Formación en promoción de autonomía y apoyo pedagógico durante confinamiento por covid-19 / Training on autonomy promotion and pedagogical support during COVID-19 lockdowns

(analítico) Se analiza la implementación de un programa de formación docente en promoción de autonomía y apoyo pedagógico y su relación con el compromiso de niños en el aula. El programa se desarrolló duran-te el cierre de escuelas por la pandemia causada por el covid-19. Se usó diseño mixto convergente-paralelo. Participaron cinco docentes de primaria, de escuelas públicas de Cali, Colombia, y sus estudiantes (N=110). La formación consistió en dos talleres grupales y tres sesiones de acompañamiento individual en modalidad virtual. Se grabaron las clases antes y durante el proceso, codificándose las interacciones. Se observó alta variabilidad en promoción de autonomía y apoyo pedagógico. El compromiso de los niños fue mayor cuando las profesoras promovían mayor autonomía y apoyo pedagógico. Se discutieron variables que afectan el aprovechamiento de la formación.

(analytical) This paper analyzes the implementation of a professional development program on autonomy promotion and instructional support in the classroom, and the relationship between this program and students' engagement. The program was designed during the delivery of online classes as a result of the COVID-19 pandemic. The study used a convergent parallel design. Participants were five elementary teachers and their students (N=110) at a public school in Cali, Colombia. The program consisted of two workshops and three online individual feedback sessions. Classes were recorded before and during the program and classroom interactions were coded. The results show high variability in teachers' autonomy promotion and instructional support during the classes. Students' engagement was higher when teachers promote greater autonomy and instructional support. Variables that could affect teachers' use of learning from the program are discussed.

(analítico) Analisase a implementação de um programa de formação docente para a promoção da autonomia e o apoio pedagógico e sua relação com a performance das crianças na sala de aula. O programa foi desenvolvido durante o fechamento das escolas pelo Covid-19. Um método misto convergente-paralelo foi usado. Participaram cinco professoras de ensino básico de escolas públicas de Cali-Colômbia e seus alunos, 110 crianças. A formação consistiu em duas oficinas grupais e três sessões de trabalho individual na modalidade virtual. As aulas foram gravadas antes e durante o processo, e as interações foram codificadas. Observa-se alta variabilidade na promoção da autonomia e apoio pedagógico. O comprometimento das crianças foi maior quando as professoras promoveram maior autonomia e apoio pedagógico. As variáveis que afetam o aproveitamento do treinamento são discutidas.

Evaluación del Curso de liderazgo para cirujanos ortopédicos en Cuba

Se requiere de estrategias e infraestructuras sostenibles, así como del perfeccionamiento en la gestión y la forma de dirigir las organizaciones sanitarias, para mejorar la atención traumatológica ortopédica. Sin embargo, hay pocas oportunidades para el desarrollo formal del liderazgo, especialmente en América Latina; por ello, la Asociación de Cirujanos Traumatólogos de las Américas realizó un Programa de Desarrollo de Liderazgo adaptado a los cirujanos ortopédicos latinoamericanos. El primer curso se realizó en México en 2019, y esta experiencia se trasladó a La Habana en febrero de 2022. Este documento informa sobre las necesidades para el desarrollo del liderazgo entre los cirujanos ortopédicos cubanos y los estudiantes, el plan de estudio del curso y las impresiones de sus asistentes.

Sustainable strategies and infrastructures, as well as improvements in management and governance of health organizations, are required to improve orthopedic trauma care. However, there are few opportunities for formal leadership development, especially, in Latin America. For this reason, the Association of Traumatologist Surgeons of the Americas carried out a Leadership Development Program adapted to Latin American orthopedic surgeons. The first course was held in Mexico in 2019. This experience was transferred to Havana in February 2022. This document reports on the needs for leadership development among Cuban orthopedic surgeons and students, the course curriculum, and impressions of the attendees.

