La prevención del embarazo en la adolescencia desde un enfoque interdisciplinario, humanista, activo y transformador

Introducción: El embarazo en la adolescencia constituye un problema de salud de carácter complejo que exige para su prevención el empleo de un enfoque holístico, sustentable desde posicionamientos colaborativos e intersectoriales. Objetivo: Elaborar una estrategia para la prevención del embarazo en la adolescencia desde un enfoque interdisciplinario, humanista, activo y trasformador. Materiales y métodos: Investigación descriptiva, longitudinal y retrospectiva, comprendida entre mayo y diciembre de 2023. Entre los métodos empleados se encuentran el histórico-lógico, el analítico-sintético, la sistematización y la modelación, aplicados fundamentalmente en el diseño categorial de la estrategia y sus contenidos estructurales. También se empleó la revisión de documentos, la encuesta y la conformación de un grupo focal para la recogida de información empírica vinculada al proceso de prevención y a la obtención de criterios valorativos. Resultados: Se evidencia, en el diseño de las acciones estratégicas, la integración de varias disciplinas como medicina familiar, sicología, derecho médico, ginecobstetricia y educación para la salud, así como relaciones interprofesionales entre especialistas de la salud, docentes, trabajadores sociales y líderes comunitarios. Concluida la implementación de la estrategia, en el orden cognitivo-comunicacional, se constata un posicionamiento proactivo de los adolescentes en el autocuidado y la autogestión de salud, desde una proyección trasformadora e intersectorial. Conclusiones: Prevalecen criterios valorativos favorables y un ordenamiento organizacional de alcance intersectorial, que indican la pertinencia del enfoque interdisciplinario, humanista, activo y trasformador aplicado a la estrategia para la prevención del embarazo en la adolescencia, constatándose el cumplimiento del objetivo propuesto.

Introduction: Adolescent pregnancy is a complex health problem that requires the use of a holistic approach, sustainable from collaborative and intersectoral positions, for its prevention. Objective: To prepare a strategy for the prevention of pregnancy in adolescence from an interdisciplinary, humanistic, active and transformative approach. Materials and methods: Descriptive, longitudinal and retrospective research carried out between May and December 2023. Among the methods used are historical-logical, analytical-synthetic, systematization and modeling, mainly applied in the categorical design of the strategy and its structural contents. The review of documents, the survey and the formation of a focal group for the collection of empirical information linked to the prevention process and to obtain evaluative criteria were also used. Results: In the design of strategic actions, the integration of several disciplines such as family medicine, psychology, medical law, gyneco-obstetrics, and health education, as well as inter-professional relationships between health specialists, teachers, social workers and community leaders, is evidenced. After the implementation of the strategy, in the cognitive-communicational order, it was stated a proactive positioning of adolescents in self-care and self-management of health, from a transformative and intersectoral projection. Conclusions: Favorable evaluative criteria and an organizational arrangement of intersectoral scope prevail, which indicate the relevance of interdisciplinary, humanistic, active and transformative approach applied to the strategy for the prevention of pregnancy in adolescence, confirming the fulfillment of the proposed objective.

Avances de un estudio psicoanalítico acerca de la distancia afectiva en la relación madre-bebé / Advances of a psychoanalytic study about the affective distance in the mother-baby relationship

Medir el empuje que transmite la voz materna es casi inconcebible, (Didier-Weill,1998) ya que la estructura de su discurso primordial incluye una paradoja. ¿De qué manera entonces medir un espacio de encuentro que está en construcción? Este estudio explora la distancia afectiva en la díada madre-bebé desde una perspectiva intersubjetiva, durante la emisión del fenómeno sonoro denominado "tono maternés". Como parte de los avances de la investigación en curso, se destaca el valor de la interdisciplina para la obtención de los datos y el modo en que su procesamiento conduce a una posible categorización de su objeto de estudio. La consulta a expertos (del campo de la fonoaudiología y la psicomotricidad) permitió abordar un "único cuerpo suficientemente complejo"(Bernardi,2000)y de este modo cercar la realidad compartida. Se acuerda con Winnicott (1989) en la idea de que, si distintos observadores llegan a conclusiones semejantes, probablemente signifique que se ocupan de cosas reales(AU)

