Intervención clínica cognitiva en paciente con trastorno esquizoide de personalidad: reporte de caso / Cognitive clinical intervention in a patient with schizoid personality disorder: Case report

El presente reporte de caso describe a un paciente varón de 19 años, que presentaba como principales síntomas frialdad emocional, ausencia de relaciones cercanas, problemas para experimentar placer con otras personas y carencia de motivación para trabajar o retomar sus estudios. Se diagnosticó un trastorno de personalidad esquizoide, producto de esquemas maladaptativos tempranos como inhibición, privación emocional, aislamiento social e inadecuación. Asimismo, se evidenció un contexto familiar rígido y fragmentado, con ausencia afectiva de padres y direccionado hacia normas estrictas en la conducta. El objetivo del estudio fue intervenir desde un enfoque clínico cognitivo los esquemas maladaptativos tempranos y síntomas que mantenían los rasgos de trastorno esquizoide de la personalidad en el paciente. Para esto se realizó una terapia cognitiva conductual, con técnicas como debates, imágenes para reparentalizar, asignación de tareas, uso del humor, entrenamiento de habilidades sociales, entre otros. Como conclusión se puede manifestar que los esquemas maladaptativos tempranos mantenían la sintomatología de personalidad esquizoide. Por último, se demostró a través de un criterio clínico y psicométrico que la terapia cognitiva conductual disminuyo las conductas de personalidad esquizoide en el paciente.

The present case report describes a 19-year-old male patient whose main symptoms were emotional coldness, absence of close relationships, difficulty experiencing pleasure with other people, and lack of motivation to work or to continue his studies. A schizoid personality disorder was diagnosed as a product of early maladaptive patterns such as inhibition, emotional deprivation, social isolation, and inadequacy. Likewise, a rigid and fragmented family context was evidenced, with an affective absence of parents and a focus on strict behavioral rules. The study aimed to intervene, from a cognitive clinical approach, the early maladaptive patterns and symptoms that maintained the features of schizoid personality disorder in the patient. For this purpose, cognitive behavioral therapy was carried out, with techniques such as debates, images to reparentalize, assignment of tasks, use of humor, and social skills training, among others. In conclusion, it can be stated that the early maladaptive patterns maintained the schizoid personality symptomatology. Finally, it was demonstrated through clinical and psychometric criteria that cognitive behavioral therapy decreased schizoid personality behaviors in the patient.

Validación de dominios y competencias por grupos focales y juicio de expertos / Validation of domains and competencies by focus groups and expert judgment

Resumen El Consejo Mexicano de Ginecología y Obstetricia certifica a los especialistas para ejercer su especialidad y brindar una atención de alta calidad a las pacientes. En la actualidad, el Consejo está rediseñando el examen de Certificación en Ginecología y Obstetricia orientado a la evaluación de competencias profesionales a partir de las actividades profesionales confiables que permitan identificar los dominios de la competencia médica en un especialista. La competencia es una variedad de habilidades ejercidas a través de múltiples dominios o aspectos del desempeño profesional; sus descriptores requieren que contengan habilidades relevantes, contexto y la etapa o nivel de evaluación. Por su parte, los dominios son un conjunto de competencias clave. Este informe incluye los resultados de la primera validación en México de dominios y competencias para la evaluación de los ginecoobstetras a partir de una metodología cualitativa que comprende una revisión de la bibliografía, grupos focales, análisis de trabajos colegiados y validación por juicio de expertos. Los resultados se presentan divididos por los ocho dominios en los que se trabajó, se mencionan los comentarios más relevantes a discutir por los cuatro grupos focales. Éstos y la validación por expertos permitió reunir comentarios valiosos, coherentes y funcionales para el sistema de evaluación que quiere llevar a cabo el Consejo. Este ejercicio permitirá el posterior desarrollo de la tabla de especificaciones, reactivos o nuevos instrumentos de evaluación coherentes con un sistema de dominios, competencias y actividades profesionales confiables.

Abstract The Mexican Council of Gynecology and Obstetrics certifies specialists to practice their specialty and provide high-quality healthcare to patients. Currently, the Council is redesigning the Gynecology and Obstetrics Certification exam, oriented to the evaluation of professional competencies based on reliable professional activities that allow the identification of domains of a specialist's medical competencies. Competency can be defined as a variety of skills across multiple domains or aspects of professional performance. Its descriptors require to contain relevant skills, context, and the stage or level of assessment. Domains can be described as a set of competencies that are considered essential. This report includes the results of the first validation done in Mexico. The validation of domains and competencies for the evaluation of physicians in the area of Obstetrics and Gynecology is based on a qualitative methodology that includes a literature review, focus groups, analysis of collegiate works, and validation through expert judgment. The obtained results are divided into eight domains that mention the most relevant observations that were discussed by the four focus groups. The focus groups and the validation through expert judgment made it possible to gather valuable, coherent, and functional feedback for the evaluation system that the Council wants to carry out. This method will allow the subsequent development of the table of specifications, items, or new evaluation instruments congruent with a system of domains, competencies, and reliable professional activities.

