Análisis de la tasa de cesáreas por grupos de Robson en Clínica Universidad de los Andes

Introducción: La tasa de cesáreas es importante para cualquier centro de atención hospitalaria. Es un indicador de calidad utilizado en muchas publicaciones y, aunque no es una estadística vital, se ha reconocido como un indicador de la calidad de atención. Objetivo: Conocer la tasa de cesáreas en una institución utilizando los grupos de Robson. Métodos: Estudio retrospectivo de bases de datos de la maternidad. Se consideraron las variables de paridad, cesárea anterior, trabajo de parto, inducción, para poder clasificar la población según los grupos de Robson. El análisis consideró los nacimientos desde octubre del 2014 hasta junio del 2021. Resultados: Se observó una tasa de 27,9% en el periodo de estudio. El grupo 5 de Robson, que considera pacientes con una o más tasa de cesáreas, mostró una elevada tasa (68%), contribuyó con el 36% de todas las cesáreas, siendo solamente el 15% de la población. El grupo 3, de multíparas con trabajo de parto espontáneo, tuvo una tasa del 1,8%, contribuyó al 0,4% de las cesáreas, siendo el 20% de la población de estudio. Se encontró una correlación significativa entre uso de parto instrumental y menor tasa de cesáreas, al realizar análisis por operador (Spearman rho: -0,45; IC95%: -0,788 a -0,0190; p = 0,043). Conclusión: La tasa de cesáreas observada fue 27,9%, y las pacientes con cesárea anterior son un grupo donde pueden concentrarse mayores esfuerzos para bajar la tasa global. Entre los operadores, los usuarios de parto instrumental tuvieron menor proporción cesáreas.

Introduction: The cesarean section rate is important for any hospital care center. It is a quality indicator used in many publications, and although not a vital statistic, it has been recognized as an indicator of the quality of care. Objective:: To know the cesarean section rate in an institution using Robson groups. Methods: Retrospective study of maternity databases. The variables of parity, previous cesarean section, labor, induction was considered in order to classify the population according to Robson groups. The analysis considered births from October 2014 to June 2021. Results: A rate of 27.9% was observed in the study period. Robson's group 5, which considers patients with one or more rate of cesarean sections, showed a high rate (68%), contributing to 36% of all cesarean sections, being only 15% of the population. Group 3, multiparas with spontaneous labor, had a rate of 1.8%, contributing to 0.4% of cesarean sections, making up 20% of the study population. A significant correlation was found between the use of instrumental delivery and a lower rate of cesarean sections, when analyzing by operator (Spearman rho: -0.45; IC95%: -0.788 to -0.0190; p = 0.043). Conclusion: The observed cesarean section rate was 27.9%, and patients with a previous cesarean section are a group where greater efforts can be concentrated to lower the overall rate. Among the operators, users of instrumental delivery had a lower proportion of cesarean sections.

Experiencia de parto instrumental con vacuum en Hospital Público de Santiago de Chile

Introducción: El vacuum es el instrumento de elección para asistir el parto instrumental en países desarrollados. Objetivo: El objetivo del estudio es exponer los resultados maternos y fetales del uso del vacuum en población chilena y promover su disponibilidad y uso en nuestro país y Latinoamérica. Método: El estudio se realizó entre octubre de 2017 y diciembre de 2021, incluyendo a pacientes que tuvieron parto instrumental con vacuum en el Hospital San Juan de Dios de Chile. Se compararon los partos exitosos con vacuum y los partos en los que se requirió el uso de otro instrumento o una cesárea posterior al uso del instrumento. Resultados: Se realizaron 153 vacuum, correspondientes al 28,59% del total de partos instrumentales. El 79,74% tuvo éxito. El 5,88% no recibió anestesia o se aplicó anestesia local. Solo el 3,27% presentó desgarro perineal con compromiso del esfínter anal. El 91,5% de los recién nacidos no tuvieron complicaciones fetales. Un 20,3% requirió reanimación neonatal. Conclusiones: El estudio muestra que el vacuum es una opción segura y efectiva de parto instrumental en nuestra población. La correcta capacitación y protocolos adecuados son necesarios para garantizar resultados exitosos.

Introduction: Vacuum extraction is the instrument of choice for assisting instrumental delivery in developed countries. Objective: The aim of the study is to present the maternal and fetal outcomes of vacuum use in the Chilean population and promote its availability and usage in our country and Latin America. Method: The study was performed between October 2017 and December 2021, including patients who underwent instrumental delivery with a vacuum extraction at the Hospital San Juan de Dios in Chile. Successful vacuum deliveries were compared with deliveries where another instrument was required, or a cesarean section was performed after instrument use. Results: A total of 153 vacuum deliveries were carried out, accounting for 28.59% of all instrumental deliveries. 79.74% were successful. 5.88% did not receive anesthesia or received local anesthesia. Only 3.27% experienced perineal tear with involvement of the anal sphincter. 91.5% of newborns had no fetal complications. 20.3% required neonatal resuscitation. Conclusions: The study demonstrates that the vacuum is a safe and effective option for instrumental delivery in our population. Proper training and appropriate protocols are necessary to ensure successful outcomes.

