Estado de la salud materna un análisis global a puertas de la endemia de la covid-19 / State of maternal health a global analysis on the point of the covid-19 endemia

Dentro de los cambios endémicos por la infección del SARSCoV-2, con efectos en el perfil epidemiológico de la mortalidad materna a nivel global, este articulo refleja los contraste en la accesibilidad a los servicios de salud, más evidente en países de ingresos bajos a medianos, con debilidades en los sistemas de vigilancia epidemiológica que se ven influenciados por la superposición de datos relevantes en la atención prenatal , el parto y atención al recién nacido, el puerperio, y el acceso a la planificación familiar. Siendo necesario identificar las tendencias de mortalidad y morbilidad materna, para reducir el impacto sobre todo en grupos prioritarios.

Within the endemic changes due to SARS-CoV-2 infection, with effects on the epidemiological profile of maternal mortality globally, this article reflects the contrasts in accessibility to health services, more evident in low-income countries. to medium, with weaknesses in the epidemiological surveillance systems that are influenced by the overlapping of relevant data in prenatal care, delivery and newborn care, the postpartum period, and access to family planning. It is necessary to identify trends of maternal mortality and morbidity, to reduce the impact, especially in priority groups

Integrative Dimensional Personality Inventory for ICD-11: Development and Evaluation in the Peruvian Correctional Setting / Inventario Integrativo de la Personalidad Dimensional para la CIE-11: desarrollo y evaluación en el sistema penitenciario peruano

Abstract Background: Personality disorder (PD) is an important predictor of the commission of crimes; however, there is a lack of clinical instruments adjusted to the characteristics of Peruvian convicts. Objective: To develop a reliable and valid comprehensive personality measurement instrument, the Integrative Dimensional Personality Inventory, ICD-11 version (IDPI-11), according to the standards of the International Classification of Diseases (ICD-11). Method: A stratified simple of prisoners from the Huancayo Penitentiary (HP) was selected (n study 1 = 60; n study 2 = 1095). Results: High reliability indices(McDonald's _ _ .73) and adequate levels of content validity(CVI-S ≥ .87), construct validity, and criterion validity of the scales were found. This could explain the probability (a) of belonging to the group of inmates with instrumental or impulsive crimes (R2 N ≥ .52, OR ≥ 1.02, p ≤ .021), and (b) that recidivism, designated by the prison security level imposed, increases (R2≥ .53, β ≥ 1.16, p ≤ .008). Conclusions: The instrument is a valid and reliable measure that allows a dimensional and integrative assessment of the personality of convicts of the HP, according to ICD-11 standards

Resumen Antecedentes: el trastorno de la personalidad (TP) es un predictor importante en la comisión de delitos; sin embargo, existe una ausencia de instrumentos clínicos para las características del convicto peruano. Objetivo: desarrollar un instrumento de medición integral de la personalidad confiable y válido, el Inventario Integrativo de Personalidad Dimensional versión CIE-11 (IDPI-11), según los estándares de la Clasificación Internacional de Enfermedades (CIE-11). Método: se utilizó una muestra estratificada de reclusos del Establecimiento Penitenciario de Huancayo (EPH) (n estudio 1 = 60; n estudio 2 = 1095). Resultados: se encontraron altos índices de confiabilidad (ω de McDonald ≥ .73) y niveles adecuados de validez de contenido (CVI-S ≥ .87), constructo y criterio de sus escalas, pudiendo explicar la probabilidad de: (a) pertenecer al grupo de internos con delitos instrumentales o impulsivos (R2≥ .52, OR ≥ 1.02, p ≤ .021);y(b) que la tendencia a reincidir, designada por el grado de seguridad penitenciaria impuesto, aumente (R2 ≥ .53, β ≥ 1,16, p ≤ .008). Conclusiones: el instrumento construido es una medida válida y confiable que permite una evaluación dimensional e integrada de la personalidad del convicto de la EP de Huancayo, de acuerdo con los estándares de la CIE-11.

Health expenditures and causa mortis: an investigation on municipalities of the State of Paraná, Brazil / Gastos com saúde e causa mortis: uma investigação dos municípios do Estado do Paraná, Brasil / Gastos en salud y causa mortis: una investigación para los municipios del Estado de Paraná, Brasil

The Brazilian government shares the responsibility of financing public health among federal, state, and municipal levels. Health expenditures are thus uneven across the country and cannot contribute equally to health outcomes across disease categories. This study aims to identify how the health expenditures of municipalities affect the mortality rate in the state of Paraná by causa mortis. We considered years of life lost for each municipality, the chapters of the International Classification of Diseases (10th revision), and the elasticity of this measure in relation to public health expenditure. Considering the possibility of endogeneity, this study follows the instrumental variable approach in a panel of generalized method of moments - instrumental variable (GMM-IV) with fixed effects. Our results show that a 1% increase in health expenditure could decrease the average number of years lost specifically for some causes from 0.176% to 1.56% at the municipal level. These findings could elucidate policy perspective within state finance.

O financiamento da saúde pública é uma responsabilidade compartilhada entre as três esferas governamentais brasileiras, i.e., a federal, estadual e municipal. Logo, gastos divergem pelo território e não se poderia esperar que contribuíssem de forma homogênea para os desfechos de saúde em todos os tipos de doença. Este artigo busca identificar como gastos municipais afetam a taxa de mortalidade no Estado do Paraná dado sua causa mortis. Consideramos anos de vida perdidos para cada município, os capítulos da Classificação Internacional de Doenças (10ª revisão) e estimamos a elasticidade dessa medida em relação aos gastos públicos em saúde. Considerando uma possível endogeneidade, este artigo segue a abordagem variável instrumental em um painel de método generalizado de momentos (GMM-IV) com efeitos fixos. Nossos resultados mostram que um aumento de 1% nos gastos municipais com saúde pode diminuir o número médio de anos perdidos entre 0,176% e 1,56% para algumas causas especificas de mortalidade. Nosso estudo pode lançar alguma luz sobre a perspectiva política das finanças dos estados.

