El laboratorio de fertilidad masculina, su evolución en los últimos 20 años / The male fertility laboratory, its evolution over the last 20 years / O laboratório de fertilidade masculina, sua evolução ao longo dos últimos 20 anos

Resumen La mayor accesibilidad a los tratamientos de reproducción asistida (RA) y los avances de la criobiología produjeron cambios en los laboratorios de andrología. El objetivo de este trabajo fue analizar la demanda y evolución de las variables seminales en las últimas dos décadas, caracterizar el laboratorio andrológico actual, evaluar el impacto de la incorporación del aseguramiento de la calidad y la inclusión de los sistemas computarizados (CASA). Se utilizaron datos de las medias mensuales del control de calidad interno (n=22 528) y encuestas a profesionales de laboratorios andrológicos (n=65) y a médicos especialistas en fertilidad (n=33). La demanda global se redujo significativamente con el aumento de las solicitudes de primera vez. El volumen y recuento, variables dependientes de andrógenos, disminuyeron con los años. El criterio estricto en morfología disminuyó el porcentaje de normales; la mitad de los médicos encuestados recibieron resultados entre 0 y 10% y el 40% consideró que ponía en riesgo el valor clínico de la variable. El sistema CASA permitió objetivar la cinética espermática e incrementar el porcentaje de progresivos rápidos, pero pocos laboratorios lo incorporaron. El 66% de los médicos resuelven el factor andrológico severo por tratamientos clínicos y el 95% utiliza técnicas de RA. El análisis de semen es ejecutado fundamentalmente por bioquímicos especializados, con baja adhesión a la automatización y acreditación del laboratorio, pero con participación en programas de evaluación externa de calidad. La demanda disminuyó como consecuencia del aumento del tratamiento por RA. La reducción del porcentaje de formas normales compromete su utilidad clínica.

Abstract Increasing availability to assisted reproduction (AR) treatments in Argentina and advances in cryobiology resulted in changes in andrology laboratories. The aim of this study was to evaluate the demand and evolution of seminal variables in the last two decades, characterise the current andrology laboratory, evaluate the impact of the incorporation of quality assurance and the introduction of computer assisted semen analysis (CASA). Data were taken from internal quality control (IQC) monthly means (n=22 528) and professionals in charge of laboratories (n=65) and fertility physicians' (n=33) surveys. Overall demand decreased significantly while first-time orders increased. Sperm volume and sperm count -androgen dependent parameters- decreased over the years. Strict morphology criteria reduced the percentage of normal results; half of the physicians received results between 0 and 10% and 40% considered that it compromised the clinical value of the variable. The CASA system made it possible to objectify sperm kinetic, increasing the percentage of fast progressives, but few laboratories have incorporated it. Sixty-six percent of physicians resolve severe andrological factor by clinical treatments and 95% use AR techniques in those cases. Semen analysis is mainly performed by specialised biochemists, with low adherence to laboratory automatisation and accreditation, but with participation in external quality assessment programmes. The demand decreased because of the increase in AR treatment. The lower percentage of normal forms compromises their clinical utility.

Resumo O aumento do acesso aos tratamentos de reprodução assistida (RA) e os avanços na criobiologia levaram a mudanças nos laboratórios de andrologia. O objetivo deste trabalho foi analisar a demanda e a evolução das variáveis de sêmen nas últimas duas décadas, caracterizar o laboratório de andrologia atual, avaliar o impacto da incorporação da garantia da qualidade e a inclusão dos sistemas computadorizados (CASA). Foram utilizados dados das médias mensais do controle de qualidade interno (n= 22 528) e pesquisas a profissionais de laboratórios andrológicos e a médicos especialistas em fertilidade (n=33). A demanda geral diminuiu significativamente com o aumento das solicitações de primeira vez. O volume e a contagem de esperma, parâmetros dependentes de andrógenos, diminuíram ao longo dos anos. O critério morfológico rigoroso diminuiu a porcentagem de normais; metade dos médicos entrevistados recebeu resultados entre 0 e 10% e 40% considerou que isso comprometía o valor clínico do parâmetro. O sistema CASA, permitiu objetivar a cinética espermática e aumentar o percentual de progressões rápidas, mas poucos laboratórios o incorporaram. 66% dos médicos resolvem o fator andrológico grave por tratamentos clínicos e 95% utilizam técnicas de RA nesses casos. A análise do sêmen é realizada principalmente por bioquímicos especializados, com baixa aderência à automação e acreditação laboratorial, mas com participação em programas de avalação externa de qualidade. A demanda diminuiu como consequência do aumento do tratamento por RA. A diminuição em percentagem de formas normais compromete sua utilidade clínica.