Measuring the drive transmitted by the maternal voice is almost inconceivable (Didier-Weill 1998). This statement is based on the idea that the primordial discourse structure is paradoxical. How then, to measure a meeting space that is under construction. One of the objectives of this psychoanalytic thesisis to explore the affective distance present in the dyad, while she emits the sound phenomenon 'babytalk'. As part of the progress, the author presents some moments of the investigation. This paper highlights the value of interdisciplinary approach to obtain the data and presents a possible categorization of the affective distance present in the early relationship.To study the real movements for the psychical constitution, it was required the dialogue with experts (from the areas of phonology and psychomotricity) to border a shared reality and address a "single sufficiently complex body (Bernardi, 2000). In agreement with Winnicott (1989), if different observers arrive at a similar conclusion, it possibly implies that they are dealing with real things(AU)

Evaluation of metabolic syndrome and obesity in breast cancer survivors undergoing interdisciplinary approach: a prospective cohort study

Objective: The purpose of this study was to evaluate the occurrence of the metabolic syndrome and obesity during the first year after the diagnosis of breast cancer in women undergoing interdisciplinary approach. Methods: In this prospective study, 81 women (age ≥45 years) with recent histological diagnosis of breast cancer, no established cardiovascular disease, who attended at a single specialized center with an interdisciplinary approach (medical, nutritionist, and psychological) were included. Results: Women with metabolic syndrome were considered to have three or more diagnostic criteria: waist circumference >88 cm, triglycerides ≥150 mg/dL, high-density lipoprotein <50 mg/dL, blood pressure ≥130/85 mmHg, and glucose ≥100 mg/dL. Obesity was considered when body mass index >30 kg/m2 and abdominal obesity with waist circumference >88 cm. The evaluations were carried out at three time points: first cancer visit (T0m), 6 months (T6m), and 12 months (T12m). For statistical analysis, the McNemar test was used to compare these time points and the chi-square test was used for trends. The mean age of the patients was 58.4±10.7 years, and 83.3% of them were in the postmenopausal stage. There were no differences in the metabolic syndrome, body mass index, and waist circumference assessments at the indicated time points. When comparing the individual quantitative criteria for metabolic syndrome, there was a statistically significant difference in the values of triglycerides and blood glucose. At times T0m, T6m, and T12m, an increase in the mean triglyceride values was observed, 121, 139.4, and 148.46 mg/dL (p=0.003) and a reduction in the mean glucose values, 106.6, 100.46, and 98.96 mg/dL (p=0.004), respectively. Conclusion: Women with breast cancer subjected to interdisciplinary evaluation did not show an increase in the occurrence of metabolic syndrome and obesity during the first year following their cancer diagnosis.

Humanidades Médicas e seu Lugar no Currículo: Opiniões dos Participantes do Cobem/2017 / Medical Humanities and their Place in the Curriculum: Opinions of Cobem/2017 Participants