La financiación de la salud pública es una responsabilidad compartida entre las tres esferas del gobierno brasileño, a nivel federal, estatal y municipal. En este sentido, los gastos son desiguales en el territorio, y no se puede esperar que contribuyan de forma homogénea a los resultados de salud en las distintas categorías de enfermedades. La función de este trabajo es identificar cómo los gastos de los municipios afectan a la tasa de mortalidad en el Estado de Paraná, por causa mortis. Se consideraron los años de vida perdidos para cada municipio, los capítulos de la Clasificación Internacional de Enfermedades (10ª revisión), y se estimó la elasticidad de esta medida en relación con el gasto sanitario público. Teniendo en cuenta la posibilidad de endogeneidad, este trabajo sigue el enfoque de variables instrumentales en un panel de los método generalizado de momentos (GMM-IV) con efectos fijos. Nuestros resultados muestran que un aumento del 1% en el gasto sanitario puede disminuir el número medio de años perdidos específicamente por algunas causas del 0,176% al 1,56%, a nivel municipal. Esto puede arrojar algo de luz sobre la perspectiva política dentro de las finanzas de los estados.

Asignación diagnóstica del CIE-10 entre psicólogos en un hospital salvadoreño / ICD-10 diagnostic assignment among psychologists in a Salvadoran hospital

Objetivo. Describir la asignación del diagnóstico psiquiátrico realizado por psicólogos en un hospital de San Salvador. Metodología. Estudio transversal analítico de 307 consultas de salud mental entre adolescentes menores de 18 años que recibieron atención en el Hospital Nacional "Enfermera Angélica Vidal de Najarro". Se digitalizaron las consultas del período 2014-2016. Se utilizó regresión logística multinomial y pruebas de chi-cuadrado globales para evaluar la asignación diagnóstica por bloque CIE-10 de tres psicólogos. Se controló la edad y el sexo del paciente, la fecha y el servicio hospitalario que generó la consulta. Resultados. En el modelo multinomial ajustado, el chi-cuadrado global para el efecto de cada psicólogo fue estadísticamente significativo; el efecto de cada psicólogo mostró una especificidad de resultado al comparar los diagnósticos del bloque F30-F39 con los diagnósticos del bloque F40-F49, de la CIE-10, fueron los más prevalentes en la muestra. Los valores ajustados para las probabilidades de diagnóstico por bloque CIE-10 sugieren variabilidad cuantitativa en el diagnóstico según el psicólogo que lo proporciona. Conclusiones. Se identifica variación en la asignación diagnóstica por bloques CIE-10 entre los psicólogos que trabajan en un hospital urbano de segundo nivel en San Salvador. Esto deberá estudiarse con mayor profundidad

Objective. To describe the psychiatric diagnoses made by psychologists at a hospital in San Salvador. Methodology. A cross-sectional analytical study of 307 medical consultations of adolescents' mental health (≤18 years old) provided at the "Enfermera Angélica Vidal de Najarro National Hospital." Handwritten registry Consultations from 2014 to 2016 were digitalized. Multinomial logistic regression and global chi-squared tests were used to evaluate diagnostic assignment by each ICD-10 block made by three professional psychologists. Patients' age and sex were controlled as well as date and type of service provided. Results. In the adjusted multinomial model, the global chi-squared for the effect of each psychologist was statistically significant, and the effect of each psychologist showed outcome specificity when diagnostic blocks F30-39 were compared with blocks F40-49, which were the most prevalent ICD-10 blocks in the sample. The adjusted probability values by ICD-10 diagnostic block suggest quantitative variability in diagnostic patterns according to the psychologist providing the diagnosis. Conclusions. Signs of a significant variation in ICD-10 block diagnostic assignment among psychologists working in an urban secondary hospital in San Salvador were detected, which should be carefully study

Caracterización del trastorno por videojuegos: ¿Una problemática emergente? / Characterization of Gaming Disorder: An Emerging Problem? / Caracterização do transtorno pelos videojogos: um problema emergente?

Resumen Objetivo. Sistematizar la literatura actual disponible en torno a la caracterización del trastorno por videojuegos (VDJ), aportando a la comprensión de este fenómeno en el contexto latinoamericano y su incidencia en la población infanto-juvenil. Método. Se utilizó una revisión sistemática de literatura, de corte analítico. Como eje de búsqueda se consideraron las categorías: (a) uso de las TIC, (b) videojuegos, (c) adicción y (d) trastorno por videojuegos, de acuerdo con estudios publicados en las bases de datos PubMed, ScienceDirect y Google Scholar, teniendo como referencia el DSM-V y CIE-11. Resultados. Las manifestaciones clínicas descritas para su uso adictivo son aún heterogéneas. También, se pudo observar que, cuanto más temprano se empieza, mayor será la frecuencia de su uso en edades posteriores, lo que aumenta las conductas de riesgo en el futuro y su incidencia en el tiempo de ocio y la recreación cotidiana. Conclusión. Los efectos que puede generar el uso problemático de dispositivos tecnológicos en el desarrollo de las personas, se contrapone al uso de los VDJ en el tratamiento de diversos trastornos como en el plano educativo. Adicionalmente, se reafirma el desafío de construir saberes e investigaciones multidisciplinares en torno al uso problemático de estos dispositivos.

Abstract Objective. Systematize the current literature available on the characterization of video game disorder, in order to contribute to the understanding of this phenomenon in the Latin American context and its incidence in the child/youth population. Method. A systematic review and analysis of the literature was used. The following categories were considered lines of inquiry: (a) use of ICT, (b) video games, (c) addiction and (d) video game disorder, according to studies published in the PubMed, ScienceDirect and Google Scholar databases, having the DSM-V and ICD-11as references. Results. The clinical manifestations of its addictive use are still heterogeneous. Also, it was observed that the earlier it starts, the greater the frequency of its use in later ages, which increases risk behaviors in the future and its incidence in leisure time and daily recreation. Conclusion. The effects that the problematic use of technological devices can generate in the development of individuals are contrasted to the use of video games in the treatment of various disorders, such as in the educational field. Additionally, the challenge of building knowledge and multidisciplinary research around the problematic use of these devices is reaffirmed.