Impact of communication campaigns to Blaan indigenous peoples covered by Community Health and Development Program, University of the Philippines Manila

Background@#The Community Health and Development Program (CHDP) is a longstanding program of the University of the Philippines (UP) Manila, School of Health Sciences, Extension Campus in South Cotabato. While its service goes beyond teaching and extends to community development projects benefiting indigenous sectors, yet there has been no comprehensive and systematic evaluation on the program's health communication materials which promote culturally safe and acceptable health care practices that lead to normative changes.@*Objective@#Using descriptive-interpretive qualitative approach, the researcher identified the communication approaches and documented their health knowledge, attitude, and practices (KAP) to identify any normative changes.@*Methodology@#A total of 24 respondents gave their views on the program's dengue, malnutrition, teenage pregnancy, and family planning campaigns using a closed-ended survey, qualitative KAP analysis, and ethnovideography.@*Results@#Results showed that information dissemination is limited to printed media and interpersonal communication via small groups; contents of health communication campaigns are less understandable; and social mobilization efforts demonstrated low levels of community engagement. Also, communication between health workers and Blaan indigenous peoples is not transactional due to the lack of feedback and involvement in the decision-making process. The respondents' knowledge on health demonstrated low levels of end-user engagement reflective of unsustainable knowledge on modern medicine. Normative changes are only evident on family planning campaigns.@*Conclusion@#The long-term sustainability of health promotion among indigenous peoples may be inhibited due to non-evident normative changes that trigger societal transformation. The paper suggests that a specialized communication strategy intended for Blaan indigenous peoples must be considered and applied in order to react collectively and effectively to address health issues.

Thoughts on the development of International Organization for Standardization standards for Traditional Chinese Medicine information models / 国际中医中药杂志

The development of the International Organization for Standardization (ISO) standard for Traditional Chinese Medicine (TCM) information model is needed to promote the coordinated development of TCM information research and application on a global scale, and it is of great significance to promote the use of TCM data. Based on the 13 years of experience in the development of the ISO standard for the TCM information model, we introduced and discussed the development background, development platform, internationality and classification of the standard development. We determined the necessity of the ISO standard of TCM information model to be independent of modern medical information model standard, the necessity of developing standards on a large scientific platform, and the necessity of health informatics experts participating in standard development. We summarized the main points of international and domestic coordination. We emphasized the balance between the overall layout and new areas development, and the importance of application and promotion.

Impact Analysis of the National Faculty Development Program for Medical Teachers: A Way Forward

Background: Medical Council of India, New Delhilaunched a National Faculty Development Program(NFDP) across India in 2009. NFDP was neverevaluated in the context of its operational utility,efficiency and effectivity. Aim and Objectives: Presentstudy was undertaken to evaluate the NFDPat one of theMedical Council of India (MCI) Nodal Centre foridentifying the gap with regards to its impact,operational utility and effectivity as envisioned by theregulatory body and to invocate interventionaloperations arising thereof and to calibrate it and tocreate evidences for the same. Material and Methods:The study has been carried out at Jawaharlal NehruMedical College (JNMC), Sawangi (Meghe), Wardha, aNodal Centre recognized by MCI New Delhi for theNFDP. A validated questionnaire was sent to 667stparticipants of the NFDP at JNMC from 1 July 2009 tost31 July 2017 and responses were obtained aboutgenerating evidences in education technology, transferof knowledge at the workplace and contribution in theinstitutional growth. The impact analysis was studied interms of individualization, internalization andinstitutionalization of the participants. Results: 220(52%) of the participants confirmed their involvementin educational research activities in the form of eitheradvance course or a conference or an educationalresearch project. 250 (59%) of the participants couldtransfer their learning to the workplace and broughtchanges in the teaching learning Practices and 28.3% inassessment methods. 255 - 338 (60.32% to 79.90%)participants opined positive impact of NFDP onpersonal/ professional/ Institutional growth.Conclusions: In terms of the observations and findingsthereto, it was proposed that certain modifications(structural, operational and conceptual) are warranted inthe said program. Operational utility of the NFDP isdiscussed under two headings. Its link with CompetencyBased Medical Education and its relation toAccreditation Status of Medical schools in India.

