Ethnobotany as a parameter for the study of cultural mimicry among Roma people / La etnobotánica como parámetro para el estudio del mimetismo cultural entre el pueblo gitano

The nomadic behavior of Roma people has allowed their cultural interaction with people from different continents. Brazil has received Roma immigrants since its colonization, and there are currently more than 800,000 Roma people among the Brazilian population. This article describes the ethnobotanical knowledge of two Calon families (Alves a nd Dantas) esta blished in hinterland cities of Pernambuco, northeastern Brazil. The survey was conducted with 23 informants (≥ 40 years old, 85% of the target audience) selected through the snowball technique and using semi - structured interviews. The plants mentioned wer e collected, identified and deposited in the IPA and UFP herbaria. The 157 species (85 native) are used for food, condiment, cosmetic, medicinal, ritualistic, technological, veterinary, and other purposes. The useful flora and forms of use are similar to t hose reported by non - Roma communities living in the same region, showing a kind of mimicry adopted by the Roma people, yet maintaining their cultural identity.

El comportamiento nómada de los gitanos ha permitido su interacción cultural con personas de diferentes continentes. Brasil ha recibido inmigrantes romaníes desde su colonización y actualmente hay más de 800.000 romaníes entre la población brasileñ a. Este artículo describe el conocimiento etnobotá nico de dos familias Calon (Alves y Dantas) establecidas en ciudades del interior de Pernambuco, noreste de Brasil. La encuesta se realizó con 23 informantes (≥ 40 años, 85% del público objetivo) seleccionados mediante la técnica de bola de nieve y mediant e entrevistas semiestructuradas. Las plantas mencionadas fueron recolectadas, identificadas y depositadas en los herbarios IPA y UFP. Las 157 especies (85 nativas) se utilizan para alimentos, condimentos, cosméticos, medicinales, ritualistas, tecnológicos, veterinarios y otros fines. La flora útil y las formas de uso son similares a las reportadas por las comunidades no gitanas que viven en la misma región, mostrando una especie de mimetismo adoptado por el pueblo gitano, pero manteniendo su identidad cultu ral.

Assessing the diagnostic performance of four ovarian malignancy prediction risk models in differentiating benign and malignant ovarian masses in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Introduction@#Ovarian cancer is considered the most lethal gynecologic malignancy because it is difficult to diagnose in its early stages. Ovarian malignancy prediction models may be useful in discriminating between benign and malignant masses, allowing for accurate and timely referral as well as proper therapeutic care@*Objective@#To evaluate the diagnostic performance of the four ovarian prediction models: Risk of Malignancy Index‑4 (RMI‑4), Risk of Ovarian Malignancy Algorithm (ROMA), Copenhagen Index (CPH‑I), and International Ovarian Tumor Analysis (IOTA)‑Assessment of Different NEoplasias in the AdneXa (ADNEX) in identifying malignant and benign ovarian masses@*Materials and Methods@#This was a retrospective, cross‑sectional, analytical diagnostic study in a tertiary hospital between January 2017 and December 2020. Receiver operating characteristic (ROC) curves, area under the curves (AUCs), sensitivities, specificities, positive and negative predictive values, and positive and negative likelihood ratios were used to assess the diagnostic performance of the prediction models.@*Results@#We analyzed a total of 248 patients. One hundred and sixty‑one (65%) had benign tumors, 28 (11%) had borderline, and 59 (24%) had malignant tumors. The AUCs of all models were all above 90%, but when compared to the other models, CPH‑I had the best estimate. RMI‑4 had the highest sensitivity (98.3%) in diagnosing malignancy. For appropriately diagnosing benign disease, the IOTA‑ADNEX model exhibited the highest specificity (92.1%). Overall, RMI‑4 had the lowest diagnostic accuracy (74.6%), whereas IOTA‑ADNEX had the greatest (93.2%).@*Conclusion@#The four malignancy prediction models in this study were all useful tools in discriminating between benign and malignant ovarian tumors. IOTA‑ADNEX, CPH‑I, and ROMA all demonstrated overlapping diagnostic performances indicating that they are equal in that regard. In terms of sensitivity in predicting malignancy, RMI‑4 was the most sensitive. CPH‑I is the predictor with the best overall estimate. Lastly, IOTA‑ADNEX was the most specific, and displayed highest diagnostic accuracy among the four

O Oriente Cigano na Umbanda / The Gypsy Orient in Umbanda

O objetivo deste artigo é descrever a representação dos ciganos no panteão umbandista e modos característicos de uso e o sentido psicológico da sua inclusão neste contexto. Para esse efeito foram realizadas pesquisa etnográfica e consulta a banco de dados com registros audiovisuais de rituais umbandistas e entrevistas com médiuns incorporados e não incorporados por espíritos da linha cigana. A análise de dados foi feita a partir da identificação dos pontos de convergência nas observações diretas e indiretas (registros audiovisuais),nas entrevistas e no diário de campo. Em seguida foi feita uma comparação com o que a literatura refere relativamente às outras categorias de espíritos. Encontrou-se que a chamada linha dos ciganos, de um ponto de vista etnopsicológico, não agrega novos conteúdos simbólicos à umbanda, mas reorienta sentidos previamente existentes, numa perspectiva de futuro.

