relativa de los problemas detectados. Se llevaron a cabo grupos focales para determinar las causas del problema más importante. RESULTADOS: En Chile, los problemas de calidad y seguridad más importantes son la falta de comunicación interprofesional, falta de liderazgo para abordar los problemas de seguridad y calidad, y resistencia a antibióticos debido a su uso inapropiado. Problemas relacionados al personal y relacionados al hospital fueron las causas primarias de la falta de comunicación. CONCLUSIONES: Los hospitales podrían utilizar este enfoque de forma sistemática para categorizar sus principales problemas de calidad y seguridad, analizar las causas y diseñar soluciones.

O preparo intestinal em dose dividida é superior à dose direta em pacientes hospitalizados submetidos à colonoscopia hospitalar / Split-dose bowel preparation is superior to straight-dose in hospitalized patients undergoing inpatient colonoscopy

ABSTRACT Background: There is a two-fold higher rate of failed colonoscopy secondary to inadequate bowel preparation among hospitalized versus ambulatory patients. Split-dose bowel preparation is widely used in the outpatient setting but has not been generally adapted for use among the inpatient population. Objective The aim of this study is to evaluate the effectiveness of split versus single dose polyethylene glycol bowel (PEG) preparation for inpatient colonoscopies and determine additional procedural and patient characteristics that drive inpatient colonoscopy quality. Methods: A retrospective cohort study was performed on 189 patients who underwent inpatient colonoscopy and received 4 liters PEG as either split- or straight-dose during a 6-month period in 2017 at an academic medical center. Bowel preparation quality was assessed using Boston Bowel Preparation Score (BBPS), Aronchick Score, and reported adequacy of preparation. Results: Bowel preparation was reported as adequate in 89% of the split-dose group versus 66% in the straight-dose group (P=0.0003). Inadequate bowel preparations were documented in 34.2% of the single-dose group and 10.7% of the split-dose group (P<0.001). Only 40% of patients received split-dose PEG. Mean BBPS was significantly lower in the straight-dose group (Total: 6.32 vs 7.73, P<0.001). Conclusion: Split-dose bowel preparation is superior to straight-dose preparation across reportable quality metrics for non-screening colonoscopies and was readily performed in the inpatient setting. Interventions should be targeted at shifting the culture of gastroenterologist prescribing practices towards use of split-dose bowel preparation for inpatient colonoscopy.

RESUMO Contexto: Há uma taxa duas vezes maior de colonoscopia com falha secundária ao preparo intestinal inadequado entre pacientes hospitalizados versus ambulatoriais. O preparo intestinal em dose dividida é amplamente utilizado em ambulatório, mas geralmente não foi adaptado para uso entre a população hospitalar. Objetivo: O objetivo deste estudo é avaliar a eficácia da preparação do intestino de polietilenoglicol (PEG) em dose única versus doses separadas para colonoscopias hospitalares e determinar características adicionais do procedimento e do paciente que promovam a qualidade da colonoscopia do paciente internado. Métodos Um estudo de coorte retrospectivo foi realizado em 189 pacientes que foram submetidos a colonoscopia hospitalar e receberam 4 litros de PEG como dose dividida ou direta durante um período de 6 meses em 2017 em um centro médico acadêmico. A qualidade do preparo intestinal foi avaliada usando-se o Boston Bowel Preparation Score (BBPS), o Aronchick Score, e relatório sobre a adequação do preparo. Resultados O preparo intestinal foi relatado como adequado em 89% do grupo de dose dividida versus 66% no grupo de dose direta (P=0,0003). Preparações intestinais inadequadas foram documentadas em 34,2% do grupo de dose única e 10,7% do grupo de dose dividida (P<0,001). Apenas 40% dos pacientes receberam PEG em dose fracionada. O BBPS médio foi significativamente menor no grupo de dose direta (total: 6,32 vs 7,73, P<0,001). Conclusão O preparo intestinal em dose dividida é superior ao preparo de dose única em todas as métricas de qualidade relacionadas para colonoscopias sem triagem e foi adequadamente realizado no ambiente de internação. As intervenções devem ser direcionadas para mudar a cultura das práticas de prescrição de gastroenterologistas para o uso de preparação intestinal em dose dividida para colonoscopia hospitalar.