Síndrome de respuesta inflamatoria sistémica en cuidados intensivos pediátricos

Introducción: La sepsis es un proceso potencialmente letal caracterizado por una disfunción orgánica motivada por la respuesta del huésped a la infección y que conlleva a un desequilibrio inmunológico: proinflamatorio e inmunosupresión. Objetivo: Caracterizar el síndrome de respuesta inflamatoria sistémica en cuidados intensivos pediátricos. Métodos: Investigación descriptiva transversal realizada en el Hospital Pediátrico Docente "Pepe Portilla" de Pinar del Río durante el periodo 2015-2018. La muestra quedó constituida por todos los pacientes que ingresaron en cuidados intensivos pediátricos del citado hospital con diagnóstico de síndrome de respuesta inflamatoria sistémica de causa infecciosa o no. Se revisaron las historias clínicas y se elaboró un modelo de recogida de datos en correspondencia con el modelo 241-485-02 del sistema de información del síndrome de respuesta inflamatoria sistémica. Resultados: Hubo un predominio de la afección en pacientes con edades entre 1-4 años 122 (44 %). casos Se recibieron en estadio de sepsis 169 (61 %) pacientes El mayor número de casos, 70,4 % tuvo origen extrahospitalario. La neumonía como causa, se diagnosticó en 52 % de los pacientes. En los pacientes con estadios avanzados 17 (70,9 %) casos fue superior el número de defunciones. Conclusiones: La sepsis continúa siendo un importante problema de salud. Es necesario el ingreso precoz en las unidades de cuidados intensivos pediátricos para lograr una atención integral de estos pacientes.

Introduction: Sepsis is a potentially lethal process characterized by an organ dysfunction motivated by the host's response to infection and leading to an immune, pro-inflammatory and immunosuppression imbalance. Objective: To characterize systemic inflammatory response syndrome in pediatric intensive care units. Methods: Cross-sectional descriptive research carried out at "Pepe Portilla" Pediatric Teaching Hospital in Pinar del Río during the period 2015-2018. The sample consisted of all patients admitted in the pediatric intensive care unit at the aforementioned hospital with a diagnosis of systemic inflammatory response syndrome of infectious or non-infectious cause. The medical records were reviewed and a data collection model was developed in correspondence with model 241-485-02 of the systemic inflammatory response syndrome information system. Results: There was a predominance of the condition in patients aged between 1-4 years, 122 cases (44%). 169 (61%) patients were received in sepsis stage. The highest number of cases, 70.4% had out-of-hospital origin. Pneumonia was diagnosed as a cause in 52% of patients. In patients with advanced stages (17 cases (70.9%)), the number of deaths was higher. Conclusions: Sepsis continues to be a major health problem. Early admission to pediatric intensive care units is necessary to achieve comprehensive care for these patients.

Functional dentition and associated factors: the evaluation of three indicators

Studying the different indicators of functional dentition classification can contribute to the understanding of the associated factors, and thus help in the definition of strategies associated with oral health care. This approach has been little explored in the literature, especially when considering the older age group. Aim:The aim of this study is to evaluate the factors associated with three distinct functional dentition classification. Methods: Cross-sectional exploratory study using secondary data from the Frailty in Older Brazilians (FIBRA) Project of 876 older adults living in Campinas, Brazil. The indicators of dental function assessed was number of natural teeth present, occluding pairs of teeth and the Eichner index, which were verified by trained dentists, following the World Health Organization criteria for epidemiological studies in oral health. The explanatory variable assessed was the self-perception of oral health-related quality of life measured by the Geriatric Oral Health Assessment Index (GOHAI) and its dimensions. It was also collected sociodemographic information such as age, gender, race/ethnicity, schooling, family income, smoking behavior and frailty status. The association was verified through Poisson regressions for number of teeth and pairs of teeth in occlusion and multinomial regression for the Eichner index, adjusted by sociodemographic and health variables. Results: Lower prevalence of participants with less than 21 teeth who negatively perceived GOHAI ́s pain and discomfort dimension and higher prevalence of having less teeth among the ones that negatively perceived GOHAI ́s physical and functional dimensions. No association was found between the perception of quality of life and occlusion pairs of teeth and the Eichner Index. Conclusion: Two out of three indicators assessed were associated with quality of life. Therefore, it is important to select sensitive indicators to be able to identify and better comprehend this relationship

Tumor de colisión en el ovario, con fibrotecoma. Reporte de un caso / Collision tumor in the ovary, with fibrothecoma. Case report

Resumen ANTECEDENTES: La coincidencia temporo-espacial de dos o más neoplasias benignas, malignas o combinadas, que afectan a un mismo órgano o tejido es lo que define al tumor de colisión, con diferencias conductuales, genéticas e histológicas. Los tumores de colisión ovárica son un subtipo raro. CASO CLÍNICO: Paciente de 53 años, que acudió al servicio de Urgencias debido a un dolor intermitente de siete meses de evolución que, en las últimas semanas, se intensificó y se agregaron náuseas y vómitos. Durante la exploración abdominal se detectó un aumento de volumen en el área pélvica, sin irritación peritoneal. Los marcadores tumorales: CA-125, CA 19-9 y antígeno carcinoembrionario se reportaron en parámetros normales. La ecografía pélvica informó la existencia de una imagen quística simple y compleja, con componente sólido. El examen de anatomía patológica diagnosticó: tumor de colisión en el ovario izquierdo. CONCLUSION: Los tumores de colisión en el ovario son poco frecuentes según lo reportado en la bibliografía. El diagnóstico anatomopatológico minucioso y el seguimiento clínico-radiológico adecuado son necesarios para descartar los tumores de colisión.

Abstract BACKGROUND: The temporal-spatial coincidence of two or more benign, malignant or combined neoplasms that affect the same organ or tissue is what defines the collision tumor, with behavioral, genetic and histological differences. Ovarian collision tumors are a rare subtype. CLINICAL CASE: A 53-year-old patient, who came to the Emergency Department due to intermittent pain of seven months' evolution, which, in recent weeks, intensified and nausea and vomiting were added. During abdominal examination, an increase in volume was detected in the pelvic area, without peritoneal irritation. Tumor markers: CA-125, CA 19-9 and carcinoembryonic antigen were reported in normal parameters. Pelvic ultrasound reported the existence of a simple and complex cystic image, with a solid component. Pathological anatomy examination diagnosed: collision tumor in the left ovary. CONCLUSION: Collision tumors in the ovary are rare according to reports in the literature. A thorough pathological diagnosis and adequate clinical-radiological follow-up are necessary to rule out colliding tumors.

Perda de função mastigatória e risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo / Masticatory function loss and frailty risk in community-dwelling older people in the State of São Paulo

Resumo Objetivo Verificar se a perda de função mastigatória aumenta o risco de fragilidade em idosos vivendo em domicílios familiares no Estado de São Paulo. Métodos Foi adotado um delineamento de coorte prospectivo sobre a base de dados do estudo FIBRA (Fragilidade em Idosos Brasileiros), com linha de base realizada em 2008-2009 e seguimento em 2016-2018, transcorrendo em média 100,2 ± 9,2 meses. A variável desfecho foi a incidência de fragilidade, a variável de exposição foi a função mastigatória conforme a condição de edentulismo e autorrelato de dificuldade mastigatória. As variáveis de ajuste foram condições sociodemográficas, comportamentais e de saúde geral. Foi utilizado um modelo de regressão de Poisson, com variância robusta, estimando o risco relativo Resultados a incidência acumulada de fragilidade aos oito anos em média foi de 30 casos a cada 100 participantes edêntulos com dificuldade mastigatória, que apresentaram maior risco de desenvolver fragilidade (RR:1,75 IC 95% 1,09-2,81) do que os idosos dentados sem dificuldade mastigatória, independentemente de tabagismo (RR: 1,71 IC 95% 1,07-2,73) e de condição socioeconômica (RR: 1,72 IC 95% 1,13-2,62). Conclusão A perda de função mastigatória aumentou o risco de fragilidade em idosos.Futuras pesquisas deverão estudar se a reabilitação da função mastigatória contribui para diminuir esse risco.

Abstract Objective To verify if the loss of masticatory function increases the risk of frailty in community-dwelling older people in the state of São Paulo. Methods A prospective cohort design was adopted based on the FIBRA study database (Fragility in Brazilian Elderly), with a baseline performed in 2008-2009 and follow-up in 2016-2018, elapsed on average 100.2 ± 9.2 months. The outcome variable was the incidence of frailty. The exposure variable was masticatory function according to edentulism and self-reported chewing difficulty. Adjustment variables were sociodemographic, behavioral, and general health conditions. A Poisson regression model with robust variance was used to estimate the relative risk. Results the cumulative incidence of frailty over eight years was 30 cases per 100 edentulous participants with chewing difficulties, who had a higher risk of developing frailty (RR: 1.75 95% CI 1.09-2.81) than the dentate elderly without chewing difficulties, regardless of smoking (RR: 1.71 95% CI 1.07-2.73) and socioeconomic status (RR: 1.72 95% CI 1.13-2.62) Conclusion Loss of masticatory function increases the risk of frailty in older people. Future research should study whether the rehabilitation of oral function reduces this risk.

Caracterización del estado y soporte nutricional en pacientes pediátricos graves / Characterization of nutritional status and support in critically-ill pediatric patients

RESUMEN Introducción: la alimentación y nutrición asumen una función relevante en la recuperación del paciente enfermo grave. Un estado nutricional no óptimo es la causa más frecuente de la mala evolución de los pacientes hospitalizados y de la calidad de vida. Objetivo: caracterizar el estado y soporte nutricional en los pacientes graves hospitalizados en la Unidad de Cuidados Intensivos del Hospital Pediátrico "Pepe Portilla" de Pinar del Río, de mayo 2016- mayo 2018. Métodos: se realizó una investigación observacional, descriptiva y transversal en 51 pacientes que requirieron intervención nutricional, en los cuales se utilizaron nutrientes enterales y/o parenterales. La información se obtuvo de la revisión documental. Resultados: la terapia de soporte nutricional prevaleció en pacientes de cero a cuatro años para un 47,1 %, el 62,7 % fueron del sexo masculino. Predominó la nutrición enteral en los ingresados por insuficiencia respiratoria (44 %), sepsis (16 %) y enfermedades oncológicas (13 %). Recibieron soporte nutricional parenteral el 68,4 % de las enfermedades quirúrgicas. Las complicaciones digestivas fueron las más frecuentes (54,8 %) seguida de las metabólicas (13,7 %). Conclusiones: los pacientes desnutridos o en riesgo de estarlo, requirieron soporte nutricional, con predominio de la edad de cero a cuatro años, esto se relacionó a las causas quirúrgicas, enfermedades respiratorias y sepsis. Fueron utilizados nutrientes enterales y parenterales con complicaciones digestivas como vómitos y diarreas.

ABSTRACT Introduction: food and nutrition presuppose a relevant role in the recovery of the critically-ill patient. A non-optimal nutritional status continues to be the most frequent cause of poor evolution of hospitalized patients and quality of life. Objective: to characterize the nutritional status and support in critically-ill patients hospitalized in the Intensive Care Unit at Pepe Portilla Pediatric Hospital of Pinar del Rio, from May 2016- May 2018. Methods: an observational, descriptive and cross-sectional research was conducted in 51 patients who required nutritional intervention, in which enteral and/or parenteral nutrients were used. Information was collected from a documentary review. Results: nutritional support therapy prevailed in patients aged zero to four years, representing 47,1 %; 62,7 % were male. Enteral nutrition predominated in patients admitted for respiratory failure (44 %), sepsis (16 %) and cancer diseases (13 %). Parenteral nutritional support was given to 68,4 % of surgical diseases. Digestive complications were the most frequent (54,8 %) followed by metabolic complications (13,7 %). Conclusions: malnourished patients or at risk of malnutrition required nutritional support, predominantly in patients from zero to four years old, related to surgical causes, respiratory diseases and sepsis. Enteral and parenteral nutrients were used with digestive complications such as vomiting and diarrhea.

Planificación microcurrícular de asignaturas en la profesión de enfermería y su vinculación con los modelos conceptuales / Microcurricular planning of subjects in the nursing profession and its link with conceptual models / Planejamento microcurricular de disciplinas da profissão de enfermagem e sua vinculação com modelos conceituais

INTRODUCCIÓN: el estudio tuvo como objetivo determinar desde la academia la inclusión y utilización de los modelos conceptuales, ligadas al proceso de atención, en las asignaturas relacionadas al cuidado dentro del microcurrículo, para verificar su nivel de inserción en la planificación curricular y transferencia de conocimientos al estudiante. MÉTODO: se tipificó como descriptiva, de campo, transversal. La muestra estuvo constituida por 29 docentes del área profesionalizantes. Se diseñaron 2 instrumentos de recolección de datos: Ficha de registro de 12 sílabos para el análisis de los contenidos del cuidado con vinculación de teorizantes en y test a los docentes para confrontar su utilidad en las clases. RESULTADOS: la revisión de los sílabos evidenció el 21,43% incluyen teorizantes y el 78,57% no involucran en la planificación de las asignaturas, organización basada en patologías clínicas y no a diagnósticos enfermeros. La aplicación del test evidencia un dominio medio 63,06% en el conocimiento de los modelos conceptuales, un dominio medio 46,55% en el conocimiento y utilización de las teorizantes en el proceso de atención, 39,65% corresponde al involucramiento de las teorizantes en los contenidos de las asignaturas seguido de un 31,03% con utilización bajo. CONCLUSIONES: se evidencia la poca inclusión de las teorizantes de enfermería, en el Proceso de Atención de Enfermería en la mayoría de las asignaturas de la unidad profesional y en las guías prácticas, lo que dificulta la relación teoría-practica del hacer enfermero.

INTRODUCTION: the study aimed to determine from the academy the inclusion and use of conceptual models, linked to the care process, in subjects related to care within the microcurriculum, to verify their level of insertion in curricular planning and knowledge transfer to the student. METHOD: it was classified as descriptive, field, cross-sectional. The sample consisted of 29 professors from the professional area. Two data collection instruments were designed: Record sheet of 12 syllables for the analysis of the contents of care with linking of theorists in and test the teachers to confront their usefulness in the classes. RESULTS: the review of the syllables showed that 21.43% include theorizers and 78.57% do not involve organization based on clinical pathologies and not on nursing diagnoses in the planning of the subjects. The application of the test shows a 63.06% average domain in the knowledge of the conceptual models, a 46.55% average domain in the knowledge and use of theorizers in the care process, 39.65% corresponds to the involvement of the theorizing in the contents of the subjects followed by 31.03% with low use. CONCLUSIONS: the little inclusion of nursing theorists is evident, in the Nursing Care Process in most of the subjects of the professional unit and in the practical guides, which hinders the theory-practice relationship of becoming a nurse

INTRODUÇÃO: o estudo objetivou determinar a partir da academia a inclusão e utilização de modelos conceituais, vinculados ao processo de cuidar, em disciplinas relacionadas ao cuidado no microcurricular, para verificar seu nível de inserção no planejamento curricular e transferência de conhecimento. para o aluno. MÉTODO: foi classificado como descritivo, de campo, transversal. A amostra foi composta por 29 docentes da área profissional. Foram elaborados dois instrumentos de coleta de dados: ficha de registro de 12 sílabas para a análise dos conteúdos do cuidado com vinculação dos teóricos e provas aos professores para confrontar sua utilidade nas aulas. RESULTADOS: a revisão das sílabas mostrou que 21,43% incluem teorizadores e 78,57% não envolvem organização baseada em patologias clínicas e não em diagnósticos de enfermagem no planejamento das disciplinas. A aplicação do teste mostra um domínio médio de 63,06% no conhecimento dos modelos conceituais, um domínio médio de 46,55% no conhecimento e uso de teorizadores no processo de cuidar, 39,65% corresponde ao envolvimento dos teorizar nos conteúdos das disciplinas seguido de 31,03% com baixo uso. CONCLUSÕES: fica evidente a pouca inserção de teóricos de enfermagem, no Processo de Cuidado de Enfermagem na maioria das disciplinas da unidade profissional e nos guias práticos, o que dificulta a relação teoria-prática para se tornar enfermeiro.

Uso de coadyuvantes en dolor postoperatorio / Use of adjuvants in postoperative pain

Resumen: Los analgésicos coadyuvantes son compuestos que tienen una baja potencia analgésica. Sin embargo, la sinergia con opioides incrementa su efecto y favorece una reducción en los eventos adversos de los narcóticos para el control del dolor postoperatorio. Las estrategias ahorradoras de opioides están relacionadas con el efecto de una variedad de receptores, de los cuales podemos nombrar: los antagonistas NMDA como la ketamina, magnesio y dextrometorfano, los agonistas α-2 como la clonidina y la dexmedetomidina, los inhibidores de la subunidad α-2δ de los canales de calcio como la pregabalina y la gabapentina, los bloqueadores de los canales de sodio como la lidocaína y, finalmente, los glucocorticoides. En esta revisión se describirán las características, indicaciones, dosis y niveles de evidencia del uso de los coadyuvantes de uso intravenoso y regional en el contexto perioperatorio. (visite http://www.painoutmexico.com para ver artículo completo y Tablas).

Abstract: The adjuvant analgesics are compounds that have a low analgesic potency. However, with these compounds, the adverse effects of opioids may be diminished for the control of postoperative pain. Opioid-sparing strategies are related to the effect on a variety of receptors, of which we should name: the NMDA antagonists such as ketamine, magnesium and dextromethorphan, the α-2 agonists such as clonidine and dexmedetomidine, subunit α-2δ of calcium channels inhibitors; such as pregabalin and gabapentin, sodium channels blockers such as lidocaine and finally glucocorticoids. In this review we describe the characteristics, indications, doses and levels of evidence of use of adjuvants in the perioperative context (visit http://www.painoutmexico.com to see the full article and Tables).

Validity of self-report of oral conditions in older people

Aim: To verify if self-report is a valid instrument to study the clinical oral condition in older people without cognitive deficit. Methods: A Cross-sectional study was conducted with 647 older people from the community, without cognitive deficit, living in Campinas, Brazil. A self-report questionnaire assessing the presence or absence of teeth (edentulism) and use of complete denture was applied, identifying the location of the denture, whether in the upper and/or lower arch. In the same session oral clinical exams were performed, considered the gold standard. The self-report validation was performed by calculating sensitivity, specificity, predictive values, odds ratios and Kappa agreement. Results: There were high percentages of sensitivity (95­99%), specificity (84­97%), positive (81­97%) and negative (95­98%) predictive values, obtaining an elevated level of confidence and quality intrinsic value of self-report. Agreement with the clinical examination was excellent for all variables (greater than 0.80). The likelihood ratios showed compelling evidence that with self-report an edentulous individual (+LR 32), non-edentulous (-LR 0.06) and absence of complete denture (-LR 0.01) could be correctly identified, with moderate evidence to identify the presence and location of complete denture use (+LR 6.5 to 6.9). Conclusion: Self-report is a valid instrument to study the clinical oral condition in the older people of the community

Magnitud del riesgo por accidentes con objetos cortopunzantes en la consulta odontológica / Magnitude of isk for Accidents with Sharps in the Dental Practice / Magnitude do risco para acidentes com perfurocortantes na prática odontológica

Antecedentes: El personal del área de la salud está constantemente expuesto a sangre y fluidos provenientes de los pacientes durante su jornada laboral. Por lo tanto, el personal de odontología corre el riesgo de contraer enfermedades infecciosas. Objetivo: Conocer la frecuencia del riesgo laboral por objetos punzocortantes en odontólogos de primer nivel de atención de los Centros de Salud urbano y rural de los Servicios de Salud de Nuevo León Monterrey Nuevo León, México. Métodos: diseño del estudio no experimental, descriptivo, transversal y prospectivo. Población de estudio: odontólogos aplicativos de los Servicios de Salud de Nuevo León con un muestreo probabilístico 108 odontólogos. Se utilizó un cuestionario diseñado con 12 preguntas relacionadas con los accidentes punzocortantes, con una confiabilidad de un alfa de Cronbach de .832. Resultados: el 38.8 % de los masculinos informó haber presentado accidente laboral y femeninas el 67.2 % señalaron haber sufrido un accidente con punzocortante. En relación al conocer si habían sufrido algún accidente por objetos punzocortantes, solo el 59.3 % lo reportó y un 40.7 % no había sufrido accidente; un 49 % si recibió capacitación en bioseguridad y un 51 % no ha recibido capacitación. Conclusión: Con base a estos resultados podemos concluir que aún falta por mejorar las capacitaciones y ampliar la cobertura de capacitación a los odontólogos en materia de normativas de bioseguridad y manejo de residuos peligrosos biológicos infecciosos, así como actualizar el conocimiento de infecciones transmitidas por objetos punzocortantes.

Background: The staff of the health area is constantly exposed to blood and / or fluids coming from patients during their workday. Therefore, dentistry personnel run the risk of contracting infectious diseases. Purpose: To know the frequency of occupational risk due to sharp objects in top-level dentists of the urban and rural Health Centers of the Health Services of Nuevo León. Methods: design of the non-experimental, descriptive, cross-sectional and prospective study. Study population: applicative dentists of the Health Services of Nuevo Leon with a probabilistic sampling 108 of dentists. A questionnaire designed with 12 questions related to sharps accidents with a reliability of a Cronbach's alpha of .832 was used. Results: 38.8 % of the men reported having presented an accident at work and 67.2 % of the women reported having suffered an accident with a sharp cut. In relation to knowing if they had suffered an infection due to an accident by sharp objects, 59.3 % had suffered an accident and 40.7 % had not suffered an accident; 49 % were trained in biosecurity and 51 % have not received training. Conclusion: Based on these results we can conclude that there is still a need to improve the training and expand the coverage of training to the dentist in matters of biosafety regulations and management of infectious biological dangerous wastes as well as to update the knowledge of puncture-borne infections.

Antecedentes: A equipe da área de saúde é constantemente exposta ao sangue e / ou fluidos provenientes dos pacientes durante o dia de trabalho. Portanto, o pessoal de odontologia corre o risco de contrair doenças infecciosas. Objetivo: Conhecer a frequência do risco ocupacional por objetos pontiagudos em dentistas de nível superior dos Centros de Saúde urbanos e rurais dos Serviços de Saúde de Nuevo León. Métodos: delineamento do estudo não experimental, descritivo, transversal e prospectivo. População do estudo: dentistas aplicativos dos Serviços de Saúde de Nuevo León com amostragem probabilística 108 de cirurgiões-dentistas. Foi utilizado um questionário elaborado com 12 questões relacionadas aos acidentes com perfurocortantes, com confiabilidade de um alfa de Cronbach de 0,832. Resultados: 38,8% dos homens relataram ter sofrido acidente no trabalho e 67,2% das mulheres relataram ter sofrido acidente com um corte acentuado. Em relação a saber se sofreram infecção por acidente por objetos pontiagudos, 59,3% sofreram acidente e 40,7% não sofreram acidente; 49% foram treinados em biossegurança e 51% não receberam treinamento. Conclusão: Com base nesses resultados, podemos concluir que ainda há uma necessidade de melhorar o treinamento e ampliar a cobertura do treinamento para o dentista em questões de regulamentos de biossegurança e gestão de resíduos infecciosos biológicos perigosos, bem como atualizar o conhecimento sobre punção. infecções suportadas.

Caracterización del lenguaje en niños con discapacidad intelectual, implicación de las nociones elementales de Matemática / Characterization of language development in children with intellectual disabilities; contribution of the basic notions of Mathematics

RESUMEN Introducción: Objetivo: Métodos: Resultados: Conclusiones:

ABSTRACT Introduction: the characterization of early language development is essential to respond to the process of evaluation and intervention in children with intellectual disability. The county of Pinegrove of the River occupies the fourth national place of cases of intellectual discapacidad. Objective: to analyze the relevance of the characterization of language development in children with intellectual disability and the contribution of the basic notions of Mathematics. Methods: a pedagogical study where theoretical, empirical and statistical methods were applied to compile, interpret and process the information related to the subject. Scientific observation was used during the application of logopedic exploration to 35 children with intellectual disability from 2014 to 2017. Results: the approach to perform the characterization of language development was created, along with the analysis of the need to work with the basic notions of Mathematics from the management of a set of scientific observations during the application of logopedic exploration. It results in a resource to support the early diagnosis and its quality with a multidisciplinary and intersectorial nature, involving the health and the educational areas. Conclusions: the logopedic exploration allows the characterization of language development of children with intellectual disability; it is a requirement to achieve the improvement in the processes of characterization and intervention in order to develop the communication. The implication of the basic notions of Mathematics demands the renovation of the educational process with a multidisciplinary and intersectorial approach that projects the actions to support the development of social inclusion.

Impact of environmental pollution on the ocular surface of Sjögren's syndrome patients / Impacto da poluição ambiental na superfície ocular de pacientes com síndrome de Sjögren

ABSTRACT Purpose: To evaluate the effect of air pollution on the ocular surface of patients with Sjögren's syndrome. Methods: We investigated the ocular surfaces of thirty patients with Sjögren's syndrome and thirty healthy volunteers (control group) living in the Metropolitan Area of Buenos Aires. We used nitrogen dioxide as an indicator of exposure to air pollution. An ocular symptoms questionnaire was answered by all subjects, who also underwent a complete ocular surface ophthalmic examination-including an Ocular Surface Disease Index questionnaire, biomicroscopy, tear breakup time, Schirmer 1 test, corneal and conjunctival vital staining with fluorescein and lissamine green, tear lysozyme concentration, and impression cytology. Results: In almost all ocular surface test findings, we found a positive and significant correlation between higher levels of exposure to air pollution and higher levels of ocular surface damage in both the control group and Sjögren's syndrome patients. In Sjögren's syndrome patients, the Ocular Surface Disease Index questionnaire, tear breakup time, vital staining and impression cytology showed a significant correlation between high levels of air pollution and ocular surface disease. In the control group, the Ocular Surface Disease Index questionnaire, tear breakup time, and impression cytology showed a significant correlation between high levels of air pollution and ocular surface disease. Conclusions: Here we demonstrated that in patients with dry eye syndrome associated with Sjögren, abnormalities of the ocular surface and eye irritation related to air pollution are more severe than those in the control group. We believe that measuring air quality should be not only an integral part of the evaluation of ocular surface disease but also a therapeutic consideration.