Application of Mendelian randomization analysis in exploring the etiology of nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease （NAFLD） is an abnormal lipid metabolic disorder of the liver characterized by accumulation of a large amount of lipids in the liver， and it is currently the most common liver disease around the world. Mendelian randomization （MR） incorporates genomic data into traditional epidemiological study designs to infer the causal relationship between exposure factors and disease risk. In recent years， MR has been widely used in studies on inference of the etiology of NAFLD. This article systematically summarizes the advances in the application of MR in NAFLD research， so as to provide new ideas for understanding the nature of the disease and scientific interventions.

Applications and advancements of instrumental variable approach in causal inference in environmental epidemiology / 环境与职业医学

In environmental epidemiological research, extensive non-random environmental exposures and complex confounding biases pose significant challenges when attempting causal inference. In recent years, the introduction of causal inference methods into observational studies has provided a broader range of statistical tools for causal inference research in environmental epidemiology. The instrumental variable (IV) approach, as a causal inference technique for effectively controlling unmeasured confounding factors, has gradually found application in the field of environmental epidemiological research. This article reviewed the basic principles of IV and summarized the current research progress and limitations of applying IV for causal inference in environmental epidemiology. IV application in the field of environmental epidemiology is still in the initial stage. Rational use of IV and effective integration with other causal inference methods will become the focus of the development of causal inference in environmental epidemiology. The aim of this paper is to provide a methodological reference and basis for future studies involving causal inference to target population health effects of environmental exposures in China.

Análisis de las propiedades psicométricas del Cuestionario de Competencias Socioemocionales SEC-Q en estudiantes universitarios chilenos / Analysis of the psychometric properties of the Social and emotional Competencies Questionnaire SEC-Q in Chilean university students

Introducción/objetivo: Las competencias socioemocionales median la gestión emocional y el ajuste social, son relevantes para el aprendizaje, el desempeño profesional, la salud mental y el bienestar entre otras. El objetivo de este estudio es analizar las propiedades psicométricas del Cuestionario de Competencias Socioemocionales SEC-Q en estudiantes universitarios chilenos. Método: Los participantes fueron 699 estudiantes universitarios, 493 mujeres y 206 varones. La estructura interna se analizó mediante validación cruzada, aplicando análisis factorial exploratorio y confirmatorio. La validez convergente y discriminante fue evaluada mediante correlaciones de Pearson entre las subescalas del SEC-Q con: la Escala Autoeficacia Percibida Especifica de Situaciones Académicas, Satisfacción con la vida e Inventario de Burnout de Maslach. Resultados: El cuestionario evidencia adecuadas propiedades psicométricas y los cuatro componentes del instrumento original: autoconciencia, autogestión, conciencia social y toma de decisiones; se presentan de acuerdo con lo esperado, una relación directa con autoeficacia y satisfacción con la vida, e inversa con el estrés. La conciencia social presentó diferencias según el género, siendo mayor en mujeres que en hombres. Conclusión: El SEC-Q es un instrumento confiable y válido para utilizar con estudiantes universitarios chilenos.

Introduction/objective: Socio-emotional competencies are skills that mediate between emotional management and social adjustment. These skills are relevant for: learning, professional performance, mental health, and well-being. The objective is to analyze the psychometric properties of the Social and emotional Competencies Questionnaire SEC-Q in Chilean university students. Method: The sample included 699 university students, 493 women and 206 men. The internal structure was analyzed through cross validation, an exploratory and confirmatory factorial analysis. Convergent and discriminant validity were determined using the Pearson correlation coefficient between the subscales of the SEC-Q with the Scale of Perceived Self-Efficacy Specific to Academic Situations, Life Satisfaction and Maslach Burnout Inventory. Results: adequate psychometric properties in the questionnaire, observing the four components proposed by the structure of the original instrument - self-awareness, self-management, social awareness and decision-making. These competencies showed, as expected, a positive relationship with self-efficacy and life satisfaction, and an inverse relationship with stress. Also, social awareness presented differences according to gender, being higher in women than in men. Conclusion: The SEC-Q is a reliable and valid instrument for the evaluation of Chilean university students.