Resumo: É crescente a percepção de que uma formação médica com enfoque exclusivo nas disciplinas biológicas é insuficiente para a apreensão da complexidade e da singularidade do adoecimento humano. Partimos, assim, do pressuposto de que as humanidades médicas oferecem uma contribuição importante para a formação médica, por meio de referências para uma compreensão ampliada do processo saúde-doença e para a organização do cuidado em saúde, isto é, voltadas para a humanização. Este trabalho buscou conhecer as percepções de um grupo de discentes, docentes e coordenadores de curso médico sobre a integração das disciplinas de humanidades médicas nos currículos dos cursos de Medicina. A pesquisa de abordagem descritiva, quantitativa e de corte transversal consistiu na aplicação de um questionário estruturado a um grupo de participantes do 55º Congresso Brasileiro de Educação Médica (Cobem, Porto Alegre, RS, outubro de 2017), considerado assim uma amostra de conveniência. Os participantes do evento foram abordados nos intervalos das conferências e convidados a responder a um questionário que buscava opiniões sobre a inserção e a integração das disciplinas das Ciências Humanas nos currículos dos cursos de Medicina. O questionário continha ainda a caracterização da amostra quanto à região de origem, ao âmbito jurídico da instituição (privada, pública ou confessional) e ao papel do respondente (docente, discente ou coordenador/a). Foram obtidos 234 questionários, submetidos posteriormente à análise estatística descritiva. A análise evidenciou que as humanidades médicas são percebidas como importantes na formação, mas não há consenso sobre serem fundamentais na aquisição de habilidades humanísticas. As experiências interdisciplinares curriculares existem, porém nem todos percebem as temáticas de humanidades em diversos momentos no currículo médico ou articuladas a outras disciplinas. Enquanto as experiências interdisciplinares são percebidas com maior facilidade, a articulação transversal das temáticas humanísticas aparece em menor medida. De acordo com as respostas, as disciplinas permanecem concentradas apenas nos períodos iniciais, contudo a percepção de suficiência apresenta opiniões divididas. Também há discreta diferença na opinião sobre a articulação das humanidades nos ciclos básico e avançado. A menor percepção de integração das humanidades aparece nas práticas que integram ensino-serviço-comunidade.

Abstract: There is a growing perception that medical training with an exclusive focus on biological disciplines is insufficient for the understanding of the complexity and individuality of human illness. We start from the assumption that medical humanities make an important contribution to medical education, through references to expanded understanding of the health-disease process and to the organization of health care, that is, directed at humanization. This work sought to assess the perceptions of a group of students, teachers and coordinators of a medical course on the integration of the disciplines of medical humanities in the curricula of medical courses. The descriptive, quantitative and cross-sectional research consisted of the application of a structured questionnaire to a group of participants of the 55th Brazilian Congress of Medical Education (COBEM, Porto Alegre, RS, October/2017), considered to be a convenience sample. The event participants were approached during the intervals of the conferences and invited to answer a questionnaire that sought opinions on the insertion and the integration of the disciplines of the human sciences into the curricula of the medical courses. The questionnaire also contained the sample's characterization of the region of origin, the legal scope of the institution (private, public or confessional) and the role of the respondent (teacher, student or coordinator). A total of 234 (two hundred and thirty-four) individuals answered the questionnaires, which were submitted to descriptive statistical analysis. The analysis showed that the medical humanities are perceived as important for the medical formation, but there is no consensus about their being crucial for the acquisition of humanistic skills. There are interdisciplinary curricular experiences; however, not all of them perceive the subjects of humanities at different times in the medical curriculum or articulated with other disciplines. While interdisciplinary experiences are perceived more easily, the cross-sectional articulation of humanistic topics appears to a lesser degree. According to the answers, the disciplines remain concentrated only in the initial periods; however, the perception of sufficiency discloses quite divided opinions. There is also a slight difference in opinion about the articulation of the humanities in the basic and advanced cycles. The lower perception of integration of the humanities appears in practices that integrate teaching-service-community.

La clínica con pacientes crónicos y terminales / The clinic with chronic and terminal patients

El presente trabajo desarrolla la problemática de un sujeto desde que conoce su enfermedad. ¿Cómo vivencia el diagnóstico el pronóstico y la terapia sugerida? ¿Cómo afecta esta situación al resto de los integrantes de la familia? ¿Cuál es el abordaje con pacientes crónicos y terminales? Además se hace incapié en la importancia de un tratamiento interdisciplinario. El rol del psicólogo frente a este tipo de pacientes consiste en sostener una postura ética que no haga foco solo en el diagnóstico orgánico, sino que tome en cuenta el sufrimiento de quien nos convoca, escuchando cuál es su deseo y su proyecto de vida más allá de la enfermedad. Se abordan los siguientes temas: la clínica con niños, el acompañamiento de docentes, clowns o payamédicos en la internación hospitalaria o domiciliaria: el lugar de la familia en este proceso, sus angustias y temores; los avances en la legislación sobre muerte digna; los cuidados paliativos. Algunas viñetas clínicas acompañan los aportes teóricos.

