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.

Development of programmes and curriculum of physical therapy at undergraduate level using ICF and rehabilitation competency framework / 中国康复理论与实践

@#Objective To develop programmes and curriculum of physical therapy competency for undergraduate education for the training of competent physical therapy.Methods Using World Health Organization Rehabilitation Competency Framework (RCF) and International Classification of Functioning, Disability and Health (ICF) as framework, a discipline of physical therapy, and programmes and curriculum for undergraduate education were developed.Results The basic concepts of rehabilitation and disability, laws, regulations and ethics and physical therapy of functioning and disability were explored within RCF. The contents, core values and beliefs of physical therapy competencies were developed using RCF. Results -oriented and backward strategy was used to develop programmes and curriculum of undergraduate education in physical therapy based on competency. Conclusion The theory of ICF and RCF is important for developing programmes and curriculum of physical therapy competency. Based on RCF, the physical therapy competency domain, principles, strategies and educational framework for undergraduate education in physical therapy are constructed, helping for developing competency-based undergraduate education standards for physical therapy and professional competency standards in China.

Noise exposure abatement: a perspective from industry occupational health risk assessment reports

Background: Occupational health risk assessments are building blocks for occupational health programmes, allowing for the rating of identified risks and the continuous re-evaluation of the effectiveness of abatement measures. In South African industry, occupational health risk assessments are formally documented in reports, which can be presented as demonstration of legal compliance with legislation. Objective: To identify noise abatement measures recorded in noise risk assessment reports of four manufacturing companies and to rate their effectiveness. Methods: We analysed the occupational health risk assessment reports from 21 operational facilities in four South African companies from the manufacturing and utilities sectors to evaluate, through document analysis, the recorded noise abatement measures. Noise abatement measure effectiveness was rated using a preassigned effectiveness percentage scale. Results: Administrative controls and hearing protection devices were the most commonly used noise exposure abatement measures, but hearing conservation programmes were generally poorly formulated. There were inter- and intra-company differences in the qualitative risk assessment approaches used for rating or ranking the noise risk, which led to different risk conclusions and prioritisation outcomes. The calculated control effectiveness of the abatement measures showed that noise exposure remained largely unacceptable: 16 of the 21 operational units had unacceptable noise exposures, four had tolerable exposures, and one had broadly acceptable exposures. Conclusion: The four companies' common noise abatement measures, as elements of formalised hearing conservation programmes, which included administrative controls and hearing protection devices, were not effective in reducing noise exposure to the broadly acceptable level, reflective of limited use of engineering controls.

Programa Bolsa Família e saneamento: uma revisão sistemática dos efeitos na diarreia e na desnutrição / Bolsa Família Program and environmental health: a systematic review of the effects on diarrhea and malnutrition

Resumo O Programa Bolsa Família e intervenções em saneamento são políticas públicas que podem ter efeito combinado positivo no enfrentamento das iniquidades em saúde. O Programa Bolsa Família busca propiciar melhoria das condições de saúde, diminuição da insegurança alimentar e aumento da renda familiar. Intervenções em saneamento objetivam garantir a saúde pública e a proteção do meio ambiente. O estudo objetivou revisar a literatura, procurando indícios de interações entre estas duas intervenções, influenciando nos desfechos morbidade e mortalidade por diarreia e desnutrição em menores de cinco anos. Foi realizada busca nas bases LILACS, SciELO e PubMed e a metodologia dos artigos foi avaliada por meio de escores da escala de Downs & Black adaptada. Foram identificados 1.658 artigos, dos quais quatro apresentaram todos os critérios para inclusão no estudo. Os estudos selecionados mostraram evidências do efeito positivo do Programa Bolsa Família e de intervenções em saneamento relacionados aos desfechos de interesse, quando analisados de forma independente um do outro. No entanto, nenhum artigo apresentou resultados que pudessem esclarecer o efeito conjunto destas políticas públicas em um modelo de interação, revelando lacuna na literatura nestas doenças particularmente atribuíveis à pobreza.