Análisis microbiológico a corto y largo plazo del material usado para esterilizar instrumental odontológico / Short and long-term microbiological analysis of the material for sterilize dental instruments

Introducción: el material para empaquetar el instrumental odontológico, como pueden ser bolsas de tela, papel o plástico, es usado por profesionales de la salud; sin embargo, es necesario esclarecer la efectividad de cada uno y determinar el tiempo que permanece estéril luego del procedimiento. Objetivo: identificar la eficacia de tela, plástico y papel como materiales para esterilizar instrumental a corto y largo plazo. Material y métodos: se realizaron cultivos sólidos y líquidos de instrumental esterilizado en tres materiales y con diferentes tiempos de postesterilización. Se incubaron a 36 oC por 72 horas en condiciones aerobias y anaerobias. Los resultados se analizaron usando una prueba de Kruskal-Wallis, seguida de una prueba de Dunn. Resultados: los resultados mostraron que inmediatamente después del proceso de esterilización, los tres materiales son efectivos (Kruskal-Wallis test, p = 0.2752), 24 horas (p = 0.2492), siete (p = 0.0509) y 14 días (p = 0.0006). Veinticuatro horas posterior a la esterilización la tela no es efectiva, el plástico disminuye su efectividad y el papel sigue siendo efectivo. Conclusión: en nuestros resultados, el papel es la mejor opción para esterilizar instrumental (AU)

Introduction: material such as cloth, paper or plastic bags to wrap dental instruments is used by health professionals, however, it is necessary to clarify the effectiveness of each one and determine if it remains sterile after the procedure. Objective: to determine the effectiveness of cloth, plastic and paper as materials to sterilize dental instruments in the short and long term. Material and methods: we carry out solid and liquid cultures of sterilized instruments in three materials, at different post-sterilization times, incubated at 36 oC for 72 hours under aerobic and anaerobic conditions, and the results were analyzed using a Kruskal-Wallis test, followed by from a Dunn's test. Results: our results showed that immediately after the sterilization process the three materials are effective (Kruskal-Wallis; p = 0.2752), 24 hours (p = 0.2492), 7 (p = 0.0509) and 14 (p = 0.0006) days. Twenty-four hours after the cloth is not effective, plastic decreases its effectiveness and paper remain effective. Conclusion: in our results, paper is the best option to sterilize dental instruments (AU)

Protective effects of ginseng total saponins on reward-directed operant conditioning in hindlimb suspension rats / 数字中医药（英文）

Objective@#To explore the therapeutic effects of ginseng total saponins (GTSs) on cognitive impairments in astronauts caused by prolonged exposure to microgravity environment.@*Methods@#Fifty specific pathogen-free (SPF) male Wistar rats were randomized into control, hindlimb suspension (HLS), Huperzine A (HLS-Hup A 0.1 mg/kg), low-dose GTSs (HLS-GTSs 100 mg/kg), and high-dose GTSs (HLS-GTSs 200 mg/kg) groups, based on the completion time of reward-directed conditioning tasks. Except for rats in the control group, the others were subjected to HLS and treated with drugs (day 20 – 58), received reflex test under the condition of rewarding, and underwent Nissl body staining and Western blot detection on hippocampal.@*Results@#After modeling, rats in HLS group exhibited a reduction in the number of lever presses and an increase in the completion time of the reward-directed operant conditioning task Ⅰ (P < 0.05) when compared with the control group, which were not substantially altered in the HLS-GTSs 100 and 200 mg/kg groups (P > 0.05). In the reward-directed operant conditioning task Ⅱ, the HLS group rats demonstrated a marked decrease in the number of lever presses (P < 0.05) and nose pokes (P < 0.01) when compared with the control group rats; the HLS-GTSs 100 mg/kg showed a significant increase in the number of lever presses and nose pokes (P < 0.05), while the HLS-GTSs 200 mg/kg demonstrated a significant reduction in completion time and an elevation in the number of lever presses (P < 0.05) when compared with the HLS group rats. In visual signal discrimination task, compared with the control group rats, the HLS group rats showed decrease in the indexes of the visual signal discrimination(P < 0.01), while HLS-GTSs 100 and 200 mg/kg groups exhibited manifest increase in it (P < 0.01). In reward extinction experiment, the number of lever presses in HLS rats significantly increased when compared with the control group (P < 0.01); compared with the HLS group, HLS-GTSs 100 and 200 mg/kg groups demonstrated a marked descrease (P < 0.05). The expressions of N-methyl-D-aspartic acid receptor 1 (NR1) and phosophorylated N-methyl-Daspartic acid receptor 2B (p-NR2B) proteins were markedly decreased in rats in the HLS group (P < 0.05 and P < 0.01, respectively), while that of NR2B protein maintained the same (P > 0.05). GTSs increased the expression levels of p-NR2B (P < 0.01).@*Conclusion@#GTSs improved the learning and memory ability of complex operations by regulating the NR1/NR2B phosphorylation pathways in rats.