Resumo Escopo. Sistematizar a literatura atual disponível sobre a caracterização do transtorno pelos videojogos (VDJ), aportando à compreensão de este fenômeno no contexto latino-americano e sua incidência na população infanto-juvenil. Metodologia. Foi empregada uma revisão sistemática de literatura, de corte analítico. Como eixo de procura foram consideradas as categorias: a) uso das TIC, b) Videojogos, c) Vício e d) transtorno pelos videojogos, de acordo com estudos publicados nas bases de dados PubMed, ScienceDirect e Google Scholar, tendo como referencia o DSM-V e C1E-11. Resultados. As manifestações clínicas descritas para o seu uso aditivo ainda são heterogéneas. Também, foi observado que, quanto mais cedo começar, maior será a frequência do seu uso em idades posteriores, o que aumenta as condutas de risco no futuro e sua incidência no tempo de ócio e a recreação cotidiana. Conclusão. Os efeitos que pode gerar o uso problemático de dispositivos tecnológicos no desenvolvimento das pessoas, está contraposto ao uso dos VDJ no tratamento dos diversos transtornos como no plano educativo. Além do mais, é reafirmado o desafio de construir saberes e pesquisas multidisciplinares sobre o uso problemático de estes dispositivos.

Características del registro y codificación diagnóstica de los pacientes hospitalizados en un hospital del seguro social de Chiclayo / Characteristics of the registration and diagnostic coding of hospitalized patients in a social security hospital of Chiclayo

Objetivo: Describir las características del registro y codificación diagnóstica de los pacientes hospitalizados en el servicio de Medicina interna, Cirugía general, Pediatría, Ginecología y Obstetricia del Hospital Nacional Almanzor Aguinaga Asenjo en el periodo Enero- Junio del 2016. Material y Métodos: Estudio observacional tipo descriptivo, transversal, con una población de 3003 pacientes, muestra de 341 mediante afijación proporcional se obtuvo la cantidad de las historias clínicas a revisar por servicios: Cirugía General (72), Ginecología (38), Medicina Interna (58), Obstetricia (142) y Pediatría (31), finalmente se realizó un muestreo aleatorio simple con reemplazo. Para la recolección de la información se utilizó ficha de recolección de datos y el procesamiento mediante el programa SPSS versión 24, se empleó un análisis descriptivo univariado y bivariado. Resultados: El registro y codificación diagnóstica del CIE 10 en las historias clínicas fue incorrecto al diagnóstico de ingreso 57,8% y diagnóstico de egreso 55,7%. Con respecto al CIE 10 registrado en las historias clínicas y el sistema de gestión hospitalaria se encontró que no concuerda en un 67%. Conclusiones: La codificación y registro diagnóstico del CIE 10 en las historias clínicas y el sistema de gestión hospitalaria es incorrecto, lo que indica la importancia de implementar y reforzar la capacitación adecuada al personal de salud.

Objetive: To describe the characteristics of the registration and diagnostic coding of patients hospitalized in the Internal Medicine, General Surgery, Pediatrics, Gynecology and Obstetrics departments of the Almanzor Aguinaga Asenjo National Hospital in the period January-June 2016. Material and Methods: Observational study descriptive, cross-sectional type, with a population of 3003 patients, sample of 341 by proportional allocation was obtained the number of clinical records to be reviewed by services: General Surgery (72), Gynecology (38), Internal Medicine (58), Obstetrics (142) and Pediatrics (31), finally a simple random sampling with replacement was carried out. To collect the information, a data collection form was used and the processing was carried out through the SPSS program, version 24, using a descriptive univariate and bivariate analysis. Results: The registration and diagnostic coding of the ICD 10 in the medical records was incorrect at diagnosis of 57.8% and diagnosis of discharge 55.7%. Regarding the ICD 10 registered in the medical records and the hospital management system, it was found that it does not agree with 67%. Conclusions: The coding and diagnostic registry of the ICD 10 in the medical records and the hospital management system is incorrect, which indicates the importance of implementing and reinforcing adequate training for health personnel.

Correlation study between specification of velvet antler and its color and chemical composition / 中国药学杂志

OBJECTIVE: To investigate the color and chemical composition of the wax slices, w-powder slices, r-powder slices, blood slices and bone slices of two-branch Velvet Antler, three-branch Velvet Antler and reborn Velvet Antler with different growth years, and analyze the relationship between the color characteristics and chemical composition (protein, polysaccharide, phospholipid). METHODS: The color parameters of five kinds of slices with different growth periods were detected by CIEL*a*b* color space. The content of protein was determined by Coomassie blue colorimetric method, the content of polysaccharide was determined by phenol sulfuric acid method, and the content of phospholipid was determined by molybdenum blue colorimetric method. Pearson correlation analysis was used to analyze the correlation between color and components. RESULTS: There were significant differences in color and chemical composition between the five types of Velvet Antlers with different grow periods. Pearson correlation analysis showed that the Velvet Antler color parameter b* had a significant negative correlation with the three chemical components. CONCLUSION: The color determination method based on the principle of colorimetry can effectively distinguish Velvet Antlers in different growth stages. And the correlation analysis showed that the color digital index can reflect the difference in chemical composition of Velvet Antler in a certain degree.

Preliminary Result of Randomised Controlled Trial of Three Different Coated Archwires Part 2: Colour Change and Patient Perception

@#Introduction: Coated archwires improve aesthetics because of the tooth-coloured appearance. However, colour change of the coated archwires have been reported in vitro. Nonetheless, little is known to what extent this colour change occurs clinically. This second part of the multi-centre, double-blind, randomised controlled trial evaluated the colour change (∆E*) of three coated archwires with their controls and patient perception. Methods: 84 patients who received treatment with upper and lower fixed appliance treatment were invited. Consented patients were randomised to receive one of four treatment interventions using 0.014” superelastic nickel-titanium archwires from (1) Orthocare (2) RMO (3) G&H, and (4) 3M Unitek® uncoated. These archwires were ligated during bonding and collected after 8th week. After removal, the digital images of the archwires were assessed for colour change using Adobe® Photoshop® software, and the CIE L*a*b* system was used to calculate the ΔE* values. Patient perception was measured using oral aesthetic subjective impact scale (OASIS) questionnaire. Results: For colour change and patient perception assessment, 132 archwires from 66 participants who had been treated with aesthetic archwires were collected. Two fractured archwires were excluded. Initial analysis revealed all three aesthetic archwires groups showed significant mean of ∆E* with the highest was found in Orthocare (23.9), and the lowest is G&H (16.8). Post hoc comparison revealed statistically significant mean of ∆E* in Orthocare when compared with other groups (p <0.001). There was no statistically significant difference for patient perception between archwire groups. Conclusion: Preliminary results revealed that significant ∆E* in Orthocare group and patients showed positive perception following clinical use