Abstract The Bolsa Família Programme and environmental health interventions are public policies that can have a combined positive effect on health inequities. The Bolsa Família Programme is designed to improve health conditions, reduce food insecurity and increase family incomes. Environmental health interventions aim to ensure public health and environmental protection. This study reviewed the literature for possible interactions between these two types of intervention that influence morbidity and mortality outcomes due to diarrhoea and malnutrition in the under-fives. A total of 1,658 articles were identified in the LILACS, SciELO and PubMed databases. The studies' methodologies were evaluated by scores on an adapted Downs & Black scale and four met all the study inclusion criteria. The findings showed evidence of the positive independent effects of the Bolsa Família Programme and of environmental health interventions in reducing illness and death from diarrhoea and malnutrition in the study age group. However, none of the articles offered results that might elucidate a joint effect of these public policies on an interaction model, revealing a gap in the literature on these diseases attributable particularly to poverty.

Factores de no adherencia al Programa de atención integral de salud para adolescentes, Santa Ana, El Salvador / Factors of non-adherence to the Comprehensive Health Care Program for Adolescents, Santa Ana, El Salvador

Introducción: La adolescencia se considera una etapa fundamental para el desarrollo del sujeto. Desde el 2015 en El Salvador se instauró un programa de atención integral para el adolescente. Objetivo: Caracterizar los principales factores asociados a la no adherencia al Programa de atención integral de salud para adolescente de 11 a 15 años, del municipio Santa Ana del El Salvador. Métodos: Estudio descriptivo transversal en el primer nivel de atención del municipio de Santa Ana, entre enero y marzo de 2018. Se aplicó un instrumento confeccionado por los autores. La muestra fue de 247 adolescentes que recibieron control e inscripción. Resultados: La mayoría de los adolescentes eran del sexo femenino, el 65,2 por ciento residían en el área rural, el 96 por ciento estudiaba, solo el 32,8 por ciento conocía el programa y de estos lo utilizaban el 48,1 por ciento (15,8 por ciento del total de entrevistados), la vía por la que lo conoció fue el promotor de salud (63 por ciento). Los principales factores relacionados con el no conocimiento del programa fueron; residir en el área urbana, nivel de estudios secundarios, ser estudiante, vivir cerca del centro de salud y no tener promotor de salud. Solo el trabajar resultó significativo (razón de prevalencia 1,71 IC 95 por ciento 1,17-2,51) para no ser adherente. Conclusiones: A pesar de los esfuerzos del Estado, los servicios de salud para adolescente deben ser reorientados de acuerdo con los principios y lineamientos de los documentos regulatorios y el marco legal del país, enfatizando en acciones de promoción de la demanda temprana y prestación de servicios de atención integral(AU)

Introduction: Adolescence is considered a fundamental stage for the development of the individual. Since 2015, a comprehensive health care program for adolescents has been established in El Salvador. Objective: Characterize the main factors associated with non-adherence to the Comprehensive Health Care Program for adolescents aging 11 to 15 years, from Santa Ana municipality, El Salvador. Methods: Cross-sectional descriptive study at the first level of care of Santa Ana municipality, from January to March 2018. An instrument made by the authors was applied. The sample was of 247 adolescents who were controlled and registered. Results: Most adolescents were females, 65.2 percent lived in rural areas, 96 percent were studying, only 32.8 percent knew about the programme and it was being used by 48.1 percent (15.8 percent of all interviewees), and the way they knew about it was by the health promoter (63 percent). The main factors related to not knowing on the program were: living in the urban area, junior high school level, being a student, living near the health center and not having health promoter. Only work was significant (prevalence rate 1.71 CI 95 percent 1.17-2.51) for not being adherent. Conclusions: Despite the efforts of the State, health services for adolescents should be redirected in accordance with the principles and guidelines of the country's regulatory documents and legal framework, emphasizing in actions to promote early demand and provide comprehensive care services(AU)

The acceptability of weekly iron-folic acid supplementation and its influencing factors among adolescent school girls in Yogyakarta city: a mixmethods study