The present work develops the problem of a subject from the knowledge of his illness. How do you experience the diagnosis, prognosis and suggested therapy? How does this situation affect the rest of the family members? What is the approach with chronic and terminal patients? and the importance of an interdisciplinary treatment. The psychologist's role in dealing with this type of patients is to maintain an ethical stance that does not only remain with the organic diagnosis but also takes into account the suffering of the person who summons us, listening to what is his desire and his life project beyond the illness. The following topics are addressed: the clinic with children. The accompaniment of the teachers, clowns or payamédicos in the hospitalization or domiciliary hospitalization. The place of the family in this process, their anxieties and fears. Advances in legislation on dignified death. Palliative care. Some clinical vignettes accompany the theoretical contributions.

A Case of Decision-making by Proxy through Community-based Multidisciplinary Collaboration for a Cancer Patient with Intellectual Disabilities

In recent years, cancer treatment methods have diversified, and there are increasing numbers of occasions where patients or their families are required to make increasingly complex decisions. Currently, there are no guidelines for determining the process and the individual who decides the treatment strategy for cancer patients who are unable to decide for themselves. Particularly, no report has been published on decision-making for end-of-life care in patients with intellectual disabilities. This report documents our involvement in decision-making during end-of-life care for a cancer patient with intellectual disabilities. This patient’s decision-making ability or lack thereof was determined using reliable and validated assessment scales. The collective decision to not resuscitate in case of cardiac arrest and to care for the patient in the palliative care unit was made through a multidisciplinary collaboration between the social welfare team and the hospital based on reports and guidelines from abroad. Going forward, guidelines for decision-making support for terminal ill cancer patients with intellectual disabilities and decision-making by proxies for such patients need to be established in Japan.

Radai tion pelvicopathy:a comprehensive and interdiscipli-nary approach / 医学研究生学报

Radiotherapy is frequently employed as part of the multimodal treatment of cancers.Despite recent advances in ir-radiation techniques, radiation-induced side effects are more common.Radiation enteritis is a term traditionally used to define injury to the small intestine resulting from radiotherapy.The radiotherapy could induce damage of pelvic normal tissue.The most patients with radiation enteritits may also have co-existing radiation-induced damage of pelvic other tissue or organ.The radiation enteritis was man-aged, however, the therapy of pelvic damaged tissue or organ were ignored.Therefore, in 2015, we proposed the concept of radiation pelvicopathy which is most accurate description of the disease process and pathological characteristics.The purpose is to emphasize the interdisciplinary approach of pelvic radiation damage.

Orthognathic surgery on Skeletal Class III patiens with collapsed vertical dimension: case report

Patients who lost posterior teeth due to periodontitis or dental caries have collapsed vertical dimension, unstable occlusion and change of the mandibular position. In particular, patients in orthognathic surgery, clinician should re-establish the pre-operative stable position of mandibular condyle in articular fossa and favorable vertical dimension for high post-operative stability of mandible. Therefore, interdisciplinary approach and co-operation, including prosthetics, orthodontics, oral and maxillofacial surgeon, from diagnosis and treatment plan is important to get a good outcome. This case report was patients who had collapsed occlusal plane due to severe dental caries on maxillary molars with skeletal Class III malocclusion. Before orthognathic surgery, resetting of maxillary occlusal plane with temporary removable denture was performed. Then successful multidisciplinary approach was done and lead to acceptable clinical outcome.