Inheritance of seedlessness and the molecular characterization of the INO gene in Annonaceae / Herança da ausência de sementes e a caracterização molecular do gene INO em Annonaceae

Abstract The inheritance of the seedless fruit characteristic of Annona squamosa has not yet been explained. Molecular techniques may aid breeding programs, mainly in the assisted selection of the target gene. The INO gene may be related to seed development in these fruits. The objective of the present paper was to investigate the inheritance of seedlessness in the 'Brazilian seedless' sugar apple and INO gene conservation in Annona squamosa and Annona cherimola x Annona squamosa genotypes by assessing their homology with the INO database genes. The F1 generation was obtained by crossing the mutant 'Brazilian seedless' (male genitor) (P1) with the wild-type A. squamosa with seeds (M1 and M2, female genitors). The INO gene was studied in mutant and wild-type A. squamosa (P1, M1, M2 and M3) and in the Gefner atemoya (A. cherimola x A. squamosa) (M4) cultivar. The DNA was extracted from young leaves, and four sets of specific primers flanking the INO gene were amplified. The seedless characteristic was identified as stenospermatic in the fruits of parental P1, suggesting monogenic inheritance with complete dominance. High sequence similarity of the INO gene amplifications in the sugar apple accessions (M1, M2, M3) and the atemoya cultivar Gefner (M4) reinforces the hypothesis of their conservation.

Resumo A herança da característica de fruto sem sementes de Annona squamosa ainda não foi esclarecida. Técnicas moleculares podem auxiliar em programas de melhoramento, principalmente na seleção assistida do gene de interesse. O gene INO pode estar relacionado ao desenvolvimento da semente dessas frutas. O objetivo foi investigar a herança da ausência de sementes em Annona squamosa e a conservação do gene INO nos genótipos Annona squamosa e Annona cherimola x Annona squamosa avaliando sua homologia com banco de dados de genes INO. A geração F1 foi obtida pelo cruzamento do mutante 'Brazilian seedless' (genitor masculino) (P1) com o tipo selvagem com sementes (A. squamosa) (M1 e M2, genitores femininos). O gene INO foi estudado em A. squamosa, mutante e selvagem (P1, M1, M2 e M3) e na cultivar Gefner atemoya (A. cherimola x A. squamosa) (M4). O DNA foi extraído de folhas jovens, e quatro conjuntos de primers específicos flanqueando o gene INO foram amplificados. A característica sem sementes foi identificada como estenospermática nos frutos do parental P1, sugerindo herança monogênica com dominância completa. A alta similaridade de sequência das amplificações do gene INO nos acessos de pinha (M1, M2, M3) e na cultivar de atemóia Gefner (M4) reforça a hipótese de sua conservação.

Inheritance of seedlessness and the molecular characterization of the INO gene in Annonaceae / Herança da ausência de sementes e a caracterização molecular do gene INO em Annonaceae

The inheritance of the seedless fruit characteristic of Annona squamosa has not yet been explained. Molecular techniques may aid breeding programs, mainly in the assisted selection of the target gene. The INO gene may be related to seed development in these fruits. The objective of the present paper was to investigate the inheritance of seedlessness in the 'Brazilian seedless' sugar apple and INO gene conservation in Annona squamosa and Annona cherimola x Annona squamosa genotypes by assessing their homology with the INO database genes. The F1 generation was obtained by crossing the mutant 'Brazilian seedless' (male genitor) (P1) with the wild-type A. squamosa with seeds (M1 and M2, female genitors). The INO gene was studied in mutant and wild-type A. squamosa (P1, M1, M2 and M3) and in the Gefner atemoya (A. cherimola x A. squamosa) (M4) cultivar. The DNA was extracted from young leaves, and four sets of specific primers flanking the INO gene were amplified. The seedless characteristic was identified as stenospermatic in the fruits of parental P1, suggesting monogenic inheritance with complete dominance. High sequence similarity of the INO gene amplifications in the sugar apple accessions (M1, M2, M3) and the atemoya cultivar Gefner (M4) reinforces the hypothesis of their conservation.