La histeria clásica y moderna: una visión sinóptica Parte II Diagnóstico / Classic and modern hysteria: a synoptic view. Part II Diagnosis

Todo diagnóstico de un problema descubierto lleva implícito un proceso de análisis y síntesis. Todavía no se ha logrado encontrar una clara definición de la histeria, precisamente por su "psicoplasticidad", es decir, por la infinidad de expresiones clínicas en que se puede presentar. Además su eliminación de los códigos diagnósticos la fragmentó en diversos síndromes o conjuntos sintomáticos. El psicoanálisis, asociado al concepto, fue desperfilado por la psiquiatría americana con el advenimiento de la investigación biológica sobre trastornos mentales y nuevos descubrimientos como los sistemas de neurotransmisores. Quedaron atrás los criterios de Feighner, que abarcaban los diagnósticos de neurosis de ansiedad, neurosis obsesivo-compulsiva, neurosis fóbica, histeria. Se analiza clasificaciones CIE y DSM, en las que se puede rastrear la histeria. Palabras claves: histeria, neurosis, diagnóstico, CIE-10.

Every diagnosis of a discovered problem implies a process of analysis and synthesis. A clear definition of hysteria has not yet been found, precisely because of its "psychoplasticity", that is, by the infinity of clinical expressions in which it can be presented. In addition its elimination of the diagnostic codes fragmented it in diverse syndromes or symptomatic sets. Psychoanalysis, associated with the concept, was unburied by American psychiatry with the advent of biological research on mental disorders and new discoveries such as neurotransmitter systems. Feighner's criteria, which included diagnoses of anxiety neurosis, obsessive-compulsive neurosis, phobic neurosis and hysteria, were left behind. We analyze CIE and DSM classifications, in which hysteria can be traced.

Gastos hospitalarios por neumonía neumocóccica invasora en adultos en un hospital general en Chile / Hospital charges by bacteremic pneumococcal pneumonia in adults in a general hospital

Pneumococcal infections are important for their morbidity and economic burden, but there is no economical data from adults patients in Chile. Aims. Estimate direct medical costs of bacteremic pneumococcal pneumonia among adult patients hospitalized in a general hospital and to evaluate the sensitivity of ICD 10 discharge codes to capture infections from this pathogen. Methods. Analysis of hospital charges by components in a group of patients admitted for bacteremic pneumococcal pneumonia, correction of values by inflation and conversion from CLP to US$. Results. Data were collected from 59 patients admitted during 2005-2010, mean age 71.9 years. Average hospital charges for those managed in general wards reached 2,756 US$, 8,978 US$ for those managed in critical care units (CCU) and 6,025 for the whole group. Charges were higher in CCU (p < 0.001), and patients managed in these units generated 78.3% of the whole cost (n = 31; 52.5% from total). The median cost in general wards was 1,558 US$, and 3,993 in CCU. Main components were bed occupancy (37.8% of charges), and medications (27.4%). There were no differences associated to age, comorbidities, severity scores or mortality. No single ICD discharge code involved a S. pneumoniae bacteremic case (0% sensitivity) and only 2 cases were coded as pneumococcal pneumonia (3.4%). Conclusions. Mean hospital charges (~6,000 US dollars) or median values (~2,400 US dollars) were high, underlying the economic impact of this condition. Costs were higher among patients managed in CCU. Recognition of bacteremic pneumococcal infections by ICD 10 discharge codes has a very low sensitivity.

Las infecciones neumocócicas representan una gran carga de morbilidad y de gastos en salud en pacientes adultos pero no se dispone de datos que hayan evaluado su dimensión económica en Chile. Objetivo: Evaluar los gastos directos en un grupo de pacientes adultos hospitalizados por neumonía neumocóccica bacterémica en un hospital general y evaluar la sensibilidad de los códigos de egreso CIE 10 para capturar las infecciones por este patógeno. Métodos: Análisis de gastos por componentes de un grupo de pacientes atendidos por neumonía neumocóccica bacteriémica, actualización de gastos y conversión a US$. Resultados: Se rescató información de 59 pacientes atendidos entre el 2005-2010, con edad promedio de 71,9 años. El gasto promedio en sala fue de 2.756 US$, de 8.978 US$ en Unidades Críticas y de 6.025 US$ para el grupo total. Los gastos fueron mayores en Unidades Críticas (p < 0,001) y los pacientes en estas unidades (n = 31; 52,5% del total) generaron el 78,3% del gasto total observado. La mediana de gastos en sala fue de 1.558 US$ y de 3.993 US$ en el caso de Unidades Críticas. El 37,8% del gasto se originó por día-cama y 27,4% por medicamentos. No hubo diferencias por edad, co-morbilidades, scores de gravedad o mortalidad. Ningún código CIE 10 involucró bacteriemia por S. pneumoniae (Sensibilidad 0%) y sólo 2 casos fueron codificados como neumonía neumocóccica (3,4%). Conclusiones: El gasto promedio (aprox. 6.000 dólares americanos) y mediana (aprox. 2.400 dólares americanos) fueron elevados evidenciando la importancia económica de esta enfermedad. Los gastos fueron mayores en pacientes manejados en Unidades Críticas. La sensibilidad de los códigos CIE 10 fue baja para reconocer eventos de ENI en esta serie.