Association between nutritional status of Filipino preschool children and participation in government programmes at the household and individual levels

@#Introduction: Health and nutrition interventions in developing countries have been linked to better thriving and survival of children. Identifying programmes with significant effect on the nutritional status of Filipino preschool children may aid in identifying impactful interventions in addressing malnutrition. This study evaluated the association between nutritional status of preschool children and government programme participation based on the 2018 Expanded National Nutrition Survey (ENNS) results. Methods: Secondary data analysis of 12,949 preschool children was performed from the 2018 ENNS. The selected data included socioeconomic, anthropometric, and self-reported household-level and individual-level government programme participation. Chi-square test for association and multiple logistic regression were conducted using Stata version 16. Results: Participation in immunisation programme, growth monitoring, household food production, and awareness and usage of iodised salt were negatively associated with at least one type of undernutrition. Consequently, participation in deworming programme was positively associated with both underweight and stunting. Regression analysis showed that preschool children who underwent growth monitoring were less likely to be stunted (OR=0.58), while those who underwent newborn screening were less likely to be underweight (OR=0.53) and stunted (OR=0.62). On the contrary, dewormed children were more likely to be stunted (OR=1.63) and those from 4Ps households were more likely to be wasted (OR=2.24). Conclusion: There is a need to re-evaluate programme strategies to maximise the benefits provided. Programmes showing significant associations with nutritional status including immunisation, growth monitoring, deworming, household food production, and awareness and usage of iodised salt should be continued and sustained with updated policies.

Desperdicio de alimentos en comedores escolares de una región de la zona centro sur de Chile: Percepciones de manipuladoras de alimentos del Programa de Alimentación Escolar

Introducción: Los desperdicios de alimentos en los comedores escolares son un problema que afecta al uso de recursos naturales, humanos y económicos. Objetivo: Identificar las opiniones y percepciones de manipuladoras de alimentos sobre factores relacionados al desperdicio de alimentos y posibles estrategias para disminuirlo en comedores escolares del Programa de Alimentación Escolar de la Junta Nacional de Auxilio Escolar y Becas en Chile. Métodos: Diseño cualitativo mediante técnica de grupos focales, con 33 participantes. Se aplicó un protocolo de investigación cualitativo que incluyó consentimiento informado, caracterización sociodemográfica, pauta de observación y guion con las dimensiones exploradas. Cada grupo contó con moderador experto y un observador. Se grabó y transcribió el audio de cada sesión y se analizó mediante ATLAS. Ti, versión 8. Resultados: Según las manipuladoras, los alimentos menos consumidos por los estudiantes son las legumbres, verduras frescas, productos marinos y algunas salsas. Estiman que el desperdicio de alimentos oscila entre los 25 a 100 Kilos al día. Las mujeres identifican factores claves en el rechazo de los alimentos por parte de los escolares; estética, olor y sabor del plato; repetitividad del menú; y aspectos culturales. Como estrategias para reducir el desperdicio proponen variar el menú, incorporar alimentos conocidos por los escolares, educar a los padres en la importancia de ofrecer alimentos y preparaciones saludables y sostenibles; fomentar la participación de toda la comunidad educativa en el proceso alimentario. Conclusiones: El estudio reveló que el desperdicio de alimentos en los comedores escolares es un problema complejo que requiere una intervención multidimensional que involucre a todos los actores del sistema alimentario escolar.