Evaluation of the University of the Philippines Manila “Awakening Seminars”

Background@#Staff development is essential in sustaining organizational efficiency. In 2016, the University of the Philippines Manila started conducting the “Awakening Seminars” among administrative personnel to foster smooth interpersonal relationships and operational efficiency. @*Objectives@#This study was commissioned to determine the value of the seminars. It evaluated the trainees' perceived reactions, learning, and overall change in behaviors towards their work at the university. @*Methodology@#Out of 321 personnel who completed the seminars, 96 were calculated as sample size. Participants accomplished a survey questionnaire and 67 valid responses were collected. Data were analyzed using means and standard deviations according to Kirkpatrick's Evaluation Model from Level 1: Reactions, Level 2: Learning, to Level 3: Behavior. Different ratings were compared with selected variables using analysis of variance. @*Results@#Seven seminars were conducted from March 2016 to January 2017. Mean ratings showed that the seminars were well organized, relevant, and helped them appreciate their work, colleagues, and their workplace environment. Participants have high morale and felt privileged being in UP. Analysis of variance tests showed that evaluation ratings did not differ significantly with monthly take-home pay, tenure, performance, and job category. While these ratings are not directly translated as operational efficiency, results suggest participants' commitment to the university's goals. @*Conclusion@#UP Manila personnel appreciated the “Awakening” staff development program and can be replicated to all support personnel of the colleges.

The study on the segmentation of carotid vessel wall in multicontrast MR images based on U?Net neural network / 中华放射学杂志

Objective To investigate the value of automatic segmentation of carotid vessel wall in multicontrast MR images using U?Net neural network. Methods Patients were retrospectively collected from 2012 to 2015 in Carotid Atherosclerosis Risk Assessment (CARE II) study. All patients who recently suffered ischemic stroke and/or transient ischemic attack underwent identical, state?of?the?art multicontrast MRI technique. A total of 17 568 carotid vessel wall MR images from 658 subjects were included in this study after inclusion criteria and exclusion criteria. All MR images were analyzed using customized analysis platform (CASCADE). Randomly, 10 592 images were assigned into training dataset, 3 488 images were assigned into validating dataset and 3 488 images were assigned into test dataset according to a ratio of 6∶2∶2. Data augmentation was performed to avoid over fitting and improve the ability of model generalization. The fine?tuned U?Net model was utilized in the segmentation of carotid vessel wall in multicontrast MR images. The U?Net model was trained in the training dataset and validated in the validating dataset. To evaluate the accuracy of carotid vessel wall segmentation, the sensitivity, specificity and Dice coefficient were used in the testing dataset. In addition, the interclass correlation and the Bland?Altman analysis of max wall thickness and wall area were obtained to demonstrate the agreement of the U?Net segmentation and the manual segmentation. Results The sensitivity, specificity and Dice coefficient of the fine?tuned U?Net model achieved 0.878,0.986 and 0.858 in the test dataset, respectively. The interclass correlation (95% confidence interval) was 0.921 (0.915-0.925) for max wall thickness and 0.929 (0.924-0.933) for wall area. In the Bland?Altman analysis, the difference of max wall thickness was (0.037±0.316) mm and the difference of wall area was (1.182±4.953) mm2. The substantial agreement was observed between U?Net segmentation method and manual segmentation method. Conclusion Automatic segmentation of carotid vessel wall in multicontrast MR images can be achieved using fine?tuned U?Net neural network, which is trained and tested in the large scale dataset labeled by professional radiologists.

How to well prepare before the start of medical projects of The National Key Research and Development Program of China / 中华医学科研管理杂志

Objective The management of medical projects of the National Key Research and Development Program of China is difficult.Thus this article aims to analyze the common problems and summarize the preparatory work before the project initiation.Methods Comprehensively adopted the methodologies of literature analysis,survey investigation to analyze the common problems before the project initiation,and then particularly summarize the preparatory works for biomedical research,especially for clinical research,from the perspective of investigators.Results Proposed several aspects that should take into consideration before the initiation of the projects..clarify the organizational management framework,play the role of kick-off meeting,organize tailored training on financial management,prepare research protocol and related documents,seek Institutional Review Board approval and conduct clinical research registration,normalize document managment,formulate project management plan,and prepare research facilities timely.Conclusions Investigators should develop a detailed project management plan before initiation of the project,preparation work should focus on personnel,financial resources,facilities,research progress,quality,data,etc.