Histeria, transtornos somatoformes e sintomas somáticos: as múltiplas configurações do sofrimento psíquico no interior dos sistemas classificatórios / Hysteria, somatoform disorders and somatic symptoms: the multiple settings of psychic suffering inside the classification systems / Histeria, trastornos somatoformes y síntomas somáticos: las múltiples configuraciones del sufrimiento psíquico en el interior de los sistemas clasificatorios

O artigo retoma a história da histeria e das tentativas científicas de seu estudo. Acompanha, assim, os investimentos feitos ao longo do tempo para superar o sofrimento histérico. Os êxitos parecem limitados, e os sintomas continuam a se manifestar, moldados pelas diferentes condições sócio-históricas. A exploração das configurações da histeria no interior dos sistemas classificatórios é o objeto central desta análise. Recorre-se à Classificação Internacional de Doenças (CID) e ao Manual Diagnóstico e Estatístico de Saúde Mental (DSM), considerando também as primeiras definições freudianas de histeria. As novas nomenclaturas como neurose histérica, transtorno psicossomático, transtornos somatoformes e sintomas somáticos exprimem os esforços para circunscrever a especificidade desse mal-estar. E as definições tentam atender à possibilidade de intervenções mais precisas no tratamento dos sintomas, mas indicam também uma nova fragmentação e dispersão da percepção de modalidades de sofrimento...

This article recovers the history of hysteria and the scientific attempts to study it. Thus follows the investments made over time to overcome hysterical suffering. The successes seem limited and the symptoms continue to manifest, shaped by different socio-historical conditions. The central object of this analysis is to explore the settings of hysteria within the classification systems. The text resorts to the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual of Mental Health (DSM), also considering the first Freudian definitions of hysteria. The new classifications, such as hysterical neurosis, psychosomatic disorder, somatoform disorders and somatic symptoms express the efforts to circumscribe the specificity of this malaise. The definitions try to cater to the possibility of more precise interventions for the treatment of the symptoms, but also indicate a new fragmentation and dispersion of perception of the modalities of suffering...

Este artículo retoma la historia de la histeria y de los intentos científicos de su estudio. Continúa las inversiones hechas a lo largo del tiempo para superar el sufrimiento histérico. Los éxitos parecen limitados y los síntomas siguen manifestándose, moldados por las diferentes condiciones socio-históricas. Las configuraciones de la histeria en el interior de los sistemas clasificatorios es el objeto central de este análisis. Se recurre a la Clasificación Internacional de Enfermedades (CIE) y al Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM), considerando también las primeras definiciones freudianas de la histeria. Las nuevas nomenclaturas como neurosis histérica, trastorno psicosomático, trastornos somatoformes y síntomas somáticos, expresan los esfuerzos para circunscribir la especificidad de este mal estar. Las definiciones tratan de atender la posibilidad de intervenciones más precisas en el tratamiento de los síntomas, pero indican asimismo una nueva fragmentación y dispersión de la percepción de modalidades de sufrimiento...

TASA Y PORCENTAJES DE MORTALIDAD POR ENFERMEDADES RESPIRATORIAS ¿QUÉ LUGAR OCUPA EL ASMA BRONQUIAL? / Mortality rates and percentages of deaths from respiratory diseases: ¿What place does bronchial asthma occupy?

Introducción. El asma bronquial es una enfermedad inflamatoria crónica de las vías respiratorias. La reversibilidad de sus síntomas es su característica. La carga epigenética es un factor importante. Las estadísticas de mortalidad son una fuente importante de información para la salud ya que nos permite establecer estrategias terapéuticas preventivas. La Clasificación Internacional de Enfermedades CIE 10 nos provee un sistema alfanumérico vasto y didáctico. Objetivos. (1) Informar las tasas y porcentajes de fallecimientos por enfermedades del aparato respiratorio ocurridas entre los años 2000 a 2007 en la Provincia de Santa Fe y (2) Informar qué porcentaje y tasas de fallecimientos ocupa el asma bronquial dentro de las enfermedades crónicas de las vías respiratorias Inferiores. Material y métodos. El Ministerio de Salud de Santa Fe suministró los datos obtenidos de los certificados de defunción en el período 2000-2007; los informes se hacen en base a las normas de la OMS a través de la CIE 10, agrupados en el cap. 10 J00 a J99. Resultados. Objetivo 1: haciendo el análisis de los grupos J00 a J99 se puede observar que el mayor porcentaje de muerte es debido a neumonías agudas (J10 a J18) con 37%, le siguen J95 a J99 con 27%. Luego J40-J47 con el 22%. Este grupo incluye al asma y estado asmático con 3% del total. Los códigos J80 -84 y J60- 70 siguen con el 7 y 6% respectivamente. Objetivo 2: cuando analizamos en número y porcentaje las causas de muerte en el grupo 5 (J40-47), el grupo J44 (EPOC) tiene 82%, el grupo J45-46 (asma) 11%, el grupo J43 (enfisema) 4%, elgrupo J41-42 (bronquitis) 3% y el grupo J47 (bronquiectasias) menos del 1%. La tasa de mortalidad por asma bronquial en la provincia de Santa Fe años 2000- 2007 da un promedio anual de 24 muertes por millón de habitantes. En el grupo de 5-34 años es de 1,2 por millón de habitantes. La tasa de mortalidad por EPOC en el mismo período da un promedio de 187 por millón de habitantes. Conclusiones. Las tasas de muerte por asma son altas y los porcentajes de otras patologías del aparato respiratorio también son altas. La única fuente de datos son los certificados de defunción y es poco precisa a la hora de realizar estadísticas a pesar de ser coherentes comparando los datos de diferentes regiones del mundo. Para ajustar las estadísticas deberíamos analizar si el enfermo muere por su asma (válida) o muere con su asma (no válida). (AU)