Introduction: Food waste in school canteens is a problem that affects the use of natural, human and economic resources. Objective: Identify the opinions and perceptions of food handlers about food waste factors and possible strategies to reduce them in school canteens of the School Feeding Programme of the Junta Nacional de Auxilio Escolar y Becas in Chile. Methods: Qualitative design using a focus group technique with 33 participants. A qualitative research protocol that included informed consent, sociodemographic characterisation, observation guidelines, and a script with the dimensions explored was applied. Each group had an expert moderator and an observer. The audio of each session was recorded, transcribed, and analysed using ATLAS. Ti, version 8. Results: According to the handlers, the foods least consumed by the students are legumes, fresh vegetables, seafood, and some sauces. They estimate that food waste ranges from 25 to 100 kg per day. Women identify critical factors in the rejection of food by schoolchildren: aesthetics, smell, and taste of the dish; repetitiveness of the menu; and cultural aspects. As strategies to reduce waste, they propose varying the menu, incorporating foods familiar to schoolchildren, educating parents about the importance of offering healthy and sustainable food and preparations, and encouraging the participation of the entire educational community in the food process. Conclusions: The study revealed that food waste in school canteens is a complex problem that requires a multidimensional intervention that involves all actors in the school food system.

A systematic review of the effects of nutrition programmes in high schools

Introduction/Objectives: Obesity rates are reaching alarming levels. Adolescence is a critical period for the prevention of nutritional problems, as it is a time of development of one's own eating habits. These habits will persist into adulthood, so showing adolescents healthy lifestyle patterns is important. The ideal option would be through school-based nutrition intervention programmes. The main objective of this article is to investigate the effectiveness of intervention programmes based on nutritional knowledge and the behaviour of adolescents aged 11-19 years. Method: To carry out this systematic review we employed Scopus, PubMed, and Web of Science as databases and a search period that spanned the last 10 years, following the PRISMA statement. Subsequent to the search, 110 articles were found. Finally, 19 articles were selected for in-depth analysis after a thorough screening. Results: The results show that, in general, intervention programmers have improved the nutritional knowledge of high school students, which means an improvement in their eating behaviours. In addition, these programmes increase their levels of physical activity. However, gender differences are observed, with girls being more concerned about maintaining a balanced diet. Conclusion: In conclusion, schools are an ideal environment for developing programmes that interfere in adolescent eating behaviour.

Introducción/Objetivos: Las tasas de obesidad están alcanzando niveles alarmantes. La adolescencia es un periodo crítico para la prevención de problemas nutricionales, ya que es un momento de desarrollo de los propios hábitos alimentarios. Estos hábitos permanecerán en la edad adulta, por lo que es importante mostrarles a los adolescentes patrones de estilo de vida saludable. La opción ideal sería a través de programas de intervención nutricional en las escuelas. El objetivo principal de este artículo es investigar la efectividad de los programas de intervención basados en el conocimiento y comportamiento nutricional en adolescentes de 11 a 19 años. Métodos: Para llevar a cabo esta revisión sistemática utilizamos como bases de datos Scopus, PubMed y Web of Science y un periodo de búsqueda que abarcó los últimos diez años, siguiendo la declaración Prisma. Después de la búsqueda, se encontraron 110 artículos. Finalmente, 19 artículos fueron seleccionados para un análisis en profundidad después de una revisión exhaustiva. Resultados: Los resultados muestran que, en general, los programas de intervención han mejorado los conocimientos nutricionales de los estudiantes de secundaria, lo que significa una mejora en sus conductas alimentarias. Además, estos programas aumentan sus niveles de actividad física. Sin embargo, se observan diferencias de género, estando las chicas más preocupadas por mantener una dieta equilibrada. Conclusiones: En conclusión, las escuelas son un ambiente ideal para el desarrollo de programas que interfieren en la conducta alimentaria de los adolescentes.