Índice de desarrollo humano y eventos de salud pública: revisión sistemática de la literatura 1990-2015 / Human development index and public health events: Systematic review of 1990-2015 literature / Índice de desenvolvimento humano e eventos de saúde pública: revisão sistemática da literatura 1990-2015

Resumen Objetivo: sistematizar las publicaciones científicas que describen la relación del índice de desarrollo humano con indicadores de morbilidad y mortalidad por enfermedades transmisibles y no transmisibles. Metodología: revisión sistemática en siete bases de datos multidisciplinarias de las investigaciones que reportan coeficientes de correlación, regresión o determinación entre el índice de desarrollo humano del Programa de Naciones unidas para el Desarrollo y la morbilidad o mortalidad por eventos en salud. Resultados: Se identificaron 21 investigaciones que evaluaron la relación entre desarrollo humano y más de 35 eventos de interés en salud pública. Las enfermedades neoplásicas (con excepción del cáncer de mama y ovario) y transmisibles presentaron correlaciones inversas con el índice que van desde -0,85 hasta -0,40. El suicidio, el sedentarismo, el consumo de drogas, el cáncer de mama y ovario presentaron correlaciones directas que van desde 0,27 hasta 0,89. Se identificó que el índice constituye un excelente predictor en la ocurrencia de tuberculosis, suicidio y malaria. Conclusión: Se evidencia que el desarrollo humano discurre en paralelo con mejores condiciones de salud representadas por la reducción en la morbilidad y mortalidad por cáncer y enfermedades transmisibles; lo que da luces para que los países con bajo índice de desarrollo no aplacen inversiones socialmente importantes por ausencia de recursos, sino que inviertan simultáneamente en dimensiones económicas y servicios sociales, particularmente la promoción y atención de salud y educación básica.

Abstract Objective: Systematize scientific publications that describe the relationship of the human development index and morbidity and mortality indicators caused by communicable and non-communicable diseases. Methodology: A systematic review of 6 multidisciplinary databases research studies that report correlation, regression or determination coefficients in the human development index of the United Nations program for development and morbidity or mortality for healthcare events. Results: 21 studies that evaluated the relation between human development and more than 35 events of interest in public health were identified. Neoplastic diseases (except breast and ovarian cancer) and communicable diseases presented inverted correlations with an index ranging from -0.85 to -0.40. Suicide, physical inactivity, drug use, breast cancer and ovarian cancer presented direct correlations ranging from 0.27 to 0.89. This study identified that the index constitutes an excellent predictor regarding the occurrence of tuberculosis, suicide and malaria. Conclusion: The study evidenced that human development paralleled the best health conditions represented by a decrease in morbidity and mortality resulting from cancer and communicable diseases; this shed a light so that countries with a low development index do not delay socially important Investments because of a lack of resources. They should invest simultaneously in economic dimensions and social services, particularly promoting health care and basic education.

Resumo Objetivo: Sistematizar publicações científicas que descrevem a relação do índice de desenvolvimento humano com indicadores de morbidade e mortalidade por doenças transmissíveis e não transmissíveis. Metodologia: Revisão sistemática em sete bases de dados multidisciplinares de pesquisa que reportam coeficientes de correlação, regressão ou determinação entre o índice de desenvolvimento humano do Programa para o Desenvolvimento das Nações Unidas e morbidade ou mortalidade devido a eventos de saúde. Resultados: Foram identificadas 21 pesquisas que avaliaram a relação entre desenvolvimento humano e mais de 35 eventos de interesse em saúde pública. As doenças neoplásicas (com exceção do câncer de mama e ovário) e doenças transmissíveis apresentaram correlações inversas com o índice variando de -0,85 para -0,40. Suicídio, sedentarismo, uso de drogas, câncer de mama e ovário apresentaram correlações diretas entre 0,27 e 0,89. Identificou-se que o índice constitui um excelente preditor na ocorrência de tuberculose, suicídio e malária. Conclusão: Evidenciou-se que o desenvolvimento humano é paralelo com melhores condições de saúde representadas pela redução da morbimortalidade por câncer e doenças transmissíveis; o que dá luzes para que os países com baixo índice de desenvolvimento não adiem investimentos socialmente importantes por falta de recursos, que invistam simultaneamente em dimensões econômicas e serviços sociais, particularmente na promoção, atenção da saúde e educação básica.