The purpose of this paper is to describe the representation of gypsies in the Umbanda pantheon and the characteristic ways of using it and the psychological sense of its inclusion in this context. For this purpose, ethnographic research was carried out and a database was consulted with audiovisual records of Umbanda rituals and interviews with mediums incorporated and not incorporated by gypsy spirits. Data analysis was performed based on the identification of points of convergence, that is, the elements that were repeated in direct and indirect observations (audiovisual records), in interviews and in the field notes. Then a comparison was made with what the literature refers to in relation to other categories of spirits. It was found that the so-called gypsy line, from an ethnopsychological point of view, does not add new symbolic content to Umbanda, but rather redirects previously existing meanings in a perspective of the future.

Memória dos Troncos Velhos: um estudo sobre memória social entre ciganos / Memory of Troncos Velhos: a study on social memory among gypsies

O presente estudo teve como objetivo analisar as memórias práticas entre membros de uma comunidade cigana do estado do Espírito Santo, com cultura territorial seminômade, tradição oral e domínio linguístico do kaló. Foram realizados registros de informações em diários de campo e entrevistas individuais e em profundidade com cinco homens e cinco mulheres, com idades acima de 50 anos, integrantes das primeiras gerações da comunidade. Foi utilizado instrumento com roteiro semiestruturado explorando temas salientes à vida do grupo. As narrativas obtidas foram sistematizadas com o auxílio da classificação hierárquica descendente, procedida por meio do Programa Alceste. Entre os principais resultados encontrados, destacam-se as "relações de gênero e práticas cotidianas", "tradições e costumes" e "transformações em curso". Espera-se que o desenvolvimento deste estudo possa contribuir para ampliar o corpo de conhecimento produzido acerca da população cigana a partir de suas próprias narrativas.

The present study aimed to analyze the practical memories among members of a gypsy community from the State of Espírito Santo, with semi-nomadic territorial culture, oral tradition and mastery of language karó. Information records were made in field diaries and individual and in-depth interviews with five men and five women, aged over 50 years old, who were members of the first generations of the community. An instrument with a semi-structured script was used, exploring themes relevant to the group's life. The narratives obtained were systematized with the aid of the descending hierarchical classification, proceeding through the Programa Alceste. Among the main results found, "gender relations and everyday practices", "traditions and customs" and "ongoing transformations" stand out. It is hoped that the development of this study may contribute to expand the body of knowledge produced about the gypsy population from their own narratives.

Ethnomedicinal plants for veterinary use in gypsy communities of the northeast of Brazil / Plantas etnomedicinales para uso veterinario en comunidades gitanas del noreste de Brasil

Gypsies have been in Brazil since the 16th century and today they are more than 800,000 in the country. This article describes the veterinary use of plants by Calon gypsies living in Pernambuco, Northeastern Brazil. The research was carried out with 23 people (> 40 years old), using semi-structured forms and the snowball technique. The cited species were collected during guided tours, identified and deposited at the IPA and UFP herbaria. Ten plants were indicated for veterinary use: Agave sisalana (Asparagaceae), Aspidosperma pyrifolium (Apocynaceae), Apodanthera congestiflora (Cucurbitaceae), Heliotropium indicum (Boraginaceae), Lippia alba (Verbenaceae), Momordica charantia (Cucurbitaceae), Nicotiana tabacum (Solanaceae), Passiflora cincinnata (Passifloraceae), Phaseolus lunatus (Fabaceae), and Solanum paniculatum (Solanaceae). The participants cited various methods of preparation and therapeutic indications for ectoparasitic infections, digestive disorders, and eye and respiratory infections in farm animals. Apodanthera congestiflora and H. indicum stood out for prophylaxis and treatment of Newcastle disease in fowl.

Los gitanos están en Brasil desde el siglo XVI y hoy, son más de 800.000 en el país. Este artículo describe el uso veterinario de plantas por gitanos Calon que viven en Pernambuco, Noreste de Brasil. La encuesta fue realizada con 23 personas (> 40 años), utilizando formularios semi-estructurados y la técnica bola de nieve. Las especies citadas fueron recolectadas en giras guiadas, identificadas y depositadas en los herbarios IPA y UFP. Diez plantas fueron citadas para uso veterinario: Agave sisalana (Asparagaceae), Aspidosperma pyrifolium (Apocynaceae), Apodanthera congestiflora (Cucurbitaceae), Heliotropium indicum (Boraginaceae), Lippia alba (Verbenaceae), Momordica charantia (Cucurbitaceae), Nicotiana tabacum (Solanaceae), Passiflora cincinnata (Passifloraceae), Phaseolus lunatus (Fabaceae) y Solanum paniculatum (Solanaceae). Los participantes citaron varios modos de preparación e indicaciones terapéuticas para infecciones ectoparasitarias, disturbios digestivos, infecciones oculares y respiratorias en animales domésticos. Apodanthera congestiflora y H. indicum se destacaron en la profilaxis y tratamiento de la enfermedad de Newcastle en aves.