Interdisciplinariedade na resposta a intervenções em hábitos de vida para redução de risco cardiometabólico e a influência da depressão / Interdisciplinary approach in response to lifestyle interventions for reducing cardiometabolic risk and the influence of depression

Introdução: Doenças crônicas não transmissíveis representam as principais morbidades da atualidade, dentre estas o diabetes mellitus (DM) tipo 2 e a depressão, as quais encontram-se frequentemente associadas. Ambas contribuem para complicações cardiovasculares e mortalidade. Há evidências de que intervenções comportamentais trazem benefícios cardiometabólicos e psicológicos. Objetivos: Para avaliar intervenção no estilo de vida, este estudo incluiu: 1) revisão sistemática e metanálise destinada a investigar os efeitos de intervenções no estilo de vida na melhora da depressão em indivíduos de risco ou com diabetes mellitus tipo 2; 2) comparação do efeito de duas intervenções no estilo de vida sobre o risco cardiometabólico e na retenção dos indivíduos ao programa; 3) análise do papel da depressão na resposta cardiometabólica às intervenções, mediada pela inflamação e; 4) avaliação do efeito residual 9 meses após término das intervenções quanto às respostas de variáveis clínicas, qualidade de vida (QV) e depressão. Métodos: Para revisão sistemática os principais bancos de dados bibliográficos foram pesquisados, sendo a meta-análise conduzida por modelos de efeito aleatório. O estudo longitudinal incluiu adultos pré-diabéticos, submetidos a 18 meses de intervenção tradicional (TRD) ou interdisciplinar com psicoeducação (INT) para mudanças em hábitos de vida, sendo os dados coletados (antropometria, pressão arterial, perfil bioquímico e marcadores de inflamação PCR, TNF-, adiponectina) no momento basal, 9 e 18 meses, bem como 9 meses após o término do acompanhamento (27 meses).

Introduction: Nowadays non-communicable chronic diseases, such as diabetes mellitus and depression, are major public health problems worldwide. These conditions are commonly associated and contribute to cardiovascular complications and mortality. Previous studies showed that motivational interviews may improve cardiometabolic and psychological aspects. Objectives: In order to assess lifestyle intervention this study includes: 1) Systematic review and meta-analysis to verify effect of lifestyle interventions on depression; 2) to compare effects of two lifestyle interventions in the cardiometabolic risk and in retention of at-risk individuals; 3) to analyze influence of depression in cardiometabolic response to interventions mediated by inflammation and, 4) to assess residual effect at 9 months after completion of interventions according to clinical variables, quality of life and depression. Methods: In the systematic review major bibliographic databases were searched. Meta-analysis was conducted by random-effects model. The effect of method, duration, and frequency of the interventions were determined via subgroup analyses. Our longitudinal study includes prediabetic adults, submitted to one of two lifestyle interventions (TRD:Traditional or INT:Interdisciplinary). Data were collected (anthropometry, blood pressure, biochemical profile and inflammation markers CRP, TNF-, adiponectin) at baseline, 9th and 18th month, as well as 9 months after completion of interventions (observational phase). Diet was evaluated by 24h recalls and physical activity by IPAQ.

Enfoque interdisciplinario de la salud reproductiva y sexual en la formación de enfermeros universitarios en Cuba / Interdisciplinary approach of reproductive and sexual health in the formation of University Nursing in Cuba