Effect of low volume background instrumental flute music on visual reaction time: a cross sectional interventional study

Background: Music is believed to affect the cognitive function. However, there is conflicting evidence about the effect of background music on the same. Few studies have been done on the effect of instrumental music on cognition. Aim and Objective: The aim of our study was to study the effect of low-volume instrumental music on visual reaction time (RT). Materials and Methods: Visual RT (simple reaction time [SRT] and choice reaction time [CRT]) using Deary–Liewald software was recorded in 48 medical students aged 18–21 years, without, and then with low-volume background instrumental flute music. Results were compared with regard to change in mean values of SRT, CRT, and mean central processing time. Data were analyzed statistically using unpaired t-test and statistical significance (P < 0.05) was sought. Results: We did not find any statistically significant change in visual RT after subjecting the students to low-volume background instrumental music. Conclusion: Background instrumental does not significantly affect visual RT but this should be further analyzed.

Effect of Cooking on Physicochemical and Microstructural Properties of Chicken Breast Meat

The effect of cooking on pH, juiciness, instrumental colour and microstructural properties of chicken breast meat was investigated. Industrial skinless chicken breast meat samples were purchased, frozen and sliced into dimensions , thawed and cooked by air frying (AF), baking (BK), deep fat frying (DF) and grilling (GR) at 170, 180 and 1900C for 0, 4, 8, 12 and 16 min. The pH value of the cooked samples increased from 6.05 to 6.25. Cooking methods, temperatures and times each resulted to increase in pH. The results of objective sensory instrumental analyses showed that cooking decreased significantly (p < 0.05) juiciness of cooked chicken breast meat. Samples cooked by BK had the highest juiciness value of 24.91%, while DF cooked samples had the least value of 13.89%.The instrumental analyses increased L*, a*, b* values and browning index. The temperature and time of cooking showed similar effects on juiciness and instrumental colour. Short cooking time (8 min) and 1700C resulted in higher juiciness and best appetizing appearance to the consumers. The microstructure studies showed that raw chicken breast meat had an intact muscle fibres and bundles, but cooking caused disintegration of muscle fibres, perimysial – collagen shrinkage and it resulted to drier samples with big cracks/ voids and big surface damages, particularly in AF, BK and GR cooked products at 1900C for 8 min.

Efecto de las Técnicas Instrumentales KineticXer® en la Modificación de Parámetros Séricos y Mecánicos en Usuarios Sedentarios con Dolor Lumbar Inespecífico / Effect of KineticXer® Instrumental Techniques in the Modification of Serum and Mechanical Parameters in Sedentary Users with Nonspecific Low Back Pain

Introducción. El dolor lumbar es una de las causas mas comunes de discapacidad en el mundo, existen diferentes tratamientos conservadores dentro de la kinesiología para el manejo de este. La presente investigación describe los efectos de la aplicación de técnicas de liberación miofascial instrumental y, cómo éstas modifican parámetros mecánicos y la expresión de parámetros séricos, tales como: Leucocitos, Bilirrubina y Fierro en estudiantes sedentarios que presenten dolor lumbar inespecífico de la Universidad de las Américas. Objetivo. Describir el efecto de la técnica de liberación miofascial instrumental en la modificación de parámetros mecánicos y séricos en usuarios sedentarios con dolor lumbar inespecífico. Métodos. Analítico experimental. Resultado. Fueron intervenidos 14 participantes sedentarios con dolor lumbar inespecífico, los resultados no fueron significativos en los cambios serios, por el contrario, fueron significativo en los cambios mecánicos. Conclusión. Las técnicas de liberación miofascial instrumental pueden ser una herramienta eficaz para el manejo del dolor lumbar inespecífico, pero faltan mas estudios para demostrar sus efectos a nivel sérico.

Introduction. Low back pain is one of the most common causes of disability in the world, there are different conservative treatments within kinesiology for its management. The present research describes the effects of the application of instrumental myofascial release techniques and how they modify mechanical parameters and the expression of serum parameters, such as: Leukocytes, Biliverdin and Iron in sedentary students with non-specific lumbar pain from the University of Las Américas. Objective. To describe the effect of the instrumental myofascial release technique in the modification of mechanical and serum parameters in sedentary users with nonspecific low back pain. Methods. Case series Results. 14 sedentary participants with non-specific lumbar pain were operated on, the results were not significant in the serious changes, on the contrary, they were significant in the mechanical changes. Conclusion. Instrumental myofascial release techniques can be an effective tool for the management of nonspecific low back pain, but more studies are needed to demonstrate their effects at the serum level.