@#Introduction: Indonesia has initiated the weekly iron-folic acid supplementation programme (WIFS) among adolescent school girls since 2016. However, its acceptability needs to be investigated. This study aimed to assess the acceptability of WIFS and its influencing factors. Methods: A mixed-methods study was conducted in six schools in Yogyakarta from January-April 2018. Totally, 211 participants aged 12-18 years were involved in the cross-sectional survey, followed by four focus group discussions (FGDs) and in-depth interviews (IDIs). Body mass index-for-age, haemoglobin, serum ferritin, habitual intake, and acceptability (defined as selfreported iron folic acid tablet consumption) were assessed. Results: This study reported that 22.3% and 12.4% of the participants were categorised as iron deficient and anaemic, respectively. Almost 90% of participants had received the tablet, but only 62.0% of them reported consuming it. Logistic regression test indicated that the participants were more likely to take the tablet if it tasted good [OR (95%CI): 4.66 (1.90-11.43)]. Meanwhile, motivation for tablet consumption declined when respondents perceived the odour of tablet was unpleasant, reported forgetfulness, lacked peer support, and experienced side effects, with OR (95%CI) of 0.23 (0.07- 0.77), 0.35 (0.13-0.95), 0.30 (0.08-0.58), and 0.04 (0.04-0.39), respectively. The results from FGD and IDIs strengthened the findings that the experience of nausea, organoleptic properties of iron-folic acid tablet, forgetfulness, and mother’s support play important roles in students’ acceptability. Conclusion: This study found moderate acceptability towards the WIFS programme. The inhibiting and reinforcing factors of WIFS acceptability in this study could be considered as inputs for programme improvements in the future.

Uma história do Sistema Único de Assistência Social (SUAS), a participação do psicólogo e possibilidades de atuação / A history of the Unified Social Assistance System (SUAS), the participation of the psychologist and possibilities of performance / Una historia del Sistema Unificado de Asistencia Social (SUAS), la participación del psicólogo y las posibilidades para actuar / Historique du Système d'Assistance Sociale Unifié (SUAS), participation du psychologue et possibilités d'action

Será feita uma contextualização histórica do Sistema Único de Assistência Social (SUAS), explorando as aproximações com o Sistema Único de Saúde (SUS), considerando as origens, semelhanças nos seus princípios e diretrizes, assim como as particularidades de cada política. Busca-se compreender a importância da inserção do Psicólogo no SUAS e identificar as potências da atuação desse profissional na proteção social básica, no Centro de referência de Assistência Social (CRAS). Por fim, é explorada a possibilidade de atuação que tem como base o Cuidado, tomando como referência as tecnologias desenvolvidas por Ayres: acolhimento, vínculo, responsabilização e a possibilidade de (re)construção da identidade a partir da proposta de promoção da autonomia.

A historical contextualization of the Unified Social Assistance System (SUAS) will be presented by exploring the approaches with the Unified Health System (SUS). In doing so, its origins, similarities in its principles and in the main guidelines will be considered as well as the particularities of each policy. The article seeks to comprehend the importance of the Psychologist in the SUAS context, and to identify the potentiality of this professional in basic social protection at the Reference Center for Social Assistance (CRAS). Finally, the study explores the possibility of action based on Care, taking as a reference the technologies developed by Ayres: reception, bonding, accountability, and the possibility of (re)construction of identity based on the proposal to promote autonomy.

Se presentará una contextualización histórica del Sistema Unificado de Asistencia Social (SUAS), que explorará los enfoques dentro del Sistema Único de Salud (SUS), considerando sus orígenes, las similitudes en sus principios y las principales directrices, así como las particularidades de cada política. También se enfoca en comprender la importancia del psicólogo en el contexto SUAS e identificar la efectividad de este profesional en la protección social básica, en el Centro de referencia para asistencia social (CRAS). Finalmente, el estudio explora la posibilidad de acción basada en el cuidado, tomando como referencia las tecnologías desarrolladas por Ayres: recepción, vinculación, responsabilidad y la posibilidad de (re) construcción de identidad basada en la propuesta para promover la autonomía.

Une contextualisation historique du système unifié d'assistance sociale (SUAS) sera présentée, explorant les approches au sein du système de santé unifié (SUS), en tenant compte de ses origines, des similitudes dans ses principes et les principales lignes directrices, ainsi que des particularités de chaque politique. Il s'attache également à comprendre l'importance du psychologue dans le contexte SUAS et à identifier l'efficacité de ce professionnel en protection sociale de base, dans le Centre de référence pour l'assistance sociale (CRAS). Enfin, l'étude explore la possibilité d'action basée sur Care, en prenant comme référence les technologies développées par Ayres: accueil, lien, responsabilité et possibilité de (re) construction d'identité sur la base de la proposition de promotion de l'autonomie.