Infância Calin: Socialização Étnica e Identidade Social entre Crianças Ciganas / Calin Childhood: Ethnic Socialization and Social Identity Among Gypsy Children / Infancia Calín: Socialización Étnica e Identidad Social entre Niños Gitanos

Compreendendo fases sucessivas do momento de proteção, aprendizagem e preparação para se tornarem adultas, na infância, as crianças ciganas vão sendo formadas para uma vida em grupo e voltada para o núcleo familiar. A partir dos conceitos de socialização étnica e de identidade social, o estudo foi desenvolvido com o objetivo de analisar o universo psicossocial da infância calin entre crianças de etnia calon no estado do Espírito Santo. Participaram do estudo sete crianças, com idades entre 4 e 12 anos, que compõem a terceira geração da comunidade, a primeira após processo de fixação territorial. As entrevistas foram orientadas por um roteiro semiestruturado explorando os universos da lei cigana, tradições do grupo e vivências cotidianas, bem como técnicas de desenho a fim de conhecer as imagens de si, da família e de futuro. Todas as entrevistas foram realizadas no acampamento cigano e os dados foram analisados por meio da análise de conteúdo temática. Os principais resultados demonstraram que as crianças calin destacam em suas narrativas a vivência da lei cigana e das tradições por meio do uso de vestimentas típicas e da língua caló, moradia em tendas e obediência às normas para o matrimônio, bem como relatam rotinas envolvendo brincadeiras, escolarização e atividades de mediação para o universo adulto....(AU)

Comprising successive phases of the moment of protection, learning and preparation to become adults, gypsy children are being raised for a life in group and geared towards the family nucleus. Based on the concepts of ethnic socialization and social identity, the study was developed in order to analyze the psychosocial universe of Calin childhood among Calon children in the State of Espírito Santo. Seven children aged between 4 and 12 years participated in the study. They make up the third generation of the community, the first one after the process of territorial settlement. The interviews were guided by a semi-structured script exploring the universes of Gypsy law, group traditions and everyday experiences, as well as drawing techniques in order to know the images of oneself, the family and the future. All the interviews were carried out in the Gypsy camp and the data were analyzed through the thematic content analysis approach. The main results showed that Calin children emphasize in their narratives the experience of Gypsy law and traditions through the use of typical dress and Caló language, residence in tents and obedience to norms for marriage, as well as routines involving games, schooling and mediation activities for the adult universe. In this scenario, the resistance movements of the group rise, in which the new generation will have to protect the essential identity elements of the Gypsy culture and create resources to maintain their sociability in transit on the borders with the non-Gypsy world....(AU)

En la infancia, los niños gitanos se van formando para una vida en grupo y orientada hacia el núcleo familiar, comprendiendo fases sucesivas del momento de protección, aprendizaje y preparación para hacerse adultos, en la infancia. A partir de los conceptos de socializaciónétnica y de identidad social, el estudio fue desarrollado con el objetivo de analizar el universo psicosocial de la infancia calin entre niños de etnia calon en el estado de Espírito Santo. Participaron del estudio 7 niños, entre 04 y 12 años de edad, que componen la tercera generación de la comunidad, la primera después del proceso de fijación territorial. Las entrevistas fueron orientadas por un guion semiestructurado explorando los universos de la ley gitana, tradiciones del grupo y vivencias cotidianas, así como técnicas de dibujo a fin de conocer las imágenes de sí, de la familia y del futuro. Todas las entrevistas se realizaron en el campamento gitano y los datos fueron analizados por medio del análisis de contenido temático. Los principales resultados demostraron que los niños calin destacan en sus narrativas la vivencia de la ley gitana y de las tradiciones por medio del uso de ropas típicas y de la lengua caló, vivienda en tiendas y obediencia a las normas para el matrimonio, así como también relatan rutinas que involucran juegos, escolarización y actividades de mediación para el universo adulto. En este contexto, se manifiestan movimientos de resistencia del grupo, en el que la nueva generación tendría como tarea mantener los elementos identitarios esenciales de la cultura gitana y crear recursos para mantener su sociabilidad en tránsito en las fronteras con el mundo no gitano....(AU)

The power of the Risk of Ovarian Malignancy Algorithm considering menopausal status: a comparison with CA 125 and HE4 / 부인종양