Introducción: en este trabajo se asumió la definición presentada en la Conferencia Internacional de Desarrollo celebrada en El Cairo en el año 1994 que introdujo el enfoque social y de desarrollo humano alrededor de esta temática, lo que implica perfeccionar en los planes de estudio su abordaje.Objetivos: exponer consideraciones acerca del enfoque interdisciplinario para el estudio de los componentes de la salud reproductiva y sexual en la formación de enfermeros universitarios en Cuba. Métodos: se realizó un estudio documental, se revisó el sistema de conocimientos y habilidades declarados en los programas analíticos de las asignaturas del currículo base y se consultó a expertos. Resultados: se reconoció que 27 asignaturas, distribuidas en los dos ciclos de la carrera, incluyen el estudio de estos componentes, unido a una estrategia curricular de formación interdisciplinaria sobre la sexualidad, con mayor representatividad en el ciclo técnico y preponderancia de la disciplina principal integradora en toda la carrera. Conclusiones: varias disciplinas intervienen en el estudio de los componentes de la salud reproductiva y sexual, en un diseño que reconoce la importancia de la integración de contenidos para los planes de estudio que básicamente se estructuran en disciplinas, así como la necesidad de fortalecer esta preparación en la educación de posgrado, vista como un proceso continuo de difusión, transferencia, adaptación y aplicación de conocimientos(AU)

Background: in this work, we assumed the definition presented in the International Conference on Development held in El Cairo in the year 1994 that introduced the social and human development approach about this topic, which implies to deal with this problem on the improvement of the curriculum. Objectives: to present some considerations about the interdisciplinary approach for the study of the components of sexual and reproductive health in the formation of University Nursing in Cuba. Methods: a documentary study was conducted, the system of knowledge and skills stated in the analytical programs of the different subjects on the basic curriculum was reviewed, and experts were consulted. Results: it was recognized that 27 subjects, divided into two cycles of the studies, include the study of these components together with a curriculum strategy of interdisciplinary formation about sexuality, with greater representation in the technical cycle and preponderance of the main integrative discipline throughout the studies. Conclusions: several disciplines are involved in the study of the components of sexual and reproductive health, in a design that recognizes the importance of the contents in curriculum integration which are basically structured in disciplines, as well as the need to strengthen this preparation in the postgraduate education, seen as a continuous process of spreading, transfer, adaptation and application of knowledge(AU)

Interconsulta psicológica: demanda e assistência em hospital geral / Consultation-liaison psychology: demand and assistance in general hospital / Interconsulta psicológica: demanda y asistencia en hospital general

A interconsulta psicológica no hospital geral representa uma modalidade de atendimento clínico e um instrumento metodológico utilizado pelo psicólogo na assistência ao paciente internado, mediante solicitação de outros profissionais da saúde. O estudo objetivou caracterizar a demanda da interconsulta psicológica em um hospital geral, a partir da análise dos registros de solicitação de atendimento. Cento e sete pacientes foram atendidos entre janeiro e junho de 2010, dos quais 53 por cento eram do sexo masculino e 57 por cento eram adultos acima de 45 anos. A maioria das solicitações foi realizada por médicos (44 por cento) e enfermeiros (38 por cento), formalmente (59 por cento), e mediante contato prévio entre interconsultor e solicitante (85 por cento). Os principais motivos alegados para a solicitação da interconsulta foram sintomas psicológicos relacionados ao adoecimento (43 por cento) e identificação de comprometimento na adaptação do paciente à hospitalização (41 por cento). O modelo de interconsulta psicológica adotado no contexto estudado foi adequado, havendo engajamento da equipe multiprofissional na efetivação da prática.

The consultation-liaison psychology in general hospitals represents a modality of clinical and a methodological tool used by psychologists in inpatient care, upon the request of other health professionals. The study aimed to characterize the psychological demands of the liaison in a general hospital, from the analysis of attendance records request. One hundred and seven patients were treated between January and June 2010, in which 53 percent of the participants were male and 57 percent of adults over 45 years. Most requests were performed by physicians (44 percent) and nurses (38 percent), formally (59 percent), and previous contact between interconsultor and the applicant (85 percent). The main reasons given for the request liaison were: psychological symptoms related to illness (43 percent) and identification of impairment in the patient's adaptation to hospitalization (41 percent). The psychological liaison model adopted was appropriate to the studied context, with engagement of the multidisciplinary team in the effectiveness of practice.