La dimensión curricular como componente del conocimiento didáctico del contenido / The curricular dimension as a component of the didactic knowledge of the content / Les programmes scolaires en tant que composantes de la connaissance didactique du contenu / A dimensão curricular como componente do conhecimento didático do conteúdo

Resumen Se describe un estudio de caso centrado en el currículo de una profesora de física de bachillerato durante dos años consecutivos sobre la enseñanza del campo eléctrico, abordado desde tres niveles: declarativo, diseño y acción. La caracterización del conocimiento curricular se realiza bajo la perspectiva del conocimiento didáctico del contenido (CDC), utilizando como técnica el análisis del contenido. Los resultados muestran una alta tendencia tradicional en cada uno de los niveles considerados. Después de la intervención, el nivel de diseño es el que presenta los mayores cambios, notándose un incremento considerable en la tendencia intermedia. Estos resultados muestran la importancia del diseño curricular en los procesos de concreción del CDC.

Abstract We describe a case study focused on the knowledge of the curriculum of a high school physics teacher, two consecutive years on electric field teaching. We used three levels to characterize the knowledge of the curriculum: declarative, design and action. The characterization of the knowledge of the curriculum was doing from pedagogical content knowledge (PCK), through the content analysis as a technique. The results show a high traditional tendency in each of the levels considered. After the intervention, the level of design represents the biggest changes, where intermediate trend increases. These results show the importance of curriculum design of education, in the process of realization of the PCK.

Résumé Cet article décrit une étude de cas au long de deux années concernant le programme d'études sur l'enseignement du champ électrique d'une professeure de physique du secondaire, abordé selon trois niveaux: déclaratif, de la planification et de l'action. La caractérisation des connaissances des programmes se place dans la perspective de la connaissance didactique du contenu (CDC) s'appuyant sur la technique de l'analyse de contenu. Les résultats indiquent une forte tendance traditionnelle à tous les niveaux considérés. Après l'intervention, le niveau de la planification a été celui qui a présenté les plus grands changements, avec une augmentation considérable de la tendance intermédiaire. Ces résultats montrent l'importance de l'esquisse des programmes scolaires dans les processus de mise en œuvre du CDC.

Resumo Descreve-se um estudo de caso centrado no currículo de uma professora de física do ensino médio durante dois anos consecutivos sobre o ensino do campo elétrico, abordado a partir de três níveis: declarativo, planejamento e ação. A caracterização do conhecimento curricular é realizada da perspectiva do conhecimento didático do conteúdo (CDC), utilizando como técnica a análise do conteúdo. Os resultados mostram uma alta tendência tradicional em cada um dos níveis considerados. Depois da intervenção, o nível de planejamento apresenta as maiores mudanças, notando-se um aumento considerável na tendência intermediária. Esses resultados mostram a importância do desenho curricular nos processos de concretização do CDC.

A review of national plans of action for nutrition in Southeast Asian countries

@#This review describes national plans of action for nutrition (NPANs) in six Southeast Asia countries (Indonesia, Malaysia, Myanmar, Philippines, Thailand and Vietnam) in order to provide an understanding of the approach and framework undertaken by these countries in the formulation and implementation of NPANs, as well as the similarities and differences in various NPAN components. The six countries recognised the persistent undernutrition and escalating rates of obesity and other diet-related chronic diseases as the key drivers for nutrition action plan implementation. The prioritisation of nutrition interventions outlined in these NPANs are based on respective country context and needs. Although differing in strategies and targets set, these countries show similarities in several components including objectives, stakeholder involvement, nutritional issues to be addressed, implementation, monitoring and evaluation mechanism, programme/ activities identified and challenges in implementing NPANs. Countries have recognised that effective implementation, monitoring and evaluation are essential to successfully address both extremes of the challenging nutrition situation. Several important similarities in the NPANs studied suggest that closer collaboration among countries and stakeholders on NPANs would be beneficial. Opportunities should be created for periodic exchanges to enable sharing of experiences in the development and implementation of NPANs among the countries. Recommendations and conclusions drawn from this review could serve as useful reference for nutrition policy and planning in the future.