OBJECTIVE: To identify the power of tumor markers for predicting ovarian cancer according to menopausal status. METHODS: The medical records of 876 women with ovarian cysts were retrospectively reviewed. Cancer antigen 125 (CA 125), human epididymis protein 4 (HE4), and Risk of Ovarian Malignancy Algorithm (ROMA) were analyzed. Sensitivity, specificity, and the receiver operating characteristic (ROC) curve analyses of these tumor markers were evaluated. RESULTS: The sensitivity of ROMA was 66.7% and the specificity was 86.8% to detect ovarian malignancy. The patients were divided into 2 groups according to menopausal status: premenopause (n=532, 60.7%) and postmenopause (n=344, 39.3%). For diagnostic accuracy, ROMA was lower than HE4 in premenopausal women (82.7% vs. 91.4%) and lower than CA 125 in postmenopausal women (86.9% vs. 88.7%). The ROC curve analysis revealed that the power of ROMA was not significantly better than that of HE4 in premenopausal women (area under the curve [AUC], 0.731 vs. 0.732, p=0.832), and it was also not significantly better than that of CA 125 in postmenopausal women (AUC, 0.871 vs. 0.888, p=0.440). CONCLUSION: The discrimination power of tumor markers for ovarian cancer was different according to menopausal status. In predicting ovarian malignancy, ROMA was neither superior to HE4 in premenopausal women nor superior to CA 125 in postmenopausal women.

Assessment of tuberculosis knowledge among Lesotho village health workers and utilisation of their tuberculosis services by the communities they serve

Background: The role of village health workers (VHWs), among other roles is to educate communities about tuberculosis (TB), TB screening and its treatment. The knowledge of TB among VHWs is crucial because they will carry out their role at the community well and this will impact the overall outcome of TB treatment. Aim: The study is aimed at assessing the knowledge of TB among VHWs and households at the village level and the utilisation of VHWs' TB services. Setting: The study took place in 19 health centres from 10 districts of Lesotho. Methods: The study used a cross-sectional descriptive design. Three study populations were interviewed, two at the household level (2040 households, 8295 individuals) and one at the clinic level (723 VHW). Results: Overall, TB knowledge among VHWs for the majority of clinics except two was inadequate (below mean of 31.5). The utilisation of VHWs' TB services among community members was also low. Conclusion: Low utilisation of VHWs' TB services by community members emanated from inadequate TB knowledge of VHWs. Regular refresher training among VHWs is recommended as the way forward in order to keep VHWs abreast with new TB developments

Ancoragem psicossocial a partir dos sentimentos negativamente valorados: representações sociais de ciganos / Psychosocial anchorage based on negatively valued feelings: social representations of gypsies / Anclaje psicosocial a partir de los sentimientos negativamente valorados: representaciones sociales de gitanos

Tendo como referência a abordagem não consensual da teoria das representações sociais, este trabalho teve como objetivo investigar como se articulam as representações sociais e a dimensão afetiva associadas ao objeto social "ciganos", entre população não cigana da Grande Vitória-ES. Foram desenvolvidos dois estudos complementares com (1) 108 estudantes universitários e (2) 10 sujeitos que associaram sentimentos de valoração negativa aos ciganos. A coleta dos dados foi realizada por meio da aplicação de questionário e de entrevista em profundidade, e o tratamento das informações obtidas foi conduzido com o auxílio dos softwares SPAD-T e Alceste. Os resultados indicaram a (re)produção de estereótipos negativos vinculados aos ciganos e a dimensão afetiva fortemente marcada por medo e aversão, núcleo de preconceito e discriminação contra os ciganos.

Having as a reference the non-consensual approach of the Theory of Social Representations, this study aimed to investigate how the social representations and the affective dimension associated with the social object "Gypsies" among non-Gypsy population within the metropolitan area of Vitória-ES. Two complementary studies were developed with (1) 108 college students and (2) 10 subjects who linked feelings of negative assessment towards the Gypsies. Data collection was performed by applying a questionnaire and in-depth interview and the handling of the obtained information was processed with the help of SPAD-T and Alceste softwares. The results showed the (re)production of negative stereotypes linked to Gypsies and the affective dimension strongly marked by fear and aversion, core of prejudice and discrimination against Gypsies.

En este trabajo se analizan las relaciones sociales y la dimensión afectiva asociadas al objeto social "gitanos", entre población no gitana de la Gran Victoria-ES, teniendo como referencia el abordaje no consensuado de la Teoría de las Representaciones Sociales. Dos estudios complementarios fueron desarrollados con (1) 108 estudiantes universitarios y (2) 10 sujetos que asociaron sentimientos de valoración negativa a los gitanos. La recolección de los datos fue realizada por medio de la aplicación de cuestionario y de entrevista en profundidad y el tratamiento de las informaciones obtenidas fue conducido con la ayuda del software SPAD-T y Alceste. Los resultados indicaron la (re) producción de estereotipos negativos vinculados con los gitanos y la dimensión afectiva fuertemente marcada por miedo y aversión, núcleo de prejuicio y discriminación contra los gitanos.