La interconsulta psicológica en los hospitals generales representan una modalidad de clínica y una herramienta metodológica utilizada por los psicólogos en la atención hospitalaria del paciente, a petición de los profesionales de la salud. El objetivo del estudio fue caracterizar la demanda psicológica para referirlo a un hospital general, desde el análisis del servicio de solicitud de registros. Ciento siete pacientes fueron tratados entre enero y junio de 2010, siendo 53 por ciento hombres y 57 por ciento de los adultos mayores de 45 años. La mayoría de las solicitudes fueron realizadas por los médicos (44 por ciento) y enfermeras (38 por ciento), de manera formal (59 por ciento) y el contacto previo entre interconsultor y su interés (85 por ciento). Las razones principales de la solicitud de remisión fueron: síntomas psicológicos relacionados con la enfermedad (43 por ciento) y la identificación de la deficiencia en la adaptación del paciente a la hospitalización (41 por ciento). El modelo adoptado referencia psicológica era apropiado en el contexto estudiado, con la participación del equipo multidisciplinario en la efectividad de la práctica.

DISEÑO DE MATERIAL EDUCATIVO PARA LA ENSEÑANZA DE LA CONSERVACIÓN DEL CÓNDOR DE LOS ANDES (Vultur gryphus) / DESIGN OF EDUCATIVE MATERIAL FOR THE CONSERVATION TEACHING OF THE ANDEAN CONDOR (Vultur gryphus)

En este trabajo se diseñó un material educativo para la enseñanza de la conservación del Cóndor de los Andes (Vultur gryphus) en el Parque Nacional Natural Los Nevados, localizado en la Cordillera Central de Colombia con alturas comprendidas entre 2600 y 5300 metros sobre el nivel del mar. Para la realización de este material se tomó como referentes teóricos el modelo educativo Escuela Nueva, los estándares para la educación en Colombia y los conceptos de lúdica y creatividad. Se realizó una selección de los estándares por grados y por área, y se procedió a estructurar actividades lúdico-creativas de acuerdo con los parámetros establecidos en el modelo educativo Escuela Nueva. El material educativo está compuesto por un texto guía que contiene actividades desde cuatro áreas del conocimiento como lo son las ciencias sociales, las matemáticas, las ciencias naturales y la lengua castellana; y una cartilla que es necesaria para el desarrollo de las actividades que se proponen en el texto guía y contiene la información sobre los aspectos biológicos, ecológicos, literarios y de conservación referentes al cóndor. Se obtuvo un texto guía que contiene seis unidades y 11 guías; y se obtuvo una cartilla con 13 puntos generales sobre el Cóndor de los Andes (Vultur gryphus). El texto guía diseñado ofrece un gran número y variedad de actividades de tipo flexible, lúdicas y creativas que se dinamiza con la cartilla de la especie objeto de conservación. El material educativo diseñado está dirigido a docentes de los centros educativos, facilitadores y promotores ambientales, guías del parque, turistas y a la comunidad en general.

In this work, an educative material was designed for the conservation teaching of the Andean Condor (Vultur gryphus) in the Parque Nacional Natural Los Nevados, located in the Central Cordillera of Colombia, with heights ranging between 2600 and 5300 m. There were taken as theoretical referring the Escuela Nueva educational model, the standards for education in Colombia, and the concepts of playful and creativity. We performed a selection of standards by grade and by area and proceeded to organize the activities in accordance with the parameters established in the Escuela Nueva educational model. The educative material consists of a guide text which contains activities from four areas of knowledge such as social sciences, mathematics, natural sciences and the castilian language, and a handbook that is necessary for the development of the activities proposed in the guide text and contains information about biological, ecological, literature and conservation concerning to the condor. The result was a guide text that contains six units and 11 guides, and a handbook with 13 general points of the Andean Condor (Vultur gryphus). The guide text designed offers a great number and variety of flexible, playful and creative activities that is invigorated with the handbook of the specie object of conservation. The educational material designed is aimed at teachers of schools, facilitators and environmental promoters, park guides, tourists and the community in general.