Common gait assessment methods for neurological diseases / 中华神经科杂志

Gait is a behavioral characteristic of human walking. The formation mechanism of gait is complex and involves multiple organ systems throughout the body, so there are many factors that affect it. Many factors, such as genetics, diseases and accidental injuries, can change a certain link in the walking cycle, leading to changes in gait and abnormal gait. Accurate assessment of abnormal gait can help diagnose the disease, determine the severity of the disease, predict symptom improvement and future functional status, plan appropriate treatment targets, and monitor the effectiveness of interventions. This paper reviews the gait assessment methods commonly used in neurology, including qualitative gait assessment, scale assessment and instrumentalized gait assessment, in order to improve medical staff′s understanding and application ability of common gait assessment methods.

Evaluation of the Efficacy and Safety of Chemotherapy in Elderly Patients with Multiple Myeloma under Different Frailty Scores / 中国实验血液学杂志

OBJECTIVE@#To compare the efficacy and safety of different chemotherapy regimens in elderly multiple myeloma (MM) patients with different Frailty scores.@*METHODS@#The clinical data of elderly patients with MM were retrospectively analyzed, including age, treatment regimen, efficacy, adverse reactions, and the Frailty score included in the activity of daily living score, the instrumental activity of daily living scale and the Charlson comorbidity index. The patients were divided into fit group, mediate fit group and frail group according to the scoring standard. The treatment efficiency and adverse reaction rates of elderly MM with different physical conditions treated by different chemotherapy regimens were analyzed.@*RESULTS@#Among the 70 patients, the effective rates of the patients in fit group, the mediate fit group, and the frail group were 79.5%, 81%, and 40%, and the effective rates of the fit patients in double and triple groups were 54.5% and 89.3%, 70% and 90.9% for mediate fit patients, 42.9% and 33.3% for frail patients, the triple regimen in fit patients showed obvious advantages, and the difference showed statistically significant (P<0.05), while the efficacy for mediate patients and frail patients showed no significant difference. During the induction of bortezomib, the incidence of adverse reactions for the patients in the triple group (78.6%) was higher than 67.9% in the double group, and the difference showed no statistically significant (P>0.05).There was no significant difference in the 1-year overall survival rate of the patients and with molecular genetic abnormalities among each groups.@*CONCLUSION@#The therapeutic effect is related to the patient's physical condition. For patients with healthy physique, the triple regimen should be used first. For patients with weak physical constitution, the chemotherapy regimen with low drug toxicity should be selected for safety.

Identifying causal effects based on instrumental variables and distinguishing different models with data / 四川精神卫生

The purpose of this paper was to introduce the methods of identifying causal effects based on instrumental variables， distinguishing different models with data， and using SAS software to realize calculation. Firstly， the four main contents of causal graph theory were introduced， including sources of association， statistical properties of causal models， identification and adjustment， and instrumental variables. Secondly， for two examples and with the help of the CAUSALGRAPH procedure in SAS/STAT， the following two tasks were completed： the first task was to identify causal effects using instrumental variables； the second task was to use data to distinguish different models.

Constructing and searching adjustment sets based on a causal graph model / 四川精神卫生

The purpose of this paper was to introduce the basic knowledge of the causal graph model， the contents of the CAUSALGRAPH procedure and the method of constructing and searching adjustment sets based on the CAUSALGRAPH procedure in SAS/STAT. The causal graph model was the product of the combination of graph theory and probability theory. It could find all possible adjustment sets including the minimum adjustment set based on the action relationship between the variables set by the user. The contents of the CAUSALGRAPH procedure mainly included three identification criteria， two operating modes and one verification checking method. This paper analyzed the causal effect of two instances based on the CAUSALGRAPH procedure in SAS， and explained the output results.

Listado oficial de material, instrumental y equipo odontológico / Official list of material, instruments and equipment dental

La revisión y actualización del Listado Oficial de material, instrumental y equipo odontológico del Ministerio de Salud (MINSAL), ha sido coordinada por la Oficina de Salud Oral, de la Dirección de Políticas y Gestión de Salud, con el apoyo de la Dirección de Regulación y la Dirección de Cadena de Suministros, así como también con odontólogos de las diferentes Regiones de Salud y Nivel Local. La actualización del documento, permite la inclusión de nuevos insumos, materiales, instrumental y equipo odontológico; con el fin de utilizarlos en base a los avances tecnológicos de la industria odontológica, eliminar aquellos que ya no se utilizan y que pueden ser reemplazados por otros de mejor calidad

The review and updating of the Official List of dental material, instruments and equipment of the Ministry of Health (MINSAL), has been coordinated by the Office of Oral Health, of the Directorate of Health Policies and Management, with the support of the Directorate of Regulation and the Supply Chain Department, as well as with dentists from the different Health Regions and the Local Level. Updating the document allows the inclusion of new supplies, materials, instruments and dental equipment; in order to use them based on technological advances in the dental industry, eliminate those that are no longer used and that can be replaced by others of better quality