The effect of the Elderly Development Program on the quality of life of elderly individuals / The Health Sciences Journal

Introduction @#The increasing aging population of the Philippines impacts on the socioeconomic development of the country, prompting a deeper look into their quality of life. This study sought to determine the effect of the Elderly Development Program on the quality of life of the elderly population of Los Baños.@*Methods @#A 4-month prospective cohort study of the elderly population in Los Baños, Laguna compared the quality of life scores of a group enrolled in the Elderly Development Program and an unexposed control, using the World Health Organization Quality of Life Abbreviated Version for Filipino Older Persons questionnaire.@*Results @#Quality of life scores where higher for the EDP group during the four months of observation. In Month 2, significant differences were found in all domains except for the psychological domain. Only the physical health domain score was significant in the EDP group for Month 3 (p = 0.003) and Month 4 (p = 0.029). Both the EDP and control groups had higher overall and domain scores in Month 4 compared with baseline.@*Conclusion @#The Elderly Development Program may improve the overall quality of life of elderly persons, specifically in the physical health domain. These improvements are likely due to the focus of the program on the physical aspect of the elderly.

Prevalencia mundial de la diabetes mellitus tipo 2 y su relación con el índice de desarrollo humano / Global prevalence of type 2 diabetes mellitus and its relationship with the Human Development Index / Prevalência mundial da diabetes mellitus tipo 2 e sua relação com o índice de desenvolvimento humano

RESUMEN Objetivo Evaluar la relación entre la prevalencia de diabetes mellitus tipo 2 (DM2) y el índice de desarrollo humano (IDH) por región del mundo en el período 2010-2015. Método Se utilizaron los datos de la Federación Internacional de Diabetes para la prevalencia de DM2 (2010-2015) y el IDH del Programa de las Naciones Unidas para el Desarrollo. Se analizaron correlaciones lineales de Spearman entre el IDH y la prevalencia de DM2 y se hicieron regresiones lineales para estimar la relación entre ambos. Resultados Se observó que a menor IDH menores son las prevalencias de DM2, y a mayor IDH, mayores son las prevalencias de DM2. A nivel mundial, el IDH explica 8,6% de la varianza de la prevalencia de DM2 (P < 0,0001) y que este comportamiento fue diferente en cada región del mundo. Conclusiones El IDH puede influir en la prevalencia de DM2, aunque la relación depende de cada país, región y año analizado.

ABSTRACT Objective To evaluate the relationship between the prevalence of type 2 diabetes mellitus (DM2) and the Human Development Index (HDI), by region of the world in the period 2010-2015. Method International Diabetes Federation data were used for DM2 prevalence (2010-2015), together with HDI data (United Nations Development Program). Spearman linear correlations between HDI data and DM2 prevalence were analyzed, and linear regressions were done to estimate the relationship between the two. Results It was observed that lower HDI scores corresponded to lower DM2 prevalence rates, and higher HDI scores to higher DM2 prevalence. At the global level, the HDI explains the 8.6% variance of DM2 prevalence (P < 0.0001) and shows that the situation was different in each region of the world. Conclusions While HDI score may be associated with DM2 prevalence, the relationship between them differs from region to region and from country to country, and depends on the particular year analyzed.

RESUMO Objetivo Avaliar a relação entre a prevalência de diabetes mellitus tipo 2 (DM2) e o índice de desenvolvimento humano (IDH) por região do mundo no período de 2010 a 2015. Métodos Foram utilizados dados da Federação Internacional de Diabetes para a prevalência da DM2 (2010-2015) e o IDH do Programa das Nações Unidas para o Desenvolvimento. Foram analisadas as correlações lineares de Spearman entre o IDH e a prevalência de DM2 e feitas regressões lineares para estimar a relação entre ambos. Resultados Observou-se que quanto mais baixo o IDH, menores são as prevalências de DM2, e quanto mais alto o IDH, maiores são prevalências de DM2. Ao nível mundial, o IDH explica 8,6% da variança da prevalência de DM2 (P < 0,0001) e este comportamento difere em cada região do mundo. Conclusões O IDH pode influir na prevalência de DM2, embora a relação dependa de cada país, região e ano analisados.