Disposición hacia la colaboración médica internacional en estudiantes de Estomatología de ocho universidades cubanas / Willingness towards international medical collaboration in dental students from eight Cuban universities

Introducción: Cuba se ha caracterizado por enviar a diversos países delegaciones de salud, llamadas "misiones médicas". Sin embargo, el interés de los futuros profesionales de formar parte de esas delegaciones no se ha investigado. Objetivos: Caracterizar la disposición hacia la colaboración médica internacional e identificar los factores asociados en estudiantes cubanos de Estomatología. Métodos: Se realizó una investigación transversal, analítica de datos secundarios, en estudiantes de todos los años del curso académico 2018-2019, pertenecientes a ocho universidades. La variable dependiente fue el reporte de la disposición de ir a misiones médicas. Se calcularon las razones de prevalencia e intervalos de confianza al 95 por ciento. Resultados: Participaron 1174 estudiantes, de los cuales 830 (71 por ciento) estuvieron dispuestos a cumplir misiones médicas. Existió una mayor disposición hacia la colaboración médica conforme aumentaba la edad (RPa: 1,02; IC 95 por ciento: 1,00-1,04; p = 0,044); así como, en los estudiantes que reportaron presión familiar para estudiar la carrera (RPa: 1,17; IC 95 por ciento: 1,09-1,26; p < 0,001). Aquellos que reportaron buenas notas antes de ingresar a la universidad (RPa: 0,83; IC 95 por ciento: 0,77-0,91; p < 0,001), los de solvencia económica (RPa: 0,90; IC 95 por ciento: 0,90-0,98; p = 0,019) y los que estaban cursando el tercer y cuarto años académicos (RPa: 0,93; IC 95 por ciento: 0,88-0,97; p = 0,003) fueron los de menor disposición para colaborar; ajustado por el sexo y la universidad. Conclusión: Existe una elevada disposición hacia la colaboración médica internacional y está asociada a múltiples aspectos sociales y educativos(AU)

Introduction: Cuba has been characterized by sending health delegations to various countries, called "medical missions". However, the interest of future professionals in joining those delegations has not been investigated. Objectives: Characterize the disposition towards international medical collaboration and identify the associated factors in Cuban students of Stomatology. Methods: A cross-sectional research and secondary data analytics was carried out in students of all years of the academic year 2018-2019, belonging to eight universities. The dependent variable was the report of the willingness to go on medical missions. Prevalence ratios and 95 percent confidence intervals were calculated. Results: 1174 students participated, of which 830 (71 percent) were willing to fulfill medical missions. There was a greater willingness towards medical collaboration as age increased (RPa: 1.02; 95 percent CI 1.00-1.04; p = 0.044); as well as, in students who reported family pressure to study the career (RPa: 1.17; 95 percent CI 1.09-1.26; p < 0.001). Those who reported good grades before entering college (RPa: 0.83; 95 percent CI 0.77-0.91; p < 0.001), those of economic solvency (RPa: 0.90; 95 percent CI 0.90-0.98; p = 0.019) and those who were in the third and fourth academic years (RPa: 0.93; 95 percent CI 0.88-0.97; p = 0.003) were those with the least willingness to collaborate; adjusted by sex and college. Conclusion: There is a high disposition towards international medical collaboration and it is associated with multiple social and educational aspects(AU)

Secondary trauma amongst administrative support staff working with traumatic incident dockets within the South African Police Service in Johannesburg, South Africa

Background: Secondary trauma is trauma experienced by those in close contact with the victims of trauma. Research shows that some individuals exposed to photographs or video presentations of traumatic events may experience secondary trauma. This includes administrative staff within the South African Police Service (SAPS), who work with trauma dockets. Objectives: We explored the effects of secondary trauma on administrative support staff within the SAPS, their access to psychological support in the SAPS, and their use of the employee health and wellness (EHW) services in the SAPS. Methods: An exploratory qualitative study was conducted among administrative support staff from one of the four Johannesburg clusters of the SAPS. In-depth interviews took place with seven staff members. The data were analysed using Atlas.ti. Results: Administrative support staff are exposed to trauma through incident dockets, victim statements, and gruesome images. The study participants indicated that they experienced trauma daily, and symptoms of trauma such as flashbacks, anxiety, sadness, nightmares, paranoia, avoidance, recurrent thoughts, and fear of death. They were overprotective of their loved ones and paranoid. They were not utilising the EHW services due to lack of access to appropriate services, or the stigma attached to seeking help from mental health professionals. Conclusion: The SAPS needs to develop and implement a strategy to mitigate the impact of secondary trauma on its personnel, which include administrative support staff. Evidence-based interventions, such as resilience training, should be considered as part of the strategy