Background. Bronchial asthma is a chronic inflammatory disease of the airways characterized by the reversibility of symptoms. The epigenetic burden is a major factor. Mortality statistics are an important source of health information since they allow us to establish preventive treatment strategies. The International Classification of Diseases, Tenth Revision (ICD-10) provides an extensive and educational alphanumeric system. Aims: (1) To report rates and percentages of respiratory system deaths occurred between years 2000-2007 in the province of Santa Fe; and (2) To report rates and percentages of deaths due to bronchial asthma among "chronic diseases of the lower respiratory system". Material and methods: The Ministry of Health of Santa Fe provided data from death records for the period between 2000 and 2007. Reports are based on WHO norms using the ICD-10 codes J00 to J99 from chapter X. Results: (1) A detailed analysis of codes J00 to J99 showed that the highest percentage of deaths are due to acute pneumonias (J10 to J18), accounting for 37% of deaths, followed by codes J95 to J99 with 27% and codes J40-J47 with 22%. This last group includes asthma and status asthmaticus with 3% of the total. There follow codes J80 -84 and J60-70 with 7% and 6%, respectively. (2) After assessing the number and percentages of causes of death from chronic lower respiratory diseases (J40-47), code J44 (chronic obstructive pulmonary disease) accounts for 82% of deaths, codes J45-46 (asthma-status asthmaticus) for 11%, code J43 (emphysema) for 4%, codes J41-42 (bronchitis) for 3% and code J47 (bronchiectasis) for less than 1%. Over the period 2000-2007, mortality rates from bronchial asthma in the province of Santa Fe yield an annual average of 24 deaths per million inhabitants; being 1.2 deaths per million inhabitants in the 5-34 age-groups. COPD mortality rates during that same period give an average of 187 deaths per million inhabitants. Conclusions. Asthma death rates are high as well as percentages from other respiratory system conditions. The only source of data are death records, which are scarce and imprecise to perform statistical calculations; despite being consistent with data from different regions of the world. To adjust statistics, we should determine if patients die from their asthma (valid) or with their asthma (not valid).(AU)

Spectrophotometric analysis of crown discoloration induced by MTA- and ZnOE-based sealers

Crown discoloration can be induced by root canal sealer remnants following root canal treatment. Objective: The aim of this study was to evaluate chromatic alterations in human tooth crowns induced by a Mineral Trioxide Aggregate-based sealer (MTA Fillapex®) and a commonly used ZnOE-based sealer (Roth-811). The tested null hypothesis was that the application of the materials did not induce clinically perceptible crown discoloration (Ho: CIE color difference ΔE<3.7). Material and Methods: Forty five fully developed, intact, mandibular third molars were sectioned 1 mm below the cemento-enamel junction. The pulp chambers were chemomechanically debrided via the cervical access. The specimens were randomly assigned into three groups Group 1: MTA Fillapex, Group 2: Roth 811, Group 3: Negative control (unfilled) and immersed in individually marked vials containing distilled water up to the cervix (37±1°C). The spectral reflectance lines were recorded by utilizing a UV-VIS spectrophotometer equipped with integration sphere in the visual spectrum at baseline, 1 week, 1 and 3 months after material placement. Data were transformed into values of the CIE L*a*b* color system and the corresponding ΔE values were calculated. Statistical analysis was performed using two-way mixed ANOVA models, at p=0.05 level of significance. Results: A statistically significant increase in a* and b* chromatic parameters of the MTA Fillapex Group was measured. However, ΔE values did not exceed the human eye perceptibility threshold (set at ΔE<3.7) during the experimental period (ΔEt3=2.88). In Roth-811 Group, a statistically significant decrease in L* and a statistically significant increase in a* and b* chromatic parameters was measured, during all observation periods. Resultant ΔE values exceeded the human eye perceptibility threshold after 1 week (ΔEt1=5.65). Conclusions: Application of MTA Fillapex in tooth crowns resulted in minimal color alterations, while Roth 811 induced severe discoloration, in vitro. It could be suggested that, in terms of aesthetics, the use of MTA Fillapex appears to be favorable.

The influence of metal substrates and porcelains on the shade of metal-ceramic complex: A spectrophotometric study.

Background: The final esthetic outcome of a metal-ceramic restoration is influenced by several factors including the type of the underlying metal as well as the brand of the ceramic. Settings and Design: An in vitro study. Aims: The purpose of the in vitro study was to investigate the influence of four types of metal-ceramic alloys and two porcelain systems on the color co-ordinates of the metal-ceramic complex. It also aimed at establishing a color index which correlated the color of the metal-ceramic combination to the yellow-blue axis. Materials and Methods: Twenty-four disc-shaped metal specimens of 12 mm × 1 mm were cast from base metal alloys, nickel-chromium (Ni-Cr) (Wiron 99), cobalt-chromium (Co-Cr) (Wirobond C), a palladium (Pd)-rich noble metal alloy (Spartan Plus), and a high noble gold (Au) alloy (Pontostar). These discs were covered with two commercially available feldspathic porcelains (Vita Omega and Shofu Vintage) of A3 shade to a total thickness of 1.2 mm. Each group had six specimens, of which three were coated with Vita Omega and the remaining with Shofu Vintage. Opaque and dentin layers were applied to a standardized thickness of 0.2 mm ± 0.05 mm and 1 mm ± 0.05 mm, respectively onto the metal surface after air abrasion with 50 μm alumina particles. The reflectance spectra were measured with a spectrophotometer and data were recorded in L*, a* and b* coordinates in the CIE Lab Color Order System. Statistical Analysis: Analysis of variance (ANOVA) and path analysis were the statistical tools employed to analyze the data. A critical difference (CD) value was calculated for each color co-ordinate to make comparisons between each metal-ceramic combination. A color index for each metal-ceramic complex was also calculated from the color co-ordinates obtained. Results: ANOVA revealed that significant differences existed between the metal-porcelain combination at 0.01 ( P < 0.01) level. The L* value was significantly higher for Au and Co-Cr alloys with Vita Omega porcelain. The a* value was highest for Ni-Cr alloy when combined with Shofu Vintage ceramic. The b* value of Au alloy with Vita Omega porcelain was significantly higher than any other metal-ceramic combination. The color co-ordinates of Pd alloy with both porcelain systems did not show any significant differences. Gold alloy with Vita Omega showed the highest color index value. Conclusion: The variations in metal-ceramic alloy and porcelain can influence the shade of a metal-ceramic restoration. Color index value was the highest for gold alloy.

The evaluation of color and color difference according to the layering placement of Incisal shade composites on the body composites of the indirect resin restoration / 대한치과보존학회지

OBJECTIVES: The aim of this study was to evaluate the surface color of indirect resin restoration according to the layering placement of different shade of incisal composite. MATERIALS AND METHODS: In this study, CIE L*a*b* value of 16 Body composite of Tescera ATL (Bisco, Schaumburg IL,USA) was measured by spectrophotometer (NF999, Nippon Denshuku, Japan), and compared to CIE L*a*b* value of Vitapan shade guide. Nine shade Incisal composite of Tescera ATL were build-up to 1 mm thickness on Body composites inlay block, and CIE L*a*b* value was measured. Incisal composite was ground to 0.5 mm thickness and CIE L*a*b* value was re-measured. Color difference between Body composite and Incisal composites layered on Body composite was calculated as a function of thickness. RESULTS: Color difference between corresponding shade of Tescera Body composite and Vitapan shade guide was from 6.88 to 12.80. L* and b*value was decreased as layering thickness of Incisal composite on Body composite was increased. But, a* value did not show specific change tendency. CONCLUSIONS: Surface color difference between Body composites and Incisal composites layered on Body composite was increased as the layering thickness of Incisal composite increased (p < 0.05).

Effects of the color components of light-cured composite resin before and after polymerization on degree of conversion and flexural strength / 대한치과보존학회지

OBJECTIVES: This study investigated the effects of the color components of light-cured composite resin before and after polymerization on degree of conversion (DC) and biaxial flexural strength (FS). MATERIALS AND METHODS: Four enamel shades (A1, A2, A3, A4) and two dentin shades (A2O, A3O) of Premisa (Kerr Co.) and Denfil (Vericom Co.) were evaluated on their CIE L*, a*, b* color components using the spectrophotometer before curing, after curing and at 7 day. The DC of same specimens were measured with Near-infrared spectrometer (Nexus, Thermo Nicolet Co.) at 2 hr after cure and at 7 day. Finally, the FS was obtained after all the other measurements were completed at 7 day. The correlations between each color component and DC and FS were evaluated. RESULTS: The light-curing of composite resin resulted in color changes of Premisa in red-blue direction and Denfil in green-blue direction. The DC and FS were affected by product, time and shade (3-way ANOVA, p < 0.05) and product and shade (2-way ANOVA, p < 0.05), respectively. Premisa only showed a significant correlation between the DC and CIE a* component - before and after polymerization (Pearson product moment correlation, p < 0.05). The FS of Premisa showed significant negative correlations with CIE a* and CIE b* components. CONCLUSIONS: The DC and FS of the light-curing composite resin were affected by the color components of the material before and after polymerization.

Identificación de pacientes con iatrogenias realizadas en otrasinstituciones, que ingresaron al Servicio de Atención Prioritaria de la Facultad de Odontología de la Universidad de Antioquia en el periodo 2009-1 / Identification of patients with iatrogenic procedures performed at other institutions who were admitted to the Emergency Service, College of Dentistry, University of Antioquia during the first semester of 2009 (2009-1)

Introducción: las iatrogenias odontológicas entendidas como alteraciones de la salud bucal del paciente, provocadas por el odontólogo, se dan aun entre profesionales altamente calificados, por lo que su prevención es necesaria para una práctica consciente en el esfuerzo de disminuir errores. El objetivo de este estudio fue conocer las iatrogenias odontológicas realizadas en entidades externas a la Facultad, en los pacientes que ingresaron al Servicio de Atención Prioritaria de la Facultad de Odontología de la Universidad de Antioquia en el periodo 2009-1 y obtener datos de la historia clínica que nos permitieran caracterizar de forma global este tipo de población y así orientar el servicio de manera adecuada. Métodos: se revisaron 839 historias clínicas del Servicio de Atención Prioritaria debidamente diligenciadas. En los 36 casos que se evidenció radiográficamente la presencia de iatrogenia se realizó un análisis estadístico descriptivo, con el fin de caracterizar la población afectada. Resultados: de las historias clínicas con evidencia de iatrogenia el 61,1% correspondió a mujeres y 38,9% a hombres; en cuanto al sistema de aseguramiento, el 36,1% pertenecían al régimen subsidiado de salud. Se observaron iatrogenias como: endodoncias subobturadas (31,3%), subextendidas (23,5%), restauraciones sobrecontorneadas (15,6%), filtración coronal, perforaciones radiculares, elementos intrarradiculares desadaptados, sobreobturación endodóntica, fractura vertical radicular, trauma oclusal, fractura del diente, mal manejo de trauma dentoalveolar y subcontorneado de la restauración, en ese orden de frecuencia. Conclusiones: el 4,29% de la historias revisadas en el 2009-I evidenciaron iatrogenia odontológica, con mayor frecuencia de tipo endodóntico y con remisión al endodoncista.

Introduction: dental iatrogeny, defined as an alteration of the health status of a patient caused by a dental professional, is seen even among highly-qualified professionals; therefore, its prevention is a key factor to carry out a conciensous practice in an effort to reduce the number of mistakes. The objective of this study was to document cases of dental iatrogeny performed at outside institutions in patients who were admitted to the Emergency Service, College of Dentistry at University of Antioquia in Medellín, Colombia, during the first semester of 2009 (2009-I). Furthermore, to obtain data from the dental history in order to characterize this type of population and provide a correct orientation for this service. Methods: 839 complete dental records from the Emergency Service were reviewed. In the 36 cases with radiographic evidence of iatrogenic procedures, a descriptive statistical analysis was carried out to characterize the affected population. Results: after analyzing the dental records with radiographic evidence of iatrogeny, 61.1% corresponded to female patients and 38.9% to male patients. Regarding the health care system, 36.1% corresponded to the subsidized system. The following iatrogenic events were observed and they are presented in order of frequency: underfilled endodontic obturations (31.3%), overextended obturations (23.5%), overcontoured restorations (15.6%), coronal leaking, root perforations, poorly-adapted intraradicular elements, overfilled endodontic obturations, vertical root fractures, occlusal trauma, tooth fracture, poorly-handled dental trauma, and undercontoured restorations. Conclusions: 4.29% of the dental records reviewed in 2009-1 showed evidence of dental iatrogeny. There was a higher frequency of endodontic problems with referral to the endodontist.