Entrenamiento de la memoria de trabajo en la enfermedad vascular cerebral: revisión sistemática / Working Memory Training after cerebrovascular disease: a systematic review / Treinamento Da Memória Operacional Na Doença Cerebrovascular: Revisão Sistemática

Objetivo: mejorar la independencia funcional de los pacientes con enfermedad vascular cerebral (EVC) es uno de los objetivos que se plantean los equipos de rehabilitación física y cognitiva. Uno de los modelos que podría dar respuesta a este objetivo es el entrenamiento cognitivo de la memoria de trabajo (MT). Aunque esta estrategia se viene estudiando desde hace 20 años, aún es necesario realizar un estudio de revisión sistemática que permita conocer con claridad los efectos del entrenamiento cognitivo computarizado de la MT en el funcionamiento de la vida diaria en pacientes con EVC isquémica. Metodología: para ello, se creó una ecuación de búsqueda para aplicar en la base de datos Web of Science (WoS), en el rango temporal desde enero de 2010 a enero de 2019. Posteriormente, se realiza un análisis bibliométrico con el objetivo de identificar los autores y revistas más importantes sobre el tema de investigación. Finalmente, el reporte cronológico identifica la evolución y avances del impacto de los entrenamientos de la memoria de trabajo en la EVC. Resultados: se encontraron tres enfoques relacionados con: efectos de un programa de realidad virtual en las actividades de la vida diaria, efectos del entrenamiento de la MT en la plasticidad cerebral y efectos del entrenamiento cognitivo de la MT en las actividades de la vida diaria. Conclusión: se ha propuesto el desempeño cognitivo como uno de los componentes más importantes del funcionamiento en la vida diaria, particularmente la MT como mediador entre los programas de entrenamiento cognitivo y las habilidades funcionales. Los entrenamientos cognitivos reducen el deterioro cognitivo y el riesgo de demencia. Sin embargo, los beneficios de un entrenamiento cognitivo se limitan a dominios muy similares a los entrenados (transferencia cercana, más que lejana).

Objective: improving functional independence of patients with cerebrovascular disease has become one of the main goals for physical and cognitive rehabilitation teams. A well-known framework that addresses this issue is Working Memory Training. Although this model has been studied for more than twenty years, a systematic review on the effects of Working Memory Training after ischemic stroke and its impact on everyday functioning is still needed. Methodology: thus, a search equation has been proposed on Web of Science database from January 2010 to January 2019. Then, a bibliometric analysis presents the most important authors and journals in the research topic. Finally, a chronological report shows advanced research lines and effects of Working Memory Training in patients with cerebrovascular disease. Results:these findings showed 3 approaches related to the following: effects of virtual reality-based programs on everyday functioning, effects of Working Memory Training on brain plasticity, and effects of Working Memory Training on everyday life. Conclusion: cognitive performance has been proposed to be one of the most important components of functioning in daily life. Working Memory has been shown to strongly mediate between cognitive training and functional abilities. Cognitive training is asso-ciated with less cognitive decline and reduced risk of dementia. However, the benefits from cognitive training may be limited to highly similar domains (close transfer rather than far transfer).

Introdução: melhorar a independência funcional do paciente com doença cerebrovas-cular (DCV) é um dos objetivos traçados pelas equipes de reabilitação física e cognitiva. Um dos modelos que poderia responder a esse objetivo é o treinamento cognitivo da memória de trabalho (MT).Objetivo: embora essa estratégia seja estudada há 20 anos, ainda é necessário realizar um estudo de revisão sistemática que nos permita conhecer claramente os efeitos do treinamento cognitivo computadorizado da MT no funcionamento da vida diária em pacientes com DCV isquêmica.Metodologia: para isso, foi criada uma equação de busca a ser aplicada na base de dados Web of Science (WoS), no período de janeiro de 2010 a janeiro de 2019. Pos-teriormente, é realizada uma análise bibliométrica a fim de identificar os autores mais importantes e periódicos sobre o tema de pesquisa. Por fim, o relatório cronológico identifica a evolução e a evolução do impacto do treino da memória de trabalho no CVS.Resultados: foram encontradas três abordagens relacionadas a: efeitos de um programa de realidade virtual nas atividades da vida diária, efeitos do treinamento da MT na plas-ticidade cerebral e efeitos do treinamento cognitivo da MT nas atividades da vida diária.Conclusão: o desempenho cognitivo tem sido proposto como um dos componentes mais importantes do funcionamento na vida diária, particularmente a MT como media-dor entre programas de treinamento cognitivo e habilidades funcionais. O treinamento cognitivo reduz o declínio cognitivo e o risco de demência. No entanto, os benefícios do treinamento cognitivo são limitados a domínios muito semelhantes aos treinados (transferência próxima, em vez de distante).