Análisis de las políticas de desegregación e inclusión social en el contexto español / Análise das políticas de desagregação e inclusão social no contexto espanhol / Analysis of the desegregation and social inclusion policies in the Spanish context

Resumen En España, muchas actuaciones de erradicación del chabolismo se centraban únicamente en la eliminación de los aspectos más visibles del problema, generando desacuerdo social. Este trabajo analiza en qué medida las nuevas políticas de realojo y dispersión aplicadas recientemente en los poblados chabolistas del noroeste de este país fomentan actitudes favorables hacia la inclusión social de las personas desplazadas, la mayoría de etnia gitana. Para ello se ha realizado un cuestionario que recoge las percepciones tanto de los afectados por los realojos como de las personas que los acogen en sus vecindarios. Mediante el análisis cuantitativo y exploratorio de los datos, se ha detectado una buena predisposición social hacia la inclusión social de las personas chabolistas en las viviendas normalizadas, identificando aquellos aspectos en los que es necesario reforzar este tipo de intervenciones.

Na Espanha, muitas ações de erradicação de favelas foram focadas apenas na eliminação dos aspectos mais visíveis do problema, criando discórdia social. Este artigo analisa em que medida as novas políticas de reassentamento e dispersão recentemente implementadas nas favelas do noroeste do país promovem atitudes favoráveis à inclusão social das pessoas deslocadas, a maioria ciganos. Para isso, foi feito um questionário que captura as percepções de dois grupos: os que foram reassentados e as pessoas que os recebem em seus bairros. Por meio da análise de dados quantitativos e exploratória, temos detectado uma boa predisposição social para a inclusão social dos moradores de favelas em habitações normais, identificando os aspectos que necessitam de reforço dessas intervenções.

Abstract In Spain, many experiences in slum clearance have been focused solely on eliminating the most visible aspects of the problem, creating social dissatisfaction. This article analyzes the extent to which new policies of relocation and dispersion recently applied in the slum areas of northwest Spain, foster favorable attitudes towards social inclusion of the displaced persons, who are mostly Roma. A questionnaire was applied in order to capture the perception of both those affected by relocations and those who receive the displaced persons in their neighborhoods. By quantitative, exploratory data analysis, we have detected a good social predisposition towards social inclusion of underprivileged people in the process of adaptation to live in houses with appropriate infrastructure, identifying those aspects needed to strengthen these kinds of interventions.

Os eternos estrangeiros: contato, campo afetivo e representações sociais de ciganos entre não ciganos da grande Vitória/ES / The eternal foreigners: contact, affective field and social representations of gypsies among non gypsies in the metropolitan region of Vitória/ES / Los extranjeros eternos: contacto, campo afectivo y representaciones sociales de gitanos entre no gitanos en la región metropolitana de Vitória/ES

Este trabalho investigou a elaboração do objeto social 'ciganos' entre não ciganos da Grande Vitória/ES, a partir da dimensão afetiva e dos níveis de contato em relação ao grupo cigano. Participaram do estudo 56 pessoas, com idades entre 18 e 45 anos, que apresentaram tanto sentimentos positivos quanto negativos em relação aos ciganos. Para o tratamento dos dados, coletados por meio da aplicação de questionário, utilizou-se o software EVOC e a Análise de Conteúdo Categorial. Os resultados informam que o posicionamento afetivo se organiza, principalmente, a partir das dimensões positiva 'curiosidade' e 'respeito', e negativa 'insegurança' e 'desconfiança'. Associado a esse campo de ambiguidades, entre os elementos centrais das representações de ciganos encontram-se significados como 'nomadismo' e 'cultura diferente', além de estereótipos negativos e termos que descrevem a dimensão figurativa do objeto social. Discute-se a função das representações encontradas na manutenção do preconceito e da discriminação social contra esse grupo.

This study investigated the construction of the social object 'gypsies' among non-gypsies in the metropolitan region of Vitória/ES, based on the affective dimension and the levels of contact towards the gypsy group. Fifty-six (56) individuals aged between 18 and 45 participated in the study. They presented both positive and negative feelings towards gypsies. The data were gathered through questionnaires, and then treated using the software EVOC and Categorical Content Analysis approach. The results showed that the affective field is organized mainly based on the positive dimensions 'curiosity' and 'respect', and the negative ones 'insecurity' and 'suspicion'. Associated to this field of ambiguity, among the central elements of the representations of gypsies, we found meanings such as 'nomadism' and 'different culture', as well as negative stereotypes and terms that describe the figurative dimension of the social object. This study discusses the function of these representations in the maintenance of prejudice and social discrimination against this group.