Self-Help Groups : An Effective Approach To Women Empowerment In India

The concept of Self-Help Group has its roots in rural areas and it has been mooted along the rural semi-urban women to improve their living conditions. Today Self-Help Groups (SHGs) play a major role in poverty alleviation in rural areas. In India, this scheme was implemented with the help of NABARD as a main nodal agency in rural development. It is a self employment generation scheme especially for rural women, who do not have their own assets. The word 'Empowerment' means giving power. According to the International Encyclopaedia (1999), power means having the capacity and the means to direct one's life towards desired social, political and economic goals or status. Empowerment of women is not just a goal in itself, it is a key to all global development. Empowerment is an active multi-dimensional process to enable women to realize their identity and power in all spheres of life. This paper examines the women empowerment through SHGs and also explains the current position of women empowerment in India

Management results of a cohort of rheumatoid arthritis patients in a specialized comprehensive healthcare institution in Colombia / Resultados de gestión en una cohorte de pacientes con artritis reumatoide en una institución de atención integral especializada en Colombia

ABSTRACT Objective: To determine the management results in a cohort of patients with rheumatoid arthritis in a specialized integral healthcare institution for this disease in Colombia. Materials and methods: Descriptive cross-sectional study based on a cohort of rheumatoid arthritis patients according to ACR/EULAR 2010 criteria. The information was analysed based on consolidated data from clinical records and national reports in the period 2015-2018. Administrative records related to medication authorizations and prescriptions were considered. Sociodemographic variables, outcome indicators related to disease activity status and medication use percentage were evaluated. Results: As of June 30th 2018, 698 patients were identified, of which the female sex represented 83.8%, the general average age was 55.47 years, and the highest number of cases were in the 60-64 year age group. Of the patients, 68.3% were between remission and low disease activity. Seventy-three point one percent were managed with conventional disease-modifying antirheumatic drugs and a reduction in the use of biological therapy was recorded from 27.2% in 2016 to 17.8% at the end of the period. Conclusions: This study presents the management results of a comprehensive care model for patients with rheumatoid arthritis in Colombia, which managed to maintain the highest proportion of patients in low activity and remission as they had a longer follow-up time, to decrease the percentage of biological DMARDs use, and establish conventional DMARDs as the main therapeutic alternative.

RESUMEN Objetivo: Conocer los resultados de gestión en una cohorte de pacientes con artritis reumatoide en una institución de atención integral especializada en esta enfermedad en Colombia. Materiales y métodos: Estudio descriptivo de corte transversal, a partir de una cohorte de pacientes de artritis reumatoide, según criterios ACR/EULAR 2010. La información se analizó con base en los datos consolidados de historia clínica y reportes nacionales en el periodo 2015-2018. Se tuvieron en cuenta los registros administrativos relacionados con autorizaciones y prescripciones de medicamentos. Se evaluaron variables sociodemográficas, indicadores de resultado relacionados con el estado de actividad de la enfermedad y porcentaje de uso de medicamentos. Resultados: A 30 de junio de 2018, se identificaron 698 pacientes, de los cuales el 83,8% correspondió a sexo femenino; el promedio general de edad fue de 55,47 años y el grupo de edad de 60 a 64 años concentró el mayor número de casos. El 68,3% se ubicó entre remisión y actividad baja de la enfermedad. El 73,1% se encontró manejado con fármacos antirreumáticos modificadores de enfermedad convencionales y se registró una reducción de uso de terapia biológica desde el 27,2% en 2016 al 17,8% al final del periodo. Conclusiones: Este estudio presenta los resultados de gestión de un modelo de atención integral para pacientes con artritis reumatoide en Colombia, que logró mantener la mayor proporción de pacientes en actividad baja y remisión a medida que estos contaban con mayor tiempo de seguimiento, también logró disminuir el porcentaje de uso de FARME biológicos y establecer los FARME convencionales como la principal alternativa terapéutica.