Faculty development for clinical education in the age of international accreditation: A case study of "Teaching in Clinical Settings: A Practicum Course" at McGill University / 医学教育

<p>　To effectively educate medical teachers for clerkship and residency training, the international faculty development program was developed. Ten faculties of the School of Medicine participated in the program and learned about clinical education through lectures and direct observations, transforming their educational perspectives. Factors to optimize such an international faculty development program were discussed: 1) Authentic educational institution and environment, 2) matching the participants' specialty and subject at the observation site, 3) optimal combination of lectures, direct observations, and debriefing sessions, 4) mutual understanding of cultural differences, and 5) sense of community cultivated by experiencing the program for a week. Those factors suggest ways for further improvement to reform the program, promote better management, and conduct educational research on faculty development.</p>

Conocimiento de las madres beneficiarias del Programa Oportunidades sobre el manejo de un suplemento nutricional (Nutrisano®) / Knowledge of the beneficiary mothers of Program Oportunidades on managing a dietary supplement (Nutrisano®)

Resumen:

Introducción: en el marco del Programa Institucional Oportunidades, dirigido a potenciar las capacidades de las familias que viven en condiciones de pobreza para que puedan alcanzar una mejor calidad de vida por su propio esfuerzo e iniciativa, una medida de apoyo es la distribución de un suplemento nutricional destinado a los niños menores de cinco años.

Objetivo: describir el conocimiento de las madres beneficiarias del Programa Oportunidades sobre el manejo del suplemento Nutrisano®.

Metodología: se realizó un estudio transversal descriptivo de 40 madres de niños menores de cinco años que integraban el censo nominal del Programa Oportunidades y que recibían el suplemento Nutrisano® para sus hijos, quienes accedieron a una entrevista previo consentimiento informado. Se analizaron características de las madres y de los niños, perfil del consumo alimentario de las familias y de los niños, capacitación de las madres, nivel de conocimientos sobre los factores de riesgo, manejo del suplemento nutricional y nivel de conocimiento al respecto. Resultados: 82.5 % de las madres poseía un nivel adecuado de conocimiento acerca de los factores de riesgo y 87.5 % tuvo un nivel inadecuado de conocimiento en el manejo del suplemento nutricional.

Conclusiones: las madres con hijos menores de cinco años con algún grado de desnutrición afiliadas al Programa Oportunidades no tuvieron conocimiento adecuado sobre el manejo del suplemento nutricional y este solo quedó en nivel informativo.

Abstract:

Introduction: Within the framework of the Institutional Program Oportunidades, aimed at enhancing the abilities of families living in poverty to achieve a better quality of life by their own effort and initiative, a support measure is the distribution of a dietary supplement intended for children under five years of age.

Objective: To describe the knowledge of the beneficiary mothers of Program Oportunidades on managing dietary supplement Nutrisano®.

Methods: Cross-sectional, descriptive study in 40 mothers of children under five years of age that are part of the nominal census of Program Oportunidades, receiving dietary supplement and who agreed to the interview prior informed consent. Characteristics of mothers, child characteristics, food consumption profile of households, food consumption profile of children, training of mothers, level of knowledge about risk factors, management of dietary supplement and level of knowledge about it were analyzed.

Results: 82.5 % of mothers have an appropriate level of knowledge of the risk factors, 87.5 % had an inadequate level of knowledge of the management of dietary supplement. Conclusions: Mothers with children under 5 years of age with some degree of malnutrition embedded in the Program Oportunidades do not have adequate knowledge about management of dietary supplement.

"Study on the Evaluation Index System for ""National Major New Drug Development Program" / 中华医学科研管理杂志

Objective Establish an objective and fair evaluation index system for the implementation effectiveness of the National Major New Drug Development Program of China.Methods Based on literature review and Delphi method,the framework of the evaluation index system was built and analytic hierarchy process was applied to determine the priority of each indicator of the system.The objectiveness and validness of the results were assured by determining expert activeness coefficient,authority coefficient,indicator rationality,and by applying consistency check.Results A targeted and systematic evaluation index system was constructed for the National Major New Drug Development Program,and through expert consultation and analytic hierarchy process,the factor of product result was considered of the highest weight of 39.03％,followed by technical result,theoretical result and organization and management result.The evaluation index system suggested that product result and technical result are two relatively more significant factors to be considered during evaluation.Conclu sion After consultation on expert opinions,the evaluation index system for the National Major New Drug Development Program was constructed with each factor been assigned with a scientific and rational weight,and this will provide a guideline for the decision making of program administrators and evaluation practice.

Plantas medicinales en un proyecto de desarrollo humano / Presence of medicinal plants in a community human development project

Introducción: el establecimiento de proyectos de patios ecológicos con plantas medicinales dentro del Programa de Desarrollo Sostenible Promoción del Desarrollo Humano. Objetivos: contribuir a la transformación y remodelación de los pequeños espacios en las viviendas: patios, balcones, azoteas, jardines, como forma de obtener estilos de vida sustentables y el mejoramiento de la calidad de vida. Métodos: se desarrollaron estos proyectos en algunos territorios urbanos y rurales como Guanabacoa, Luyanó, San Antonio de los Baños, Alquizar, Guanajay; se utilizó la metodología de diagnóstico participativo donde mediante recorridos por las localidades, el diálogo y la discusión con cada propietario se realizó un diagnóstico preliminar que generó información valiosa y sensibilización sobre lo que se debía abordar: análisis de sus problemas/necesidades, posibles intereses y soluciones, condiciones actuales, recomendar lo que se desea cambiar, mantener, incorporar o suprimir; también posibilitó conocer las necesidades de capacitación y asesoramiento. Resultados: se logró hacer estos espacios más productivos al obtener además de plantas medicinales, condimentos, vegetales, frutas, plantas ornamentales, cría ecológica de conejos, gallinas y peces con recursos propios; su intercambio entre patios; la propagación de plantas para su venta en bolsas; el montaje de un secador solar que facilitó el secado de algunas plantas con utilidad como medicinales y de condimentos, su distribución y venta en la comunidad; el reciclaje de los residuos generados en la colectividad y su empleo como abono orgánico, así como la reutilización de vasijas desechables. Todo esto les ha brindado el mejoramiento de la salud y de la calidad alimentaria, algún recurso económico, concretar experiencias prácticas en agricultura ecológica para conservar los recursos(

Introduction: the setting up of projects for the creation of ecological backyards with medicinal plants within the sustainable development program called Promotion of Human Development. Objectives: to contribute to the transformation and remodeling of small spaces found in houses such as backyards, balconies, roofs, gardens, etc., so that they could contribute to sustainable lifestyles and to the improvement of the quality of life. Methods: some of these projects were carried on in some urban and rural territories like Guanabacoa, Luyanó, San Antonio de los Baños, Alquízar y Guanajay. The participatory diagnosis methodology allowed reaching, after tours of the various localities, dialogue and discussion with every owner of an unused place, a preliminary diagnosis with useful information and the level of awareness about what should be addressed: analysis of their problems and needs; possible interests and solutions, present conditions, recommendations on the things that the owner desired to change, keep, incorporate or eliminate. It was also possible to learn about the training and advisory requirements in these settings. Results: more productive spaces since the owners obtain medicinal plants, seasonings, vegetables, fruits, ornamental plants, ecological raising of rabbits, chicken and fish, based on individual resources; the exchange of productions among the backyards, the sale of plants in bags, the mounting of a sun dryer facilitating the drying of some plants for medical use and of some seasonings, their distribution and community-wide sale; the recycling of residues from the community setting and their use as organic fertilizer as well as the reuse of disposable containers. All this has provided the community with better health and food quality, obtaining of some additional financial resources, the materialization of experiences in developing ecological agriculture to preserve the natural resources and the local culture, thus contributing to the

Tutor Training, Responsibilities, and Future Tasks in Tutorial Education / 医学教育

Tutors must understand their role in advance so that tutorial education can be conducted smoothly and effectively. These abilities and attitudes require training. At our school, tutors serve as faculty for basic courses and clinical courses. We assessed their training conditions and future tasks. Of the 1, 077 faculty members who received tutor training between 1988 and 1997, 935 are current faculty members who have completed in-service training (basic course, 115; clinical course, 820). Before 1989, training was on campus, but since 1990 it has been conducted at Shirakawa Seminar House with a 2-day program. The number of working tutors per year is 192, with a basic course to clinical course ratio of 3: 7. About half of the faculty members in the basic course have had four or more experiences as tutors, whereas most clinical course faculty members have had only one experience. Thus, many tutors have had no experience. In a questionnaire survey after undergoing the training program, most participants felt that they were able to understand the theory of tutorial education and the actual role of the tutor and that they were able to concentrate on off-campus training that was removed from their everyday work. To provide added impetus to tutorial education, we suggest that in the future, in addition to the understanding and mutual cooperation of those involved, it will be necessary to provide an advanced program to train tutors who have appropriate abilities and attitudes.