Este trabajo investigó la elaboración del objeto social 'gitanos' entre los no gitanos de la Gran Vitória/ES, a partir de la dimensión afectiva y de los niveles de contacto con relación al grupo gitano. Participaron en el estudio 56 personas de 18 a 45 años de edad que presentaron tanto sentimientos positivos como negativos con relación a los gitanos. Para el análisis de los datos, recogidos por medio de cuestionarios, se utilizó el software EVOC y el Análisis de Contenido Categorial. Los resultados informan que la posición afectiva se organiza, principalmente, a partir de las dimensiones positivas 'curiosidad' y 'respeto'; y negativas 'inseguridad' y 'desconfianza'. Asociado a este campo de ambigüedades, entre los elementos centrales de las representaciones de gitanos, se encuentran significados como 'nomadismo' y 'cultura diferente', además de estereotipos negativos y términos que describen la dimensión figurativa del objeto social. Se discute la función de las representaciones encontradas en el mantenimiento del prejuicio y de la discriminación social contra este grupo.

Politica sobre etnicidad y salud (29. a Conferencia Sanitaria Panamericana) / Política sobre etnia e saúde (29a Conferência Sanitária Pan-Americana) / Politique en matière d'ethnicité et de santé (29e Conférence Sanitaire Panaméricaine) / Policy on Ethnicity and Health (29th Pan American Sanitary Conference)

En septiembre del 2017, los Estados Miembros de la OPS aprobaron por unanimidad la Política sobre etnicidad y salud en la 29.ª Conferencia Sanitaria Panamericana, 69.ª sesión del Comité Regional de la Organización Mundial de la Salud para las Américas. Con esta política, los Estados Miembros han acordado garantizar el enfoque intercultural en la salud y el tratamiento equitativo de los pueblos indígenas, los afrodescendientes, los romaníes y los miembros de otros grupos étnicos. Además, plantearon la necesidad de adoptar soluciones que sean inclusivas y promuevan la colaboración, a fin de cerrar las brechas en el acceso a los servicios de salud que afectan a estas poblaciones. Numerosos representantes de los pueblos indígenas, los afrodescendientes y los romaníes, los ministerios de salud y las organizaciones multilaterales participaron en la elaboración de esta política y se comprometieron a apoyar su aplicación. Con la aprobación de la Política sobre etnicidad y salud, la Región de las Américas se convierte en la primera región de la Organización Mundial de la Salud en reconocer la importancia de adoptar un enfoque intercultural para abordar las inequidades en la salud. Creo firmemente que esta política será una importante herramienta en los esfuerzos de toda la comunidad de la salud pública para avanzar hacia la cobertura universal de salud al reducir las desigualdades e inequidades en materia de salud de los distintos grupos étnicos.

Em setembro de 2017, na 29a Conferência Sanitária Pan-Americana (69a Sessão do Comitê Regional da Organização Mundial da Saúde para as Américas), os Estados Membros da OPAS aprovaram por unanimidade a Política sobre etnia e saúde. Com esta política, os Estados Membros concordaram em garantir o enfoque intercultural em saúde e a paridade de tratamento dos povos indígenas, dos afrodescendentes, dos roma e dos membros de outros grupos étnicos. Também abraçaram a busca por soluções colaborativas e inclusivas para contemplar as lacunas no acesso destas populações à saúde. Representantes dos povos indígenas, dos afrodescendentes, dos roma, dos ministérios da Saúde e de organizações multilaterais colaboraram na elaboração desta política e comprometeram-se a apoiar sua implementação. A Política sobre etnia e saúde torna a Região das Américas a primeira da Região da Organização Mundial da Saúde a reconhecer a importância de adotar o enfoque intercultural para enfrentar as iniquidades em saúde. Acredito firmemente que esta política servirá como uma importante ferramenta nos esforços de toda a comunidade da saúde pública de avançar rumo à saúde universal ao reduzir as desigualdades e iniquidades em saúde entre os grupos étnicos

En septembre 2017, à la 29e Conférence sanitaire panaméricaine (69e session du Comité régional de l'Organisation mondiale de la Santé pour les Amériques), les États Membres de l'OPS ont unanimement approuvé la Politique sur l'ethnicité et la santé. Par cette politique, les États Membres ont convenu de garantir une approche interculturelle de la santé et un traitement équitable des Autochtones, des Roms, des populations d'ascendance africaine, ainsi que des membres d'autres groupes ethniques. Ils ont également reconnu le besoin de solutions solidaires et collaboratives pour combler les lacunes d'accès à la santé de ces populations. Des représentants des Autochtones, des Roms et des populations d'ascendance africaine, des ministères de la Santé et des organisations multilatérales ont participé à l'élaboration de cette politique et se sont engagés à appuyer sa mise en œuvre. La Politique sur l'ethnicité et la santé fait de la Région des Amériques la première Région de l'Organisation mondiale de la Santé à reconnaître l'importance d'adopter une approche interculturelle pour répondre aux inégalités en matière de santé. Je crois profondément de cette politique constituera un outil essentiel dans les efforts déployés par l'ensemble de la communauté de la santé publique pour progresser vers la santé universelle en réduisant les inégalités et les iniquités de santé dans les groupes ethniques de la population.