Mulheres e avaliação das desigualdades na distribuição de fatores de risco de doenças crônicas, Vigitel 2016-2017 / Women and evaluation of inequalities in the distribution of risk factors for Chronic non-communicable diseases (NCD), Vigitel 2016-2017

RESUMO: Objetivo: Comparar a distribuição de indicadores de doenças crônicas não transmissíveis (DCNT) entre mulheres adultas beneficiárias e não beneficiárias do Programa Bolsa Família (PBF) nas capitais brasileiras. Métodos: Análise de dados do Sistema de Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico (Vigitel) em 2016 e 2017. Foram estimados as razões de prevalência (RP) brutas e ajustadas e seus respectivos intervalos de confiança usando o modelo de regressão de Poisson. Resultados: Mulheres do PBF tem menor escolaridade, são mais jovens e vivem com maior frequência nas regiões Nordeste e Norte do país. Prevalências mais elevadas de fatores de risco foram encontradas nas mulheres beneficiárias do PBF. A RP ajustada por idade das mulheres com BF foram: fumantes (RP = 1,98), excesso de peso (RP = 1,21), obesidade (RP = 1,63), frutas e hortaliças (RP = 0,63), consumo de refrigerantes (RP = 1,68), consumo de feijão (RP = 1,25), prática de atividade física no lazer (RP = 0,65), atividade física no domicílio (RP = 1,35), tempo assistindo à TV (RP = 1,37), autoavaliação do estado de saúde ruim (RP = 2,04), mamografia (RP = 0,86), Papanicolau (RP = 0,91), hipertensão (RP = 1,46) e diabetes (RP = 1,66). Quando comparadas as mulheres entre estratos de mesma escolaridade, as diferenças entre os fatores de risco foram reduzidas. Conclusão: Piores indicadores entre mulheres que recebem BF refletem desigualdades sociais inerentes a esse grupo mais vulnerável. O estudo evidencia também que o PBF está sendo destinado às mulheres mais vulneráveis.

ABSTRACT: Objective: To compare the distribution of chronic non-communicable diseases (CNCD) indicators among adult female beneficiaries and non-beneficiaries of the Bolsa Família Program (BFP) in Brazilian capitals. Methods: Analysis of Vigitel telephone survey data in 2016 and 2017. Gross and adjusted prevalence ratios (PR) and their respective confidence intervals were estimated using Poisson Regression model. Results: Women with BF have lower schooling, are young people, live more frequently in the Northeast and North of the country. Higher prevalence of risk factors were found in woman receiving BF. The adjusted PR of the BF women were: smokers (PR = 1.98), overweight (PR = 1.21), obesity (PR = 1.63), fruits and vegetables (PR = 0.63), consumption of soft drinks (PR = 1.68), bean consumption (PR = 1.25), physical activity at leisure (PR = 0.65), physical activity at home (PR = 1.35), time watching TV (PR = 1.37), self-assessment of poor health status (PR =2.04), mammography (PR = 0.86), Pap smears (PR = 0.91), hypertension (PR = 1.46) and diabetes (PR = 1,66). When women were compared among strata of the same schooling, these differences were reduced. Conclusion: Worst indicators among women receiving BF reflect social inequalities inherent in this most vulnerable group. The study also shows that BF is being targeted at the most vulnerable women.

Educational projects with an international dimension for seniors and the higher education an the promotion of cultural heritage / Projetos educacionais com dimensão internacional para idosos no ensino superior na promoção do patrimônio cultural

Places that were and are scenario of our lives, are an intrinsic part of our identity, individual and collective. Both Cultural Heritage and Natural Heritage are constitutive elements of our way of life. The Senior University, the university program for older adults of the University of A Coruña, develops educational initiatives with an international dimension that promote knowledge of their own identity, but from a European and international perspective, through unique projects and initiatives that have the active participation of the students. This article will describe several experiences that, under the Erasmus + Program of the European Union, promote knowledge of Cultural Heritage among older adults in an international context.(AU)

Os lugares que foram e são o cenário de nossas vidas constituem uma parte intrínseca de nossa identidade, individual e coletiva. Tanto o patrimônio cultural quanto o patrimônio natural são elementos constitutivos de nosso modo de viver. A Universidade Sênior, programa universitário para idosos da Universidade da Corunha, desenvolve iniciativas educacionais de dimensