Análise situacional da incorporação de tecnologias em hospitais públicos federais no Brasil / Situational analysis of the technology incorporation in the brazilian federal university hospitals / Análisis situacional de la incorporación de tecnologías en hospitalares públicos federales de Brasil

Objetivo: identificar o processo de incorporação de tecnologias na Empresa Brasileira de Serviços Hospitalares, com especial atenção às Comissões de Padronização de Produtos para a Saúde. Métodos: estudo transversal, descritivo, com pesquisa exploratória de campo e análise quanti-qualitativa para um diagnóstico situacional, realizado por meio de questionário eletrônico encaminhado às 36 filiais da Empresa, em todas as regiões do Brasil, de novembro de 2019 a agosto de 2020. Empregou-se a análise quantitativa por meio de estatística descritiva e a qualitativa a partir da análise de conteúdo e de Strengths, Weakness, Opportunities, Threats. Resultados: 44,4% dos hospitais possuem Núcleos de Avaliação de Tecnologias em Saúde, enquanto 91,7% deles dispõem de Comissão de Padronização de Produtos para a Saúde formalmente constituída. As variáveis observadas com maior frequência: ausência de processos documentados, fluxos não definidos e falta de infraestrutura. Conclusão: o processo de incorporação de tecnologias ocorre de maneira desigual. Os dados podem contribuir para que a Empresa Brasileira de Serviços Hospitalares (re)defina estratégias e implemente ações, no sentido de apoiar suas filiais na constituição e implantação dessas instâncias, fundamentais no processo de incorporação de tecnologias em âmbito hospitalar. (AU)

Objective: to identify the process of incorporating technologies at the Brazilian Hospital Services Company, specially to the Commission for the Standardization of Health Products. Methods: this is a cross-sectional and exploratory study, under a descriptive approach with quantitative and qualitative analysis, which sought to perform a situational diagnosis through an electronic research questionnaire sent to the 36 branches, in all regions of Brazil, from November 2019 to August 2020. Using quantitative analysis through of descriptive statistics and qualitative analysis based on content analysis and Strengths, Weakness, Opportunities, Threats. Results: 44.4% of hospitals have Health Technology Assessment Centers, while 91.7% of them have formally constituted a Commission for the Standardization of Health Products. The most frequently observed variables: absence of documented processes, undefined flows and lack of infrastructure. Conclusion: the process of incorporating technologies occurs unevenly. The data can contribute to the Brazilian Hospital Services Company defining strategies and implementing actions, in order to support its branches in the constitution and implantation of these instances, which are fundamental in the process of incorporating technologies in the hospital environment. (AU)

Objectivo: identificar el proceso de incorporación de tecnologias en la Empresa Brasileña de Servicios Hospitalarios, con especial atención a las comisiones de estandarización de productos de salud. Métodos: estudio descriptivo transversal, con investigación de campo exploratoria y análisis cuantitativo y cualitativo para um diagnóstico situacional realizado mediante um cuestionario electrónico enviado a las 36 filiales, em todas las regiones de Brasil, de noviembre de 2019 a agosto de 2020. Usado análisis cuantitativo utilizando estadística descriptiva y la análisis cualitativo basado en análisis de contenido y de la Fortalezas, Debilidades, Oportunidades, Amenazas. Resultados: el 44,4% de los hospitales cuenta con Centros de Evaluación de Tecnologías Sanitarias, mientras que el 91,7% de ellos tiene una Comisión de Estandarización de Productos de Salud formalmente constituída. Las variables observadas con mayor frecuencia: ausencia de procesos documentados, flujos indefinidos y falta de infraestructura. Conclusión: el proceso de incorporación de tecnologías ocurre de manera desigual. Los datos pueden contribuir a que la Empresa Brasileña de Servicios Hospitalarios reinicia estrategias e implemente acciones, a fin de apoyar a sus filiales en la constitución e implantación de estas instancias, fundamentales en el proceso de incorporación de tecnologías en el ámbito hospitalario. (AU)

Irrational ophthalmic fixed-dose combinations for dry eye syndrome

Dry eye syndrome (DES) is a common disorder with rising incidence due to increased use of digital devices. While multiple treatment options are available, some are not efficacious or sometimes even safe for use in DES. This is particularly true for Fixed Dose Combinations (FDCs) that may contain ingredients having no rational for their use or may actually be harmful. Various committees appointed by the Government have reviewed several FDCs marketed in India and found some of them to be irrational and recommended for their removal. This paper discusses the contents of some of these FDCs marketed for DES with an aim to ensure that prescribers are mindful of their ingredients and whether there is adequate data about their efficacy and safety and prescribe them only if they consider them necessary for managing the patient.

O recado está dado: a COVID-19 e suas repercussões para a comunicação em saúde nas instituições públicas / The message is given: COVID-19 ́s repercussions for health communication in public institutions / El mensaje está dado: COVID-19 y sus repercusiones para la comunicación sanitária de las instituciones públicas

Com a pandemia de COVID-19, questões sobre Comunicação em Saúde ganharam destaque no que diz respeito à relação, ainda distante, entre instituições de saúde e o cotidiano dos brasileiros. O Brasil precisa avançar na efetivação da comunicação como direito humano e na compreensão de que comunicar saúde não se resume à transmissão de informações. O engajamento social depende de uma relação de confiança, conquistada a partir da permanente escuta ao público, considerando suas necessidades, críticas e saberes, daí a importância de construir pontes entre as instituições de saúde e o dia a dia das pessoas. A divulgação científica, a ciência cidadã e o universo das fake news ­ e aquilo que as sustenta e lhes assegura visibilidade, as mídias sociais ­ são também problematizados neste ensaio. Destaca-se a necessidade de uso não ferramental da comunicação e, principalmente, de um diálogo direto, horizontal e construtivo com as pessoas, de modo que a ciência ocupe o lugar de influenciadora legítima não só entre os pares, mas junto à sociedade ­ beneficiária e financiadora maior de seu trabalho.

Health Communication issues gained prominence inthe COVID-19 pandemic, specially the distant relationship between health institutions and the daily lives of Brazilians. Brazil needs to advance in the communication as a human right and in the understanding that communicating healthis not limited to the transmission of information. Social engagement depends on a relationship of trust, achieved through permanent listening to the public, considering their needs, criticisms and knowledge, hence the importance of building bridges between health institutions and people's daily lives. Scientific dissemination, citizen science, and the fake news universe in social mediaare also discussed in this essay. The need for a non-tooled use of communication is highlighted and, mainly, for ahorizontal and constructive dialogue with people, so that science occupies the place of a legitimate influencer not only among peers, but with society (beneficiary and major funder of their work).

Con la pandemia de la COVID-19, las cuestiones de Comunicación en Salud ganaron destaque, en especial la relación lejana entre las instituciones de salud y el cotidiano de los brasileños. Brasil necesita avanzar en la realización de la comunicación como un derecho humano y en la comprensión de que comunicar salud no se limita a la transmisión de información. El compromiso social depende de una relación de confianza, lograda a través de la escucha permanente del público, considerando sus necesidades, críticas y conocimientos, entonces, crear enlacesentre las instituciones de salud y el cotidiano de las personases importante. La divulgación científica, la ciencia ciudadana y el universo de las fake news­y lo que las sustenta y asegura su visibilidad, las redes sociales­también son discutidas en este ensayo. Se destaca la necesidad de un uso no instrumentalizado de la comunicación y, principalmente, de un diálogo directo, horizontal y constructivo con las personas, para que la ciencia ocupe el lugar de un legítimo influenciador no sólo entre sus pares, sino con la sociedad ­beneficiaria y gran financiadora de su trabajo.

Aportes del uso de Simuladores educativos en aula como una herramienta para mejorar la calidad del aprendizaje de los alumnos de la Facultad de Psicología de la UAQ / Contributions of the use of educational simulators in the classroom as a tool to improve the quality of learning in the students of the faculty of psychology of the UAQ

Dentro de este magnífico mundo de enseñanza ­aprendizaje existen muchos elementos de influencia más allá de solo un maestro, un alumno o un aula; crear ambientes de aprendizaje dinámicos, efectivos y orientados a la generación de aprendizaje significativo es tarea de todos los profesionales de la educación; para ello debemos romper esquemas, modelos anacrónicos y pensar en estrategias propositivas adaptadas a las nuevas y diferentes formas de aprender de las generaciones actuales y futuras creando entornos amigables, prácticos y efectivos. Este artículo plantea la utilización de simuladores en los ámbitos educativos, como una forma de facilitar el aprendizaje mediante el uso de los métodos y herramientas de transmisión de conocimiento adaptadas a las necesidades de aprendizaje actuales, es decir, de explotar las herramientas propias de la época en la que vivimos; en este caso las tecnológicas; esto se vuelve necesario considerando que tanto los métodos de enseñanza ­aprendizaje, como los sistemas educativos de hoy en día, ya no son del todo suficientes para cubrir las expectativas de educación actuales, debido a que hoy en día en muchos países aún se siguen utilizando métodos y estrategias educativas diseñadas para cubrir las necesidades de las sociedades del siglo pasado. En este documento se habla sobre la necesidad actual de contar con herramientas que potencialicen la calidad y efectividad del proceso de enseñanza ­aprendizaje en las aulas y de la propuesta de un método de investigación participativa en la cual es posible identificar cómo la implementación de herramientas TIC por medio del uso de simuladores en aula, es efectiva y benéfica para mejorarla adquisición y dominio de conocimiento en los estudiantes de la licenciatura de Psicología del trabajo de la Universidad Autónoma de Querétaro, logrando en ellos un mejor desempeño profesional y mayor éxito en las actividades propias de su profesión.

Around the magnific world of the teaching -learning, exist many influencing elements more than the only a professor, a student or an classroom; work to make a dynamic and effective learning environments and oriented to create significative learning is a job of all the professionals of learning, to do that, we have to broke schemes, anachronic models and think In propositives strategies aligned to the new and different ways of learn of the actually and future generations, creating friendly, practical and effective environments. This article proposes the use of simulator systems in educational environments, is a way to facilitate the learning through the use of methods and tools to help the transmission of knowledge adapted to current learning needs, that is to, exploit the modern tools; the technology tools. That becomes necessary considering that both the teaching ­learning methods and the actually educational systems, are very far from covering the current education expectations and needs because in many countries are using educational methods and strategies designed to comply the needs of the last century societies. This article, talk about the current need to count with tools that enhance the quality and effectiveness of the teaching -learning process in the classrooms and the proposal of a participatory investigation method with which is possible to identify how the implementation of TIC tools across the use of simulators in classroom is effective and beneficial to get better and acquire mastery of learning on the psychology students of autonomous university of Querétaro, achieving a better professional performance in them and greater success in professional activities.

An advisory by the association of radiation oncologists of India for radiation therapy patients and staff among COVID 19 pandemic

Covid19 has become a major public health problem in India and the rest of the world. The dramatic rise in the incidence of COVID 19 cases has severely challenged our healthcare system and forced us to work with limited infrastructure, resources, and workforce. However, even in this time of adversity, we as oncologists cannot neglect the seriousness of cancer care and the utmost attention it requires for the timely management of our patients. Hence, the Association of Radiation Oncologists of India has come up with an advisory for radiation therapy keeping in mind such aspects.

Verification on the Developmental Toxicity of Short-term Exposure to Phenol in Rats / 生物医学与环境科学（英文）

Objective@#To verify the health advisory for short-term exposure to phenol.@*Methods@#The method of this validation experiment was the same as the US Environmental Protection Agency (EPA) methodology for toxicology experiments used to determine phenol drinking water equivalent level (DWEL). Pregnant female Sprague-Dawley rats were administered phenol in distilled water by gavage at daily doses of 15, 30, 60, 120, and 240 mg/kg body weight (b.w.) from implantation (the 6th day post-mating) to the day prior to the scheduled caesarean section (the 20th day of pregnancy). The following information was recorded: general behavior; body weight; number of corpus luteum, live birth, fetus, stillbirth, and implantation; fetal gender; body weight; body length; tail length; and abnormalities and pathomorphological changes in the dams.@*Results@#In the 60 mg/kg b.w. dose group, the mortality of pregnant rats increased with increasing doses, suggesting maternal toxicity. Fetal and placental weights decreased as phenol dose increased from 30 mg/kg b.w., and were significantly different compared those in the vehicle control group, which suggested developmental toxicity in the fetuses. However, the phenol-exposed groups showed no significant change in other parameters compared with the vehicle control group ( > 0.05).@*Conclusion@#Despite using the same method as the US EPA, a different NOEAL of 15 mg/(kg·d) was obtained in this study.

Participação social de conselheiros de segurança alimentar e nutricional / Participación social de asesores de seguridad alimentaria y nutricional / Social participation of food and nutrition security counselors

OBJECTIVE: To know the sociodemographic profile and social participation of food and nutrition security counselors. METHODS: Cross-sectional study conducted with members of municipal councils and the state council for food and nutrition security of Piauí, Brazil, between 2016 and 2017. A questionnaire was applied for identification of sex, age, schooling, skin color/race, and level of representation; segment and entity represented by them; time of participation in the Food and Nutrition Security National Council (CONSEA); theoretical-political training in food and nutrition security (FNS). The software Stata® was used to organize and analyze data. Variables were presented in numbers and proportions. For association between the variables, Pearson's chi-square test or Fisher's exact test was used, when appropriate, considering the tests with p-value ≤ 0.05 as statistically significant. RESULTS: The study found 117 councilors from 16 municipalities and the (state) CONSEA. The majority were female (69.2%, n = 81), aged between 40 and 59 years (45.3%; n = 53). Moreover, 64.1% (n = 75) attained higher education, 87.2% (n = 102) worked in urban areas, and 35% (n = 41) had been working for the councils for 4 to 6 years. There was a statistically significant association (p=0.056) between participation in conferences and confidence in CONSEA's representation. CONCLUSION: There was a higher prevalence of female counselors, aged between 40 and 59 years, with higher education, from urban area and working for the CONSEA for 4 to 6 years. In addition, there was a high level of insecurity about CONSEA's representation associated with low participation in conferences.

OBJETIVO: Conhecer o perfil sociodemográfico e a participação social de conselheiros de segurança alimentar e nutricional. MÉTODOS: Estudo transversal realizado com membros dos conselhos municipais e do conselho estadual de segurança alimentar e nutricional do Piauí, Brasil, entre 2016 a 2017. Aplicou-se questionário para identificação do sexo, idade, escolaridade, cor da pele/raça e instância de representação; segmento e entidade que representa; tempo de participação no Conselho Nacional de Segurança Alimentar e Nutricional (CONSEA) e formação teórico-política em segurança alimentar e nutricional (SAN). Utilizou-se o software Stata® para organizar e analisar os dados. As variáveis foram apresentadas em números e proporções. Para associação entre as variáveis, aplicou-se o qui-quadrado de Pearson ou teste exato de Fisher, quando apropriado, considerando-se estatisticamente significantes os testes com p-valor ≤ 0,05. RESULTADOS: Encontraram-se 117 conselheiros de 16 municípios e do CONSEA (estadual). A maioria era do sexo feminino (69,2%, n = 81), com idade entre 40 e 59 anos (45.3%; n=53). Além disso,64,1% (n = 75) tinham ensino superior, 87,2% (n = 102) trabalhavam em áreas urbanas e 35% (n = 41) possuíam entre 4 e 6 anos de trabalho nos conselhos. Houve associação estatisticamente significativa (p=0,056) entre a participação em conferências e a segurança na representação do CONSEA. CONCLUSÃO: Houve maior prevalência de mulheres conselheiras, entre 40 e 59anos de idade, com nível superior, da área urbana e com tempo de atuação no CONSEA de 4 a 6 anos. Além disso, houve alto nível de insegurança na representação do CONSEA associado à baixa participação nas conferências.

OBJETIVO: Conocer el perfil sociodemográfico y la participación social de los consejeros de seguridad alimentaria y nutricional. MÉTODOS: Estudio transversal realizado con miembros de los consejos municipales y del consejo estadual de seguridad alimentaria y nutricional de Piauí, Brasil, entre 2016 y 2017. Se aplicó un cuestionario para la identificación del sexo, la edad, la escolaridad, el color de la piel/raza y la instancia de representación; el segmento y la entidad que representa; el tiempo de participación en el Consejo Nacional de Seguridad Alimentaria y Nutricional (CONSEA) y la formación teórico-político en seguridad alimentaria y nutricional (SAN). Se utilizó el software Stata® para organizar y analizar los datos. Las variables fueron presentadas en números y proporciones. Para la asociación entre las variables, se aplicó el chi-cuadrado de Pearson o la prueba exacto de Fisher, cuando apropiado, considerándose estadísticamente significativas las pruebas con el p-valor ≤ 0,05. RESULTADOS: Se encontraron 117 consejeros de 16 municipios y del CONSEA (estadual). La mayoría era del sexo femenino (69,2%, n = 81) y con edad entre 40 y 59 años (45,3%; n=53). Además, el 64,1% (n = 75) tenía educación superior, el 87,2% (n = 102) trabajaban en áreas urbanas y el 35% (n = 41) tenían entre 4 y 6 años de trabajo en los consejos. Hubo asociación estadísticamente significativa (p=0,056) entre la participación en ponencias y la seguridad en la representación del CONSEA. CONCLUSIÓN: Hubo mayor prevalencia de mujeres consejeras entre los 40 y 59 años de edad, con educación superior, del área urbana y con tiempo de actuación en el CONSEA entre 4 y 6 años. Además, hubo elevado nivel de inseguridad en la representación del CONSEA asociado con la pequeña participación en las ponencias.

Recrutamento e perfil dos dirigentes públicos brasileiros nas áreas econômicas e sociais entre 1995 e 2012 / La contratación y el perfil de los funcionarios públicos de alto nivel brasileños en las áreas económicas y sociales de 1995 a 2012 / Recruitment and profile of Brazilian higher public administrators in economic and social areas from 1994 to 2012

Resumo O artigo analisa o perfil dos dirigentes públicos de quatro ministérios: Fazenda e Planejamento, representando a área econômica, e Saúde e Educação, como exemplos da área social. Baseado em dados empíricos, propõe uma comparação de perfil dos ocupantes desses altos cargos no período de 1995 a 2012. A pesquisa demonstra as especificidades do padrão de recrutamento nessas duas áreas do campo burocrático e evidencia que os dirigentes públicos da área econômica são provenientes de setores sociais mais favorecidos, apresentam padrão mais técnico e são menos engajados em questões de ordem política, social e sindical. Mas nem por isso são intelectualmente superiores em termos de titulação. Nossos dados permitem dialogar com as teses de Pierre Bourdieu sobre as elites do campo burocrático e ajudam a desmontar mitos sobre a maior qualificação acadêmica dos setores burocráticos da área econômica e financeira.

Resumen El artículo analiza el perfil de los funcionarios públicos de cuatro ministerios: Finanzas y Planificación, en representación del área económica, y la Salud y la Educación, como ejemplos del área social. Basado en datos empíricos, sugiere una comparación del perfil de los ocupantes de estos puestos de responsabilidad en el período de 1995 a 2012. La investigación muestra la especificidad de lo patrón de reclutamiento en estas dos áreas del campo burocrático y evidencia que los funcionarios públicos de la zona económica provienen de los sectores sociales más privilegiados, tienen un carácter más técnico y son menos dedicados a las cuestiones de la orden política, social y sindical. Pero no por ello son intelectualmente superiores en términos de titulación. Nuestros datos permiten dialogar con las tesis de Bourdieu sobre las élites del campo burocrático y ayudan a desmontar mitos sobre la mayor calificación académica de los sectores burocráticos del área económica y financiera.

Abstract This article analyzes the profile of the public managers of four ministries: Finance and Planning, representing the economic area, and Health and Education, as examples of the social area. Based on empirical data, a comparison of the profile of the occupants of these senior positions from 1995 to 2012 is proposed. The research demonstrates the specificities of the recruitment pattern in these two areas of the bureaucratic field and shows that the public leaders of the economic area come from the most favored social sectors, present a more technical pattern and are less engaged in political, social and union matters. However, they are not intellectually superior in terms of qualifications. The data allow to discuss Bourdieu`s theses on the elites of the bureaucratic field and help to demonstrate the myths about the greater academic qualification of the bureaucratic sectors of the economic and financial areas.

Opinión del Comité Consultivo de Inmunizaciones Sociedad Chilena de Infectología: Vacuna neumocóccica conjugada en niños y la emergencia de serotipo 19A / Statement of the Advisory Immunization Committee of the Chilean Society of Infectious Diseases on the emergence of serotype 19A pneumococcal infection and the use of pneumococcal conjugated vaccine in Chilean children

La incorporación de la vacuna conjugada antineumocóc-cica 10 valente (PCV10) en lactantes en Chile el año 2011 ha permitido reducir las hospitalizaciones y muertes por neumonía en este grupo etario. Sin embargo, se ha observado desde entonces un aumento progresivo de los aislados de Streptococcus pneumoniae del serotipo 19A no incluido en la vacuna en uso (de < 5% del total de cepas recibidas en el Laboratorio de Referencia Nacional del Instituto de Salud Pública para vigilancia de infecciones invasores causadas por S. pneumoniae hasta el año 2010, a 12-23% en los años 2014-2015). En lactantes, el serotipo 19A representaba 4 a 8% de los aislados en la era pre vacuna, porcentaje que se incrementa a 25% el 2014. Este aumento ha ocurrido en dos terceras partes de las regiones administrativas del país. Cepas del serotipo 19A de pacientes menores de 5 años, muestran 25% de resistencia a penicilina para aislados extra-meníngeos y casi 100% para aislados de meningitis. El análisis genético de las cepas del serotipo 19A ha demostrado que 48% pertenecen al complejo clonal 320 de carácter pandémico y asociado a resistencia antimicrobiana. Además, casi todas las infecciones invasoras por serotipo 19A en niños se han dado en pacientes con esquema completo de vacunación PCV10. Los cambios epidemiológicos presentados indican la emergencia de infecciones invasoras por el serotipo 19A y la necesidad de controlar este problema con el cambio de la vacuna PCV10 a la vacuna PCV13 que contiene el serotipo 19A.

Inclusion of the 10-valent pneumococcal conjugated vaccine (PCV10) in the Chilean infant vaccination Program in 2011 was followed by a reduction of hospital admissions and pneumonia-related deaths in this age group. However, a progressive increase of serotype 19A pneumococcal isolates (not included in PCV10) has been observed. According to the analysis of pneumococcal strains performed by the national reference laboratory of the Institute of Public Health as part of a national surveillance on invasive pneumococcal infections, the relative proportion of serotype 19A isolates increased from <5% before 2010 to 12-23% in years 2014-2015. Serotype 19A represented 4-8% of the isolates in the pre-vaccine era among children less than 2 years, increasing to 25% during 2014. This increase has been documented in two-thirds of the national territory. Aimong children <5 years of age, 25% of 19A serotype isolates from non-meningeal infections were penicillin resistant wheras from meningeal infections near 100% were penicillin resistant. Genetic analysis indicates that 48% of these 19A strains belong to clonal complex 320, recognized for its pandemic potential and high antimicrobial resistance. Among children, most invasive infections secondary to serotype 19A have occurred in patients fully vaccinated with PCV10. These epidemiological changes indicate an increase in invasive pneumococcal infections by serotype 19A in Chile and the need to control this problem by changing the current PCV10 for the PCV13 vaccine containing serotype 19A.

Comparison between an Instructor-led Course and Training Using a Voice Advisory Manikin in Initial Cardiopulmonary Resuscitation Skill Acquisition

PURPOSE: Purpose: We compared the outcomes of training between the use of voice-advisory manikin (VAM) and instructor-led (IL) courses with respect to the acquisition of initial cardio-pulmonary resuscitation (CPR) skills, as defined by the 2010 resuscitation guidelines. METHODS: This study was a randomized, controlled, blinded, parallel-group trial. We recruited 82 first-year emergency medical technician students and randomly distributed them into two groups: the IL group (n=41) and the VAM group (n=37). In the IL group, participants were trained in “single-rescuer, adult CPR” in accordance with the American Heart Association's Basic Life Support course for healthcare providers. In the VAM group, all subjects received a 20-minute lesson about CPR. After the lesson, each student trained individually with the VAM for 1 hour, receiving real-time feedback. After the training, all subjects were evaluated as they performed basic CPR (30 compressions, 2 ventilations) for 4 minutes. RESULTS: The proportion of participants with a mean compression depth ≥50 mm was 34.1% in the IL group and 27.0% in the VAM group, and the proportion with a mean compression depth ≥40 mm had increased significantly in both groups compared with ≥50 mm (IL group, 82.9%; VAM group, 86.5%). However, no significant differences were detected between the two groups in this regard. The proportion of ventilations of the appropriate volume was relatively low in both groups (IL group, 26.4%; VAM group, 12.5%; p=0.396). CONCLUSION: Both methods the IL training using a practice-while-watching video and the VAM training facilitated initial CPR skill acquisition, especially in terms of correct chest compression.

Review of Medical Advisory Services by the Korean Society of Pathologists from 2003 to 2014

BACKGROUND: Since 2003, the Korean Society of Pathologists (KSP) has been officially providing medical advisory services (MAS). We reviewed the cases submitted to the KSP between 2003 and 2014. METHODS: In total, 1,950 cases were submitted, most by private health insurance companies. The main purposes of the consultations were to clarify the initial diagnoses and to assign a proper disease classification code. We comprehensively reviewed 1,803 consultation cases with detailed information. RESULTS: In spite of some fluctuations, the number of submitted cases has been significantly increasing over the 12 study years. The colon and rectum (40.3%), urinary bladder (14.2%), and stomach (6.9%) were the three most common tissues of origin. The most common diagnoses for each of the three tissues of origin were neuroendocrine tumor (50.7%), non-invasive papillary urothelial carcinoma (70.7%), and adenocarcinoma (36.2%). Regardless of the tissue of origin, neuroendocrine tumor of the digestive system was the most common diagnosis (419 of 1,803). CONCLUSIONS: In the current study, we found that pathologic consultations associated with private health insurance accounted for a large proportion of the MAS. Coding of the biologic behavior of diseases was the main issue of the consultations. In spite of the effort of the KSP to set proper guidelines for coding and classification of tumors, this review revealed that problems still exist and will continue to be an important issue.

Teaching transfusion medicine: current situation and proposals for proper medical training

The current curricula in medical schools and hospital residence worldwide lack exposure to blood transfusion medicine, and require the reformulation of academic programs. In many countries, training in blood transfusion is not currently offered to medical students or during residency. Clinical evidence indicates that blood transfusions occur more frequently than recommended, contributing to increased risk due to this procedure. Therefore, the rational use of blood and its components is essential, due to the frequent undesirable reactions, to the increasing demand of blood products and the cost of the process. Significant improvements in knowledge of and skills in transfusion medicine are needed by both students and residents. Improvements are needed in both background knowledge and the practical application of this knowledge to improve safety. Studies prove that hemovigilance has an impact on transfusion safety and helps to prevent the occurrence of transfusion-related adverse effects. To ensure that all these aspects of blood transfusion are being properly addressed, many countries have instituted hospital transfusion committees. From this perspective, the interventions performed during the formation of medical students and residents, even the simplest, have proven effective in the acquisition of knowledge and medical training, thereby leading to a reduction in inappropriate use of blood. Therefore, we would like to emphasize the importance of the exposure of medical students and residents to blood ser- vices and transfusion medicine in order for them to acquire adequate medical training, as well as to discuss some changes in the current medical curricula regarding transfusion medicine that we judge critical.

Fotografia e pesquisa-intervenção: reflexões sobre os modos de ver, falar e viver / Photography and intervention research: reflections on ways of seeing, speaking and living / Fotografía y la intervención de investigación: reflexiones sobre formas de ver, hablar y vivir

Este texto discute a produção de fotografias como estratégia metodológica na pesquisa intervenção. Trata especificamente da intervenção fotográfica como estratégia que busca intervir nas visibilidades, provocando os processos de institucionalização e as lógicas institucionais legitimadas. Deste modo, busca as resistências que se produzem para além dos diagramas de poder e de força, que podem ser transformadoras e inventivas de modos de viver. Concebe as visibilidade e dizibilidades como forças irredutíveis que produzem modos de ver e de dizer, organizadas pelas instituições e concebe a intervenção fotográfica como um processo que envolve o fotografar e os agenciamentos sempre diferentes entre os equipamentos, as situações e as posições de fotografx. Por fim, apresenta três referências de estudos realizados no Serviço de Assessoria Jurídica universidade, no grupo que trabalha com Direitos Sexuais e de Gênero, como forma de evidenciar esta estratégia de intervenção.

This text discusses the production of photographs as a methodological strategy in research-intervention. It deals with photographic intervention as a strategy that seeks to intervene in visibilities while inciting processes of institutionalization and legitimized institutional logics. Thus, we look to identify resistances produced beyond diagrams of power and strength which can be transformative and inventive of ways of living. We posit visibility and modes of speech as irreducible forces that produce modes of seeing and speaking, organised by institutions and which conceive photographic intervention as a process that involves photographing and the always different assemblages involving equipment, settings and positions. Finally, we discuss three studies conducted by the legal advisory service of a university by the Work Group on Gender and Sexual Rights as a way to bear witness to this intervention strategy.

Este texto discute la producción de fotografías como estrategias metodológicas en la investigación-intervención. Se ocupa específicamente de la intervención fotográfica como estrategia que busca intervenir en las visbilidades, en provocación a los procesos de institucionalización y a las lógicas institucionales legitimados. Por lo tanto, busca las resistencias que se producen más allá de los diagramas de potencia y fuerza, que logran ser transformadoras y pueden inventar formas de vivir. Concibe la visibilidad y dizibilidades como fuerzas irreductibles que producen formas de ver y decir, organizados por las instituciones y concibe la intervención fotográfica como proceso que implica el fotografiar y los agenciamentos siempre distintos entre aparatos, situaciones y posiciones del fotografx. Por fin, se presentan tres referencias a estudios realizados en el Servicio de Asesoría Legal de una universidad, en el grupo de trabajo con los Derechos Sexuales y de Género, como una manera de resaltar esta estrategia de intervención.

Indian Academy of Pediatrics (IAP) Recommended Immunization Schedule for Children Aged 0 through 18 years – India, 2013 and Updates on Immunization.

Justification: There is a need to review/revise recommendations about existing vaccines in light of recent developments in the field of vaccinology where new developments are taking place regularly at short intervals. Process: Following an IAP ACVIP meeting on 3rd and 4th August, 2013, a draft of revised recommendations for the year 2013 and updates on certain new vaccine formulations was prepared and circulated among the meeting participants to arrive at a consensus. Objectives: To review and revise recommendations for 2013 Immunization timetable for pediatricians in office practice and issue statements on new vaccine formulations. Recommendations: The major change in the 2013 Immunization timetable was made in the recommendations pertaining to pertussis immunization. Taking in to the consideration of recent outbreaks of pertussis in many industrialized countries using acellular pertussis (aP) vaccines and subsequent finding of faster waning of the same in comparison to whole-cell pertussis (wP) vaccines and superior priming with wP vaccines than aP vaccines, the committee has now recommended wP vaccines for the primary series of infant vaccination. Guidelines are now also issued on the preference/ selection of a particular aP vaccine in case it is not feasible to use wP vaccine, and use of Tdap vaccine during pregnancy. The administration schedule of monovalent human rotavirus vaccine, RV1 has been revised to 10 and 14 weeks from existing 6 and 10 weeks. Recommendation is made for the need of booster dose of live attenuated SA-14-14-2 JE vaccine. Updates and recommendations are issued on new typhoid conjugate vaccine, inactivated vero-cell culture derived SA-14- 14-2 JE vaccine, inactivated vero-cell derived Kolar strain, 821564XY JE vaccine, and new meningococcal conjugate vaccines. This year the recommended immunization schedule with range for persons aged 0 through 18 years is being published together instead of two separate schedules. A subcategory of ‘general instruction’ is added in footnotes. The comments and footnotes for several vaccines are revised and separate instructions for ‘routine vaccination’ and ‘catch-up vaccination’ are added in the footnotes section wherever applicable.

School violence: Subjective theories of academic advisory board members from six chilean schools

Se estudiaron las teorías subjetivas acerca de la violencia escolar de seis docentes directivos de seis establecimientos educacionales de la comuna de Coquimbo (Chile), tres de escuelas municipales (públicas) y tres de colegios particulares. El estudio fue de tipo cualitativo y la estrategia de recolección de datos utilizó una entrevista semi-estructurada de aplicación individual, seguida por un instrumento de auto-reporte. Los resultados fueron analizados, organizados e interpretados en base a la teoría fundamentada, lo que permitió reconstruir las explicaciones que los directivos han construido acerca de la violencia escolar. Los resultados indican que todos los participantes conciben la violencia escolar como un problema social importante pero poco común en sus instituciones educativas. Además, asumen que la violencia se origina fundamentalmente por influencias externas que provienen de la sociedad en su conjunto, tales como el tipo de estructura familiar y los procesos de socialización en el hogar, la calidad de la educación recibida y la influencia de los medios de comunicación. Cuando piensan en variables del propio sujeto, usualmente atribuyen la violencia a una baja autoestima. En esta concepción, al dejar de lado la participación del individuo como un agente racional que discierne y elabora juicios morales para guiar la acción, los directivos asumen una visión pasiva del sujeto como meramente respondiente a las influencias ambientales. Los hallazgos del estudio se discuten principalmente enfatizando sus implicaciones para la educación, específicamente para la educación moral y la prevención de la violencia.

This study analyzes the subjective theories regarding school violence held by six school officials of the city of Coquimbo (Chile). School violence is action carried out by a member of a school community that intends to cause harm against any member of that community. The study's main objective is to identify and interpre tthe various subjective theories regarding school violence held by the school officials as well as to explore whether there is a moral dimension to their subjective theories. We are interested in the moral dimension of the problem because research has shown that processes such as moral reasoning, moral identity, or moral motivation are linked to students' behavior in schools. Furthermore, social interactions are critical for the development of more advanced levels of moral reasoning. The study focuses on six members of the academic advisory board from six different schools, three municipal (public) schools and three subsidized private schools in the region of Coquimbo (Chile). Because the role of the administrative team is becoming increasingly important in the proper functioning of educational institutions, characteristics of school officials such as their leadership skills, negotiation skills, or abilities solve conflicts, have a direct impact on the success or failure of any educational program. Due to the qualitative approach of this study, each participant was interviewed using an individual semi-structured interview followed by a self-report questionnaire. Results were analyzed, organized, and interpreted based on grounded theory, which has been shown to be useful in analyzing subjective theories. Participants' explanations regarding school violence were reconstructed using the semantic categories that emerged in their interview responses. Results indicate that participants view school violence as an important social problem that should be contested; however, at the same time participants feel that it is not prevalent at their own educational institutions. Moreover, all participants believe that school violence takes place because of social influences, such as socialization processes at home, family values, quality of education, and influence of mass media, among others. This shows that participants hold a concept of the individual as merely respondent to environmental forces, lacking rational process and agency to discern and make moral judgments as a base for their actions. This is problematic because school violence has a moral dimension, as it involves issues of fairness, cooperation, conflict, negotiation with others, justice, and welfare. Results show that none of the participants understand violence as related to morality. Consequently, participants support traditional approaches to combat school violence aimed either at making students behave as it is prescribed by school norms or at enhancing students' social skills. However, such approaches disregard any moral education or moral discernment, even though research has identified moral values, the main variable in the study of social behaviour (Delfino & Zubieta, 2011), and moral development as factors related to violence. In general, school officials regard violence as externally originated, caused mainly by social forces and cultural factors. They also have subjective theories that hold the causes of school violence to be external and un manageable, minimizing their responsibility and their sense of efficacy in dealing with the problem. Assuming that a major role of education is to facilitate a better understanding of the world and knowing that teachers' beliefs are very important into explain teachers' behavior, the results of this study are discussed regarding its implications for education, particularly moral education and the prevention of violence.

Are medical students being properly cared for? A question for the current student advisory program / 한국의학교육

PURPOSE: Medical students need close care and systematic management of their mental and emotional health during their academic tenure. This study examined the status of the current student advisory program and counseling office, the satisfaction of the current student advisory program, the core content of an advisory program, and the quality of a good advisor. METHODS: We asked 64 faculties that were in charge of the student advisory program and medical education and 774 medical students from 41 medical schools in Korea to answer a survey. Statistical analysis, chi-square test, and ordered multiple response analysis were performed. RESULTS: A significant number of faculty members (63.5%) and students (53.4%) indicated the existence of problems with the current advisory program. 'Deviations from the content (27.3%)' was the faculty's predominant complaint versus 'too formal (31.3%)' for students. A total of 55.5% of faculty members replied that the counseling program was helpful, but students were somewhat skeptical (13.9%). The core content of the advisory program was 'school life & academic counseling (28.3%)' by the faculty versus 'life as a medical doctor (22.3%)' for students. Both faculty and students replied that the quality of a good advisor is having 'concerns about students.' CONCLUSION: Current student advisory and counseling programs are not much help to students. A differentiated program for specific academic years should be considered to provide a tailored and valuable service.

An overview of the national immunization policy making process: the role of the Korea expert committee on immunization practices / 소아과

The need for evidence-based decision making in immunization programs has increased due to the presence of multiple health priorities, limited human resources, expensive vaccines, and limited funds. Countries should establish a group of national experts to advise their Ministries of Health. So far, many nations have formed their own National Immunization Technical Advisory Groups (NITAGs). In the Republic of Korea, the Korea Expert Committee on Immunization Practices (KECIP), established by law in the early 1990s, has made many important technical recommendations to contribute to the decline in vaccine preventable diseases and currently functions as a NITAG. It includes 13 core members and 2 non-core members, including a chairperson. Core members usually come from affiliated organizations in internal medicine, pediatrics, obstetrics, microbiology, preventive medicine, nursing and a representative from a consumer group, all of whom serve two year terms. Non-core members comprise two government officials belonging to the Korea Centers for Disease Control and Prevention (KCDC) and the Korea Food and Drug Administration. Meetings are held as needed, but at least twice a year, and sub-committees are formed as a resource for gathering, analyzing, and preparing information for the KECIP meetings. Once the sub-committees or the KCDC review the available data, the KECIP members discuss each issue in depth and develop recommendations, usually by a consensus in the meeting. The KECIP publishes national guidelines and immunization schedules that are updated regularly. KECIP's role is essentially consultative and the implementation of their recommendations may depend on the budget or current laws.

Comitê de bioética em hospital pediátrico: da proposta à ação / Comité de bioética en un hospital pediátrico: de la propuesta a la acción / Bioethics committee in a pediatric hospital: from proposal to action

Os comitês hospitalares de bioética (CHB) caracterizam-se como grupos interdisciplinares para aconselhar, consultar, discutir ou envolver-se em decisões e políticas relacionadas à ética na saúde. Buscam diferentes olhares para os conflitos decorrentes da prática clínica, possibilitando a análise mais abrangente e a tomada de decisão mais correta e prudente das situações eticamente problemáticas enfrentadas no cotidiano do exercício profissional de assistência à saúde. Este relato, baseado em estudo de caso, pretende fomentar a reflexão e a discussão da bioética vinculada à prática assistencial nos ambientes institucionais e apresentar uma experiência prática de constituição de CHB em um hospital pediátrico.