In September 2017, at the 29th Pan American Sanitary Conference (69th Session of the Regional Committee of the World Health Organization for the Americas), PAHO Member States unanimously approved the Policy on Ethnicity and Health. With this policy, the Member States agreed to guarantee an intercultural approach to health and equitable treatment of indigenous peoples, Afro-descendants, Roma populations, and members of other ethnic groups. They also embraced the need for inclusive, collaborative solutions to address the gaps in access to health for these populations. Representatives from indigenous peoples, Afrodescendants, and Roma populations, ministries of health, and multilateral organizations participated in the development of this policy and committed to supporting its implementation. The Policy on Ethnicity and Health makes the Region of the Americas the first World Health Organization Region to acknowledge the importance of adopting an intercultural approach to address inequities in health.

Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First Diagnosis

Abstract: Background. Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis. Aim. To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center. Material and methods. Abdominal computed tomography of 92 consecutive hepatocellular carcinoma cirrhotic patients, enrolled and followed from 2004 to 2014, were retrospectively studied with a software analyzing the cross-sectional areas of muscles at third lumbar vertebra level. Data was normalized for height, skeletal muscle index (SMI) calculated and presence of Sarcopenia measured. Sarcopenia was defined by SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with body mass index (BMI) ≥ 25, and ≤ 43 cm2/m2 for men and women with BMI < 25, respectively. Results. Median age at diagnosis was 71.9 years (30.7-86.4) and BMI 24.7 (17.5-36.7), comparable in women 23.1, (17.5-36.7) and men 24.7 (18.4-36.7). A class of CHILD score and BCLC A prevailed (55.4% and 41.3%, respectively); metastatic disease was found in 12% of cases. Sarcopenia was present in 40.2% of cases, mostly in females (62.9%; p = 0.005). Mean overall survival was reduced in sarcopenic patients, 66 (95% CI 47 to 84) vs. 123 (95% CI 98 to 150) weeks (p = 0.001). At multivariate analysis, sarcopenia was a predictor of reduced overall survival, independent of age (p = 0.0027). Conclusions. This retrospective study shows high prevalence of sarcopenia among cirrhotic patients with hepatocellular carcinoma. Presence of sarcopenia was identified as independent predictor of reduced overall survival. As easily measurable by CT, sarcopenia should be determined for prognostic purposes in this patient population.

Analysis of falsely elevated risk of ovarian malignancy algorithm in women with ovarian endometrioma

OBJECTIVE: To estimate the incidence of falsely elevated risk of ovarian malignancy algorithm (ROMA) in a group of women with pathologically confirmed endometrioma and to investigate the associated factors. METHODS: One hundred premenopausal women surgically diagnosed with ovarian endometrioma were selected. Preoperative clinical, laboratory, and surgical characteristics were compared between the elevated-risk group (ROMA-premenopausal value, ≥7.4%) and normal-risk group (ROMA-premenopausal value, 82.3 U/mL and serum level of human epididymis protein 4 (HE4) >46 pmol/L could predict an elevated ROMA test with a statistical significance. When serum level of HE4 ≤46 pmol/L, none of the women showed an elevated ROMA test, regardless of serum level of CA 125; however, 55.6% of the women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 ≤82.3 U/mL and all women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL. CONCLUSION: The incidence of falsely elevated ROMA was 15% in the group of women with pathologically confirmed endometrioma. Interpretation of the ROMA results should be cautious when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL in women with suspicious ovarian endometrioma.

San Martín casi muere en Roma / San Martín nearly died in Rome

La nota hace referencia a las crisisconvulsivas sufridas por el libertador General José de San Martín durante su estancia en la ciudad de Roma a mediados del Siglo XIX.

The note refers to theseizures suffered by José de San Martín during his stay in Rome in the mid- nineteenth century.

Centro dia para idosos frágeis: recursos para a promoção de qualidade de vida / Day center for the frail elderly: resources for the promotion of quality of life

O progressivo envelhecimento da população comporta um aumento no número de pessoas idosas que apresentam problemas de natureza biológica, psicológica, sociológica e de relações sociais e interpessoais. Estima-se que em 2030, os velhos com mais de 65 anos constituirão um quarto da população que compreende os atuais países da União Europeia. Nem sempre são difundidos os serviços que podem responder adequadamente às múltiplas exigências dos velhos. Entre os problemas mais emergentes, aparecem a solidão, a ausência de espaços de relação, os temores crescentes de marginalização, as agressões (especialmente nas grandes cidades) e o medo da doença e da invalidez. Outro problema são as perdas decorrentes do declínio cognitivo e afetivo. A partir desse estudo, percebe-se que a família e o grupo de assistência raramente são preparados de modo apropriado para enfrentar as novas demandas e as dificuldades que se manifestam ainda sob o plano clínico. A família com frequência esforça-se para apoiar e ajudar os idosos, mas mesmo assim tem-se consciência da importância de novas estruturas e serviços locais em condições de satisfazer as exigências da população idosa. Nesse contexto, o Centro Dia de Idosos Frágeis representa uma resposta qualificada às necessidades que emergem; de fato, permite ao idoso permanecer no próprio domicílio, às suas famílias continuarem próximas aos seus idosos e à comunidade reduzir custos.