Representaciones sociales sobre el Programa Mais Médicos entre consejeros municipales de salud de Brasil / Social representations on Mais Médicos Program among municipal health councelors of Brazil

Introducción: La atención primaria de salud en Brasil se considera una prioridad. En el año 2013 se creó el Programa Mais Médicos, de formación en servicio y de ampliación de la cantidad de médicos en el país. La cooperación cubana, gestionada por la Organización Panamericana de la Salud fue quien envió la mayor cantidad de profesionales. Objetivo: Analizar las representaciones sociales de los consejeros de salud sobre el Programa Mais Médicos, en municipios en los que prestaron atención a su población médicos provenientes de Cuba. Métodos: Estudio de caso descriptivo de corte transversal abordado con metodología cualitativa. La muestra fue intencional. Se trabajó con 58 entrevistas semiestructuradas y el análisis fue realizado mediante el software gratuito Iramuteq con la técnica de análisis lexical. Resultados: Se pudo distinguir cuatro grupos de representaciones, sobre el funcionamiento de los consejos municipales de salud, sobre las representaciones del Programa Mais Médicos, sobre las redes de atención y sobre los médicos brasileños y cubanos. El estudio aporta evidencias de la aplicación de un nuevo modelo de atención para los consejeros que objetivaron y anclaron en el concepto de nacionalidad. El modelo cubano incorpora características de humanismo, atributos que no estaban contenidos en las representaciones sobre los médicos locales. Conclusiones: Las representaciones sociales sobre el Programa Mais Médicos aluden a una acción que mejora la calidad de los servicios, no obstante, la literatura sobre atención básica aún deja ver algunos problemas de acceso y tránsito por la red del sistema único de salud(AU)

Introduction: Primary health care in Brazil is considered a priority. In 2013, Mais Médicos Program was created, providing in-service training and expanding the number of doctors in the country. Cuban cooperation, managed by the Pan American Health Organization, sent the largest number of professionals. Objective: Analyze the social representations of health counselors on Mais Médicos Program, in municipalities in which doctors from Cuba cared to their population. Methods: Descriptive cross-sectional case study approached with qualitative methodology. The sample was intentional. It was conducted a work with 58 semi-structured interviews and the analysis was carried out using the free software Iramuteq with the lexical analysis technique. Results: Four groups of representations could be distinguished: on the functioning of the municipal health councils, on the representations of Mais Médicos Program, on the care networks and on Brazilian and Cuban doctors. The study brings evidence of the application of a new model of care for counselors who objectified and anchored in the concept of nationality. The Cuban model incorporates characteristics of humanism, attributes that were not contained in the representations about local doctors. Conclusions: The social representations on Mais Médicos Program allude to an action that improves the quality of services, however, the literature on basic care still shows some problems of access and transit through the network of the health system(AU)

Knowledge, attitude, and behaviour towards nutrition radio programmes in mothers of children under five years with severe acute malnutrition in Northern Nigeria

@#Introduction: Although the mass media are increasingly becoming a platform for disseminating health messages to promote attitude and behavioural changes, little is known about how radio programmes influence safe child feeding practices among mothers of infants and children. Consequently, this study examined the knowledge, attitude and behaviour towards food and nutrition radio programmes in mothers of children under five years with severe acute malnutrition in Northern Nigeria. Methods: This study employed a survey research design using data derived from a structured questionnaire undertaken with mothers (N=402) of children suffering from severe acute malnutrition (SAM) and who have been listening to radio programmes on tackling malnutrition within six months to the time of the fieldwork. Results: Findings revealed that while mothers appeared to have a higher comprehension of child feeding programmes on the radio, their attitude and actual uptake of the messages were not encouraging. Furthermore, being young, having few children, having a primary education, and frequent listening to SAM-related messages on the radio were associated with mothers’ positive knowledge, attitude and actual uptake of the messages disseminated. Conclusion: The findings provided a link between demographic characteristics of mothers and how they comprehend, believe and act on the messages they received from these radio programmes. It is therefore argued that the understanding of this link might inform the focus of future intervention aimed at promoting best child feeding practices in Northern Nigeria.