Esthetic restorations of maxillary anterior teeth with orthodontic treatment and porcelain laminate veneers: a case report

If orthodontists and restorative dentists establish the interdisciplinary approach to esthetic dentistry, the esthetic and functional outcome of their combined efforts will be greatly enhanced. This article describes satisfying esthetic results obtained by the distribution of space for restoration by orthodontic treatment and porcelain laminate veneers in uneven space between maxillary anterior teeth. It is proposed that the use of orthodontic treatment for re-distribution of the space and the use of porcelain laminate veneers to alter crown anatomy provide maximum esthetic and functional correction for patients with irregular interdental spacing.

Esthetic restorations of maxillary anterior teeth with orthodontic treatment and porcelain laminate veneers: a case report

If orthodontists and restorative dentists establish the interdisciplinary approach to esthetic dentistry, the esthetic and functional outcome of their combined efforts will be greatly enhanced. This article describes satisfying esthetic results obtained by the distribution of space for restoration by orthodontic treatment and porcelain laminate veneers in uneven space between maxillary anterior teeth. It is proposed that the use of orthodontic treatment for re-distribution of the space and the use of porcelain laminate veneers to alter crown anatomy provide maximum esthetic and functional correction for patients with irregular interdental spacing.

A incorporação de novos temas e saberes nos estudos em saúde coletiva: o caso do uso da categoria gênero / The incorporation of new themes and knowledge at public health studies: the gender category case

Este artigo objetiva refletir sobre a incorporação da categoria gênero nos estudos acadêmicos em saúde coletiva, tendo por referência algumas das características da área, como a interdisciplinaridade, o compromisso com as demandas da sociedade, o diálogo com os trabalhadores de saúde e a sintonia com as políticas de saúde implementadas no país. Para tanto, foi realizado um levantamento dos artigos indexados na base SciELO que referem gênero e saúde como descritores, classificando-os quanto aos temas em foco, à abordagem metodológica, à população estudada e ao tipo de uso da categoria gênero. A análise dos resultados revela a heterogeneidade no uso da categoria na produção acadêmica selecionada, que, eventualmente, pode ser explicada pelas especificidades da área. Pretende-se, com este trabalho, fomentar a reflexão sobre maneiras de incrementar a abordagem de gênero nos estudos em saúde coletiva de modo a superar diferenças entre os campos de conhecimento.

This article aims to reflect how gender as a category has been incorporated into academic public health studies. The discussion is based on some characteristics of the public health area, such as: interdisciplinary approach, commitment to the demands of society; dialogue with health professionals and connection with health policies implemented in the country. With this in mind, a review of articles from the SciELO database was made referring to gender and health as descriptors. The articles were classified in terms of their focal theme, methods, groups studied and use of gender category. The results reveal some heterogeneity in the use of the category in the studies selected that eventually could be explained by the particularities of the area. Based on this discussion, this article intends to foster a reflection on the ways to improve a gender approach in public health studies so as to overcome the existing differences between knowledge accrued in various fields.

Role of Rehabilitation Counseling and Psychology in Working with Individuals with Work-related Chronic Pain Injuries: An Interdisciplinary Approach-Chronic Pain and Work Injuries in the United States / 中国康复理论与实践

This paper addresses the topic of an interdisciplinary approach of chronic pain management from a biopsychosocial perspective. The first section provides an introduction to the definitions and theories of chronic pain and the various contributing factors (psychological, interpersonal/environmental and social support, and vocational). The second section presents the role of various health care professions (medical doctors, nurses, physical therapists, occupational therapists, psychologists and rehabilitation counselors) and the evidence of their treatment effectiveness. The third section discusses the concept of an interdisciplinary pain rehabilitation program (IPRP) and its evidence to support its effectiveness. Finally, the clinical implications of rehabilitation counseling and psychology as part of the inter-disciplinary program in treating individuals with chronic pain will be highlighted.