The progressive ageing of the population carries an increase in the number of elderly people who have problems of biological, psychological,and sociological nature, and also of social and interpersonal relationships. It is estimated that in 2030, the old over 65 years constitute one quarter of the population that comprises the current European Union countries. The services that can respond adequately to the varied needs of the aged are not often distributed. Among the most emergent problems, appears loneliness, lack of opportunities for relationship, the growing fears of marginalization, the aggressions (especially in big cities) and the fear of disease and disability. Another problem is the loss from cognitive and affective decline. From this study, we find out that the family and the support group are rarely prepared in an appropriate way to face new demands and difficulties that arise even under the clinical level. The family often struggles to support and assist the elderly, yet one is aware of the importance of new local facilities and services capable of satisfying the requirements of the elderly population. In this context, the Day Center for the frail elderly is a qualified answer to the needs that emerge as it allows the elderly to stay at their homes, their families to remain close to their elders and the community to reduce costs.

The Incidence of Irritable Bowel Syndrome in Children Using the Rome III Criteria and the Effect of Trimebutine Treatment

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders and when compared to the vast knowledge pertaining to adults with IBS, very little is known about IBS in children and adolescents. We aimed to explore the prevalence of IBS, identify symptoms and contributing factors and also to examine the efficacy of trimebutine maleate in children and adolescents. METHODS: The study involved 345 children and adolescents (4-18 years) and parents were requested to fill in a questionnaire, Rome III criteria was used to diagnose IBS. To exclude organic disease, all patients underwent medical investigations. Half of the randomly selected IBS patients were treated with trimebutine maleate while the rest of IBS patients were not. The IBS patients were reevaluated at the end of 3 weeks. RESULTS: The prevalence of IBS according to Rome III criteria in children and adolescents was 22.6% and IBS with constipation was the predominant subtype. Back pain (OR, 6.68), headache (OR, 4.72) and chronic fatigue (OR, 3.74) were significantly higher in IBS group. The prevalence of IBS in both parents and depression in mothers was greater for the patient group than the healthy controls (P < 0.0001). The prevalence of functional dyspepsia in IBS group was 80.8% and was significantly higher than control group. Clinical recovery was seen in 94.9% of the trimebutine maleate group versus spontaneous recovery in 20.5% of the non-medicated group. The difference was significant (P < 0.0001). CONCLUSIONS: IBS is a common disorder in children and adolescents. IBS is closely associated with somatic and familial factors. Trimebutine maleate is effective for pediatric IBS patients.

Effect of Helicobacter pylori Eradication on Functional Dyspepsia

BACKGROUND/AIMS: This study evaluated the effect of Helicobacter pylori eradication on functional dyspepsia (FD), and the relationship between the changes of histological gastritis and FD symptom responses. METHODS: A total of 213 FD patients diagnosed by Rome III criteria were consecutively enrolled. H. pylori tests and gastritis grade by the Sydney system were performed before and 1 year after the proton pump based-eradication therapy for 7 days. Serum levels of pepsinogen, and genetic polymorphisms IL-6, IL-8 and IL-10 were investigated. RESULTS: Total of 91 patients completed the 1 year follow-up. When the response rate of dyspepsia was compared at 1 year between the non-eradicated group (n = 24) and eradicated group (n = 67), each group showed complete response of 62.5% and 62.7%; satisfactory response (> or = 50%) of 0.0% and 19.4%; partial response (< 50%) of 12.5% and 11.9%; and refractory response of 25.0% and 6.0%, respectively (P = 0.015). In addition, the responder group (complete + satisfactory response) at 1 year showed improvement of activity and chronic inflammation in both the antrum and corpus (all P < 0.001). Multivariate analysis showed that H. pylori eradication (OR, 5.81; 95% CI, 1.07-31.59) and symptom improvement at 3 month (OR, 28.90; 95% CI, 5.29-157.82) were associated with the improvement of dyspepsia at 1 year. Among the successfully eradicated FD patients (n = 67), male (P = 0.013) and higher initial BMI (P = 0.016) were associated with the improvement of dyspepsia at 1 year. CONCLUSIONS: H. pylori eradication improved FD symptoms, as well as gastritis at 1 year, suggesting that inflammation mediates FD.