RESUMO Objetivo: Avaliar o efeito da poluição do ar na superfície ocular de pacientes com síndrome de Sjögren. Métodos: Foram investigadas as superfícies oculares de trinta pacientes com síndrome de Sjögren e trinta voluntários saudáveis (grupo controle) residentes na Região Metropolitana de Buenos Aires. Usamos o dióxido de nitrogênio como um indicador de exposição à poluição do ar. Um questionário de sintomas oculares foi respondido por todos os indivíduos, que também foram submetidos a um exame oftalmológico completo da superfície ocular - incluindo um questionário do Índice da Doença da Superfície Ocular, biomicroscopia, tempo de ruptura do filme lacrimal, teste de Schirmer 1, coloração da córnea e conjuntiva com fluoresceína e lissamina verde, concentração de lisozima lacrimal e citologia de impressão. Resultados: Em quase todos os achados do teste de superfície ocular, encontramos uma correlação positiva e significativa entre níveis mais altos de exposição à poluição do ar e níveis mais elevados de danos na superfície ocular tanto no grupo controle quanto nos pacientes com síndrome de Sjögren. Em pacientes com síndrome de Sjögren, o questionário do Índice da Doença da Superfície Ocular, tempo de ruptura do filme lacrimal, coloração vital e citologia de impressão mostraram uma correlação significativa entre altos níveis de poluição do ar e doença da superfície ocular. No grupo controle, o questionário do Índice de Doenças da Superfície Ocular, tempo de ruptura do filme lacrimal e citologia de impressão mostraram uma correlação significativa entre altos níveis de poluição do ar e doença da superfície ocular. Conclusões: Aqui demonstramos que, pacientes com síndrome de olho seco associada a Sjögren, as anormalidades da superfície ocular e a irritação ocular relacionadas à poluição do ar são mais graves do que aquelas no grupo controle. Acreditamos que a medição da qualidade do ar não deve ser apenas uma parte integral da avaliação da doença da superfície ocular, mas também uma consideração terapêutica.

Traducción al español de la escala de adicción a los alimentos de Yale (Yale Food Addiction Scale) y su evaluación en una muestra de población mexicana. Análisis factorial / Spanish translation of the Yale Food Addiction rating Scale and, its evaluation in a Mexican population. A factorial analysis 29.

Resumen: Introducción: La obesidad es la acumulación excesiva de grasa corporal, lo que condiciona una alta comorbilidad. El consumo descontrolado de alimentos hipercalóricos es causa de su desarrollo; ésta es una conducta de características similares a la de pacientes con adicción a sustancias. La escala de adicción a los alimentos, YFAS (Yale Food Addiction Scale), permite identificar a sujetos con conducta adictiva a los alimentos. Objetivo: Validar la escala YFAS en español en una muestra de población mexicana adulta. Método: La muestra de participantes (160) respondió a la encuesta en dos ocasiones, con un período de tres semanas entre cada aplicación. La pertinencia de un modelo factorial se corroboró con las pruebas de esfericidad de Bartlett y la medición del parámetro de Kaiser-Meyer-Olkin. Resultados: El α de Cronbach = 0.7963 corroboró la consistencia interna de la escala. Para la confiabilidad se obtuvo el coeficiente de Spearman por la metodología test-retest, de r = 0.565, n = 96. La validación por convergencia, correlacionando con la escala para trastorno por atracón (Binge Eating Scale, BES) (r = 0.5868 p ≤ 0.0001; n = 157). Las pruebas de Bartlett (χ2(300) = 1572.3, p r = 0.2843 p ≤ 0.001; n = 151). Discusión y conclusión: Esta versión de YFAS presentó propiedades psicométricas adecuadas y similares a las de la original y a otras de sus traducciones y adaptaciones. Se considera entonces con utilidad para la práctica asistencial y para estudios de investigación clínica en población mexicana.

Abstract: Introduction: Obesity has a multifactorial etiology and is a global public health problem which also affects Mexican population. Obesity is characterized by excessive body adiposity, as well as high prevalence of diverse comorbidities, which diminish life quality. Sedentary lifestyle and hypercaloric food overconsumption are amongst the causes of obesity. It has been suggested that some traits seen in obese patients may represent an addictive behavior, similar to those observed in substance-dependent patients. Objective: The aim of this work was the validation of the Spanish version of the Yale Food Addiction Rating Scale (YFAS) in a Mexican adult population sample. Method: The scale was applied twice to 160 participants with a three weeks period in-between. The factorial model was corroborated with Bartlett's sphericity test and with that of Kaiser-Meyer-Olkin. Results: Internal consistency was calculated by means of Cronbach's alpha which was α = 0.7963; reliability, measured with Spearman's coefficient by means of the test-retest method, was r = 0.565, n = 96. Convergence validity was estimated using the Binge Eating Scale (BES) and Spearman's correlation (r = 0.5868 p ≤ 0.0001; n = 157). Bartlett's sphericity test showed (χ2(300) = 1572.33, p r = 0.2843 p ≤ 0.001; n = 151. Discussion and conclusion: The Spanish version of the YFAS showed psychometric properties not different from the original and adapted existing versions. Therefore, YFAS Spanish version could be useful in healthcare and clinical research in Mexican population.