Los comités hospitalarios de bioética (CHB) se caracterizan como grupos interdisciplinarios para aconsejar, consultar, discutir o involucrarse en decisiones y políticas relacionadas a la ética en la salud. Buscan diferentes puntos de vista para los conflictos derivados de la práctica clínica, posibilitando el análisis más amplio y la toma de decisiones más correcta y prudente de las situaciones éticamente problemáticas enfrentadas en la práctica diaria de los profesionales de asistencia a la salud. Este informe, basado en un estudio de caso, tiene como objetivo promover la reflexión y el debate de la bioética vinculadas a la práctica asistencial en los ambientes institucionales y presentar una experiencia práctica constitución de CHB en un hospital pediátrico.

Hospital bioethics committees (HBC) are characterized as interdisciplinary groups to advise, consult, debate or get involved in decisions and policies related to health ethics. They seek out different looks for conflicts deriving from clinical practice, enabling more comprehensive analysis and more accurate and prudent decision making of ethically problematic situations faced in everyday professional health care. This report, based on case study, aims to encourage reflection and discussion of bioethics linked to health care practice in institutional settings and to present a practical experience in the formation of HBC in a pediatric hospital.

Melhor isso do que nada - Participação e responsabilização na gestão dos riscos do Pólo Petroquímico de Camaçari (BA) / Better this than nothing - Participation and accountability on risk management of Camaçari Petrochemical Complex, in Bahia State

O objetivo da pesquisa foi analisar o modelo adotado na construção dos conselhos comunitários consultivos. O recorte empírico trata do Conselho Comunitário de Camaçari (BA), primeiro no país e referência para a implantação de outros. Observação participante e dezessete entrevistas foram as principais fontes de dados. O conselho se constitui num sofisticado mecanismo de docilização e responsabilização pela disseminação de uma ideologia organizacional hegemônica e de modos de governança neoliberais.

This research intends to analyze the model adopted in the construction of community advisory committees. The empirical object is the Community Advisory Committee of Camaçari Complex (BA), the first one to be set up in the country and that has been used as a reference for the implementation of others. Participant observation and seventeen interviews were the main sources of data. The advisory committee constitutes itself in a sophisticated mechanism of docilization and responsabilization for the spread of an organizational hegemonic ideology and neoliberal modes of governance.

Descriptive analysis of immunization policy decision making in the Americas / Análisis descriptivo de la toma de decisión sobre políticas de vacunación en las Américas

OBJECTIVES: Reducing and eliminating vaccine-preventable diseases requires evidence-based and informed policy decision making. Critical to determining the functionality of the decision-making process for introduction of a new vaccine is understanding the role of the national immunization technical advisory group (ITAG) in each country. The aim of this study is to document the current situation of national level immunization policy decision making for use in the Pan American Health Organization (PAHO) ProVac Initiative. METHODS: A structured 66-variable questionnaire developed by the World Health Organization (WHO) in collaboration with the University of Ottawa was distributed to all WHO regions; it was composed of dichotomous, multiple-choice, and open-ended questions. Questionnaires were e-mailed or faxed to the six WHO regional offices and the offices distributed them to all member states. This paper analyzes surveys from the Americas as part of PAHO's ProVac Initiative. RESULTS: Twenty-nine countries of the Americas answered the survey. They conveyed that immunization policy making needed to be improved and further supported by organizations such as PAHO. Areas of improvement ranged from organization and technical support to strengthening capacity and infrastructure to improved coordination among stakeholders. This survey also highlighted a variety of ITAG processes that need further investigation. CONCLUSION: This survey supports the efforts of PAHO's ProVac Initiative to disseminate knowledge and best practices for an immunization policy decision-making framework through the development of clear definitions and guidelines. By highlighting each problem noted in this study, ProVac will assist countries in Latin America and the Caribbean to build national capacity for making evidence-based decisions about introduction of new vaccines.

OBJETIVOS: Para reducir y eliminar las enfermedades prevenibles por vacunación se requiere tomar decisiones basadas en datos científicos y una política informada. Con el fin de determinar la funcionalidad del proceso de toma de decisiones para introducir una nueva vacuna es vital comprender el papel de los grupos técnicos asesores nacionales sobre vacunación (GTAN) de cada país. En este trabajo se documenta la situación actual de la toma de decisión sobre políticas de vacunación a nivel nacional como insumo de la Iniciativa ProVac de la Organización Panamericana de la Salud (OPS). MÉTODOS: Se distribuyó a todas las regiones de la Organización Mundial de la Salud (OMS) un cuestionario estructurado con 66 variables, desarrollado por la OMS en colaboración con la Universidad de Ottawa, Canadá. El cuestionario contenía preguntas abiertas, dicotómicas y de selección múltiple y se envió por correo electrónico o fax a las seis oficinas regionales de la OMS y estas lo distribuyeron a todos los estados miembros. En este manuscrito se analizan las respuestas procedentes de las Américas, como parte de la Iniciativa ProVac de la OPS. RESULTADOS: Respondieron la encuesta 29 países de las Américas. Todos coincidieron en que la formulación de políticas de vacunación debe mejorar y se necesita más apoyo de organizaciones como la OPS. Las áreas que requieren mejoras van desde la organización y el apoyo técnico hasta el fortalecimiento de la capacidad y la infraestructura, y el perfeccionamiento de la coordinación entre los diferentes actores. También se destacan algunos procesos de los GTAN que requieren mayor investigación. CONCLUSIÓN: Esta encuesta apoya los esfuerzos de la iniciativa ProVac de la OPS para diseminar el conocimiento y las mejores prácticas para elaborar un marco de trabajo para la toma de decisiones sobre políticas de vacunación mediante el desarrollo de definiciones y directivas claras. Al poner de manifiesto cada problema observado ...