A herança da característica de fruto sem sementes de Annona squamosa ainda não foi esclarecida. Técnicas moleculares podem auxiliar em programas de melhoramento, principalmente na seleção assistida do gene de interesse. O gene INO pode estar relacionado ao desenvolvimento da semente dessas frutas. O objetivo foi investigar a herança da ausência de sementes em Annona squamosa e a conservação do gene INO nos genótipos Annona squamosa e Annona cherimola x Annona squamosa avaliando sua homologia com banco de dados de genes INO. A geração F1 foi obtida pelo cruzamento do mutante 'Brazilian seedless' (genitor masculino) (P1) com o tipo selvagem com sementes (A. squamosa) (M1 e M2, genitores femininos). O gene INO foi estudado em A. squamosa, mutante e selvagem (P1, M1, M2 e M3) e na cultivar Gefner atemoya (A. cherimola x A. squamosa) (M4). O DNA foi extraído de folhas jovens, e quatro conjuntos de primers específicos flanqueando o gene INO foram amplificados. A característica sem sementes foi identificada como estenospermática nos frutos do parental P1, sugerindo herança monogênica com dominância completa. A alta similaridade de sequência das amplificações do gene INO nos acessos de pinha (M1, M2, M3) e na cultivar de atemóia Gefner (M4) reforça a hipótese de sua conservação.

Inheritance of seedlessness and the molecular characterization of the INO gene in Annonaceae

Abstract The inheritance of the seedless fruit characteristic of Annona squamosa has not yet been explained. Molecular techniques may aid breeding programs, mainly in the assisted selection of the target gene. The INO gene may be related to seed development in these fruits. The objective of the present paper was to investigate the inheritance of seedlessness in the 'Brazilian seedless' sugar apple and INO gene conservation in Annona squamosa and Annona cherimola x Annona squamosa genotypes by assessing their homology with the INO database genes. The F1 generation was obtained by crossing the mutant 'Brazilian seedless' (male genitor) (P1) with the wild-type A. squamosa with seeds (M1 and M2, female genitors). The INO gene was studied in mutant and wild-type A. squamosa (P1, M1, M2 and M3) and in the Gefner atemoya (A. cherimola x A. squamosa) (M4) cultivar. The DNA was extracted from young leaves, and four sets of specific primers flanking the INO gene were amplified. The seedless characteristic was identified as stenospermatic in the fruits of parental P1, suggesting monogenic inheritance with complete dominance. High sequence similarity of the INO gene amplifications in the sugar apple accessions (M1, M2, M3) and the atemoya cultivar Gefner (M4) reinforces the hypothesis of their conservation.

Resumo A herança da característica de fruto sem sementes de Annona squamosa ainda não foi esclarecida. Técnicas moleculares podem auxiliar em programas de melhoramento, principalmente na seleção assistida do gene de interesse. O gene INO pode estar relacionado ao desenvolvimento da semente dessas frutas. O objetivo foi investigar a herança da ausência de sementes em Annona squamosa e a conservação do gene INO nos genótipos Annona squamosa e Annona cherimola x Annona squamosa avaliando sua homologia com banco de dados de genes INO. A geração F1 foi obtida pelo cruzamento do mutante 'Brazilian seedless' (genitor masculino) (P1) com o tipo selvagem com sementes (A. squamosa) (M1 e M2, genitores femininos). O gene INO foi estudado em A. squamosa, mutante e selvagem (P1, M1, M2 e M3) e na cultivar Gefner atemoya (A. cherimola x A. squamosa) (M4). O DNA foi extraído de folhas jovens, e quatro conjuntos de primers específicos flanqueando o gene INO foram amplificados. A característica sem sementes foi identificada como estenospermática nos frutos do parental P1, sugerindo herança monogênica com dominância completa. A alta similaridade de sequência das amplificações do gene INO nos acessos de pinha (M1, M2, M3) e na cultivar de atemóia Gefner (M4) reforça a hipótese de sua conservação.