Confiabilidad por el método test retest del Barómetro de la Familia versión peruana / Reliability by test retest method of the Peruvian version of Family Barometer

Resumen Objetivo: Determinar la confiabilidad del Barómetro de la Familia por medio del método test retest. Método: Estudio de tipo instrumental, se evaluó a 299 personas que vivían con sus parejas y/o hijos al momento de ser evaluados, el 83,6 % de la muestra fueron mujeres. El rango de edad fluctuó entre los 18 y 65 años (M=40,7 años). El Barómetro de la Familia (versión peruana) está compuesto por 98 ítems con diferentes opciones de respuesta (dicotómico, Likert, respuesta múltiple nominal y abierto de respuesta numérica) que evalúan la estructura y la dinámica familiar, además de la percepción que se tiene sobre temas relacionados a la familia como el aborto o el matrimonio. Se aplicaron los estadísticos kappa de Cohen (κ) y coeficiente de correlación intraclase (CCI). Resultados: La mayoría de reactivos que indagan sobre la estructura, dinámica familiar, violencia y conductas de riesgo son confiables (κ≥ 0,4 o CCI≥ 0,4). Por otro lado, preguntas sobre la separación, matrimonio, homosexualidad y aborto no son confiables (κ< 0,4 o CCI< 0,4). Conclusión: El cuestionario del Barómetro de la Familia demostró ser confiable en la medición de diversas características familiares en la población peruana.

Abstract Objective: It is to determine the reliability of the Family Barometer using the test retest method. Method: An instrumental study, 299 people living with their partners and / or children were evaluated at the time of evaluation, 83,6 % of the sample were women. The age range fluctuated between 18 and 65 years (M = 40,7 years). The Family Barometer (Peruvian version) is made up of 98 items with different response options (dichotomous, Likert, multiple nominal response and open numerical response) that evaluate the family structure and dynamics, in addition to the perception that one has about family related issues like abortion or marriage. Cohen's kappa statistics (κ) and intraclass correlation coefficient (ICC) were applied. Results: Most of the items that inquire about the structure, family dynamics, violence and risk behaviors are reliable (κ≥ 0,4 or CCI≥ 0,4). On the other hand, questions about separation, marriage, homosexuality and abortion are not reliable (κ <0,4 or ICC <0,4). Conclusion: The Family Barometer questionnaire proved to be reliable in measuring various family characteristics in the Peruvian population.

Instrumental piezoeléctrico comparado con sierra convencional en cirugía ortognática / Piezoelectric bone surgery compared to conventional saw in orthognathic surgery

RESUMEN: Introducción: La utilización de instrumental piezoeléctrico en cirugía ortognática ha ido en aumento con el fin de minimizar el riesgo de daño a tejidos blandos en comparación al uso de sierra convencional. Sin embargo, aún existe incertidumbre respecto a las complicaciones asociadas a cada instrumental. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un meta análisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos cuatro revisiones sistemáticas que en conjunto incluyeron 10 estudios primarios, de los cuales, cuatro corresponden a ensayos aleatorizados. Concluimos que el uso de instrumental piezoeléctrico en comparación con la sierra convencional podría disminuir el riesgo de daño nervioso grave y disminuir el sangrado grave (>500 mL), pero la certeza de la evidencia es baja. Por otra parte, el uso de instrumental piezoeléctrico podría presentar poca o nula diferencia en el dolor postoperatorio, pero la certeza de la evidencia es baja. Finalmente no es posible establecer con claridad si el uso de instrumental piezoeléctrico disminuye la pérdida de sangre intraoperatoria (variable continua), la inflamación postoperatoria o el tiempo operatorio, ya que la certeza de la evidencia existente ha sido evaluada como muy baja.

ABSTRACT: Introduction: The use of piezoelectric bone surgery in orthognathic surgery has been increasing to minimize the risk of soft tissue damage compared to conventional saws. However, there is still uncertainty regarding the complications associated with each instrument. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed primary studies' data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified four systematic reviews that included 10 primary studies, four of which corresponded to randomized trials. We conclude that the use of piezoelectric instrumentation compared to the conventional saw may reduce the risk of severe nerve damage and decrease severe bleeding (>500 mL), but the certainty of the evidence is low. On the other hand, the use of piezoelectric bone surgery may make little or no difference in postoperative pain, but the certainty of the evidence is low. Finally, we are uncertain whether piezoelectric bone surgery reduces intraoperative blood loss (continuous variable), postoperative inflammation, and operative time, as the certainty of the evidence has been assessed as very low.