De H. Cleckley ao DSM-IV-TR: a evolução do conceito de psicopatia rumo à medicalização da delinquência / De H. Cleckley al DSM-IV-TR: la evolución del concepto de psicopatía rumbo a la medicalización de la delincuencia / De H. Cleckley au DSM-IV-TR: l'évolution du concept de la psychopathie vers la medicinalisation de la délinquance / From H. Cleckley to DSM-IV-TR: the evolution of the concept of psychopathy toward the medicalization of delinquency

A psicopatia é descrita como personalidade antissocial pelos manuais nosográficos contemporâneos: CID-10 e DSM-IV-TR. Contrastando tais nosografias entre si quanto aos critérios diagnósticos propostos para a psicopatia, assinalam-se as consequências de sua operacionalização, promovida, sobretudo, pelo DSM. Dentre elas, destacam-se: (1) a degradação do diagnóstico ao mero levantamento protocolar; (2) a acentuação da correlação histórica entre psicopatia e delinquência.

La psicopatía es descrita como la personalidad antisocial por los manuales nosográficos contemporáneos: CIE-10 y DSM-IV-TR. Contrastando tales nosografías entre sí, con relación a los criterios de diagnósticos propuestos para la psicopatía, se observan las consecuencias de su operacionalización, particularmente las derivadas del DSM. Entre ellas, se destaca: (1) la degradación del diagnóstico a una mera lista protocolar; (2) la acentuación de la relación histórica entre la psicopatía y la delincuencia.

La psychopathie est décrite comme personnalité antisociale par les manuels nosographiques contemporains, comme le CIM-10 et le DSM-IV-TR. La comparaison de ces nosographies entre elles par rapport à leurs critères de diagnostique de la psychopathie permet d'obtenir les conséquences opérationnelles, surtout en ce qui concerne le DSM, parmi lesquelles on retiendra spécialement: (1) la dégradation du diagnostique au simple classement protocolaire; (2) l´accentuation du rapport historique entre la psychopathie et la délinquance.

Psychopathy is described in two contemporary nosographic handbooks (ICD-10 and DSM-IV-TR0) as the condition of having an anti-social personality. This article contrasts these nosographies in terms of the diagnostic criteria used for psychopathy. The consequences of this use, especially that presented by the DSM, are discussed, such as (1) the degradation of diagnoses to the mere filling out of forms; (2) emphasis on the historical correlation between psychopathy and delinquency.

Terapeuticas noffarmacologicas en jovenes y adutos con discapacidad, desde la atencion primaria de salud / Non pharmacologic therapeutics in young and adults with incapacity from Primary Health Care

Buscando mejorar la calidad de vida en un grupo de jóvenes y adultos con discapacidad, se decide crear un taller comunitario compuesto por 15 miembros, en el cual se aplican técnicas de enfoque multidisciplinario, que han garantizado la plena reinserción social de los miembros que componen este colectivo. Para este artículo se realiza un corte longitudinal a lo largo de 3 años que muestra la evolución satisfactoria de este grupo a partir de la aplicación de las diferentes terapias establecidas.

In order to improve the quality of life of several disabled persons, a community group was created with 15 members, in which several multidisciplinary techniques were applied to guarantee the full social reinsertion of the participants. This article describes results of the work done during 8 years, showing the satisfactory evolution of the group due to the application of the different established therapies.

Envejecimiento del núcleo pulposo: verdadera causa de hernia discal (m51.8 de la cie-10): revisión bibliográfica / Ageing of pulpy nucleus: true cause of slipped disk (m51.8 of the ICD-10): bibliographical revision

Una patología frecuente de orígen vertebral precedida por alteraciones bioquímicas propias de la edad del sujeto, por microtraumatismos de la columna vertebral por cargas mecánicas, por malas posturas laborales, por un gran esfuerzo físico, o por alteraciones deformantes de la misma, es la hernia discal.Debido a que los segmentos vertebrales cervical y lumbar son los más móviles, están propensos a sufrir lesiones, por esto las afecciones más frecuentes son a estos niveles. Aproximadamente entre un 80 - 90 de los pacientes que consultan al médico por lumbalgia o lumbociática se debe a esta patología, siendo el envejecimiento del núcleo pulposo, la verdadera causa de esta discopatía simple, y en donde el dolor radicular es su principal manifestación, representando un problema de salud de gran importancia por su repercusión social, económica y laboral. Gracias a la resonancia magnética nuclear (RMN) se logra detectar la hernia discal, convirtiéndose en la técnica diagnóstica de elección. El tratamiento va desde el conservador hasta el quirúrgico incluyendo las nuevas técnicas como la discectomía percutánea, la quimionucleólisis, y la ozonoterapia como terapéutica complementaria de esta afección. Esta revisión bibliográfica se la ha realizado con el objetivo de adquirir nuevos conocimientos de patologías de la columna vertebral y la importancia que tiene el profesional en fisioterapia en la intervención del tratamiento. Además, conocer su respectiva codificación según la Clasificación Internacional Estadísticas de Enfermedades y Problemas Relacionados con la Salud en su 10º revisión CIE-10.

Slipped disk is a frequent pathology of vertebral origin preceded by biochemical alterations typical of the person’s age, spine micro traumas caused by mechanical loading, poor body postures at work, great physical effort, or deforming alterations. Owing to the fact that the cervical and lumbar vertebral segments are the most mobile, they are prone to suffer injuries, so the most frequent diseases are in these levels. Approximately between 80 - 90 of patients who go to the doctor with back pain or lumbociatic pain suffer from this pathology, being this one the pulpy nucleus ageing, the true cause of simple discopathy, and radicular pain is its main manifestation, representing a health problem of big importance because of its social, economical and labour repercussion. Thanks to MRI (Magnetic Resonance Imaging) slipped disk is possible to be detected, becoming the most valuable diagnosis technique. The treatment goes from the conservative to the surgical including new techniques such as percutaneous discectomy, chemonucleolysis, and the ozonotherapy as complementary medical treatment of this affection. This bibliographical revision has been carried out in order to acquire new knowledge of the spine and determine the importance that the physiotherapist has in the treatment intervention. Besides as well as to get to know the respective codification according to the International Statistical Classification of Diseases and Related Health Problems in its ICD-10 revision.