Instrumental piezoeléctrico en comparación a instrumental rotatorio convencional para la exodoncia de terceros molares mandibulares / Piezoelectric bone surgery versus conventional rotatory system for lower third molar surgery

RESUMEN: Introducción: Tradicionalmente la osteotomía requerida en la exodoncia de terceros molares mandibulares incluidos o semi-incluidos ha sido realizada con instrumental manual o rotatorio. Con el advenimiento de la técnica ultrasónica de la cirugía piezoeléctrica, se hace necesario comparar la seguridad y efectividad de ambas técnicas. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos ocho revisiones sistemáticas que en conjunto incluyeron 22 estudios primarios, de los cuales 12 corresponden a ensayos clínicos aleatorizados. Concluimos que el uso de instrumental piezoeléctrico en comparación con el instrumental rotatorio convencional podría aumentar el tiempo quirúrgico y podría disminuir el dolor temprano y tardío, junto con el edema al día siete, pero la certeza de la evidencia es baja. Por otra parte, el uso de instrumental piezoeléctrico podría resultar en poca o nula diferencia en el desarrollo de alteraciones neurológicas postoperatorias ya que la certeza de la evidencia es baja. Además, el uso de piezoeléctrico probablemente resulte en poca o nula diferencia en la apertura bucal.

ABSTRACT: Introduction: Traditionally, osteotomy techniques required in exodontia of included or semi-included mandibular third molars has been performed with manual or rotary instruments. With the advent of the ultrasonic technique of piezoelectric surgery, it is necessary to evaluate the effectiveness and safety of both osteotomy techniques. Methods: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed primary studies' data, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. Results and conclusions: We identified eight systematic reviews that together included 22 primary studies overall, of which 12 were randomized trials. We conclude that the use of piezoelectric surgery compared with conventional rotary instruments may increase operative time and reduce early and late pain, along with edema at day seven, but the certainty of the evidence is low. On the other hand, the use of piezoelectric instrumentation may result in little or no difference in the development of postoperative neurologic disturbances as the certainty of the evidence is low. Also, piezoelectric use probably makes little or no differences in mouth opening.

Parámetros de incubación del starter de Lactobacillus para su aplicación en pan campesino / Incubation parameters of the Lactobacillus starter for application in sourdough bread

RESUMEN El fermento natural o starter es un insumo panadero, que se ha revalorizado, en la actualidad, por sus beneficios y por su aporte de sabor. En este estudio, se determinaron los parámetros de cultivo del starter espontáneo de Lactobacillus, a partir de harina integral, para aplicarlo en la elaboración de pan campesino, en función de sus características sensoriales y mecánicas. Se elaboraron tres starters, para lo cual, se mezcló harina integral con agua, en una proporción de 45,5 y 54,5%, respectivamente; posterior a ello, se fermentaron, espontáneamente, a 20, 24 y 28°C, hasta un pH final de 4, a partir de los cuales, se elaboraron panes campesinos. Los panes fueron evaluados sensorialmente, por un panel de expertos (07), mediante una escala lineal no estructurada de 5 puntos, en cuanto a la forma ovalada, apariencia de la costra, masticabilidad de miga, gusto ácido y apariencia de los alveolos. El pan elaborado con el fermento a 24°C fue seleccionado por los panelistas, debido a que presentó puntajes superiores (p<0,05), en los atributos de apariencia de la costra (4,24), masticabilidad de la miga (5,0), gusto ácido (4,67) y apariencia de los alveolos (4,0). El fermento empleado presentó 79 x 107 UFC g-1 de bacterias acidolácticas. Finalmente, la textura del pan campesino seleccionado fue caracterizada instrumentalmente en términos de dureza (102,09N), gomosidad (43,02N), masticabilidad (37,36N), elasticidad (0,87) y cohesividad (0,42), perfil que se puede emplear como parámetro de calidad, para pan campesino y otras variedades similares.

ABSTRACT The natural ferment or sourdough starter is a bakery input that has been revalued nowadays for its benefits and flavour improve. In this study, the incubation parameters of the spontaneous Lactobacillus starter made with wholemeal flour were determined to be applied in sourdough bread production depending on its sensory and mechanical characteristics. Three starters were made with wholemeal flour mixed with water in a proportion of 45.5 and 54.5% respectively, then were fermented spontaneously at 20, 24 and 28°C until a final pH of 4, from which sourdough breads were produced. The breads were sensory evaluated by a panel of experts (07), using a 5-point unstructured linear scale, in terms of oval shape, crust appearance, crumb chewiness, sourness and alveoli appearance. The bread made with the starter at 24°C was selected because of the higher scores (p<0.05) in the attributes of crust appearance (4.24), crumb chewiness (5.0), sourness (4.67) and alveoli appearance (4.0). The starter used exhibit 79 x 107 CFU g-1 of lactic acid bacteria. Finally, the texture of the selected sourdough bread was characterized in terms of hardness (102.09N), gumminess (43.02N), chewiness (37.36N), springiness (0.87) and cohesiveness (0.42), a profile that can be used as a quality parameter for sourdough bread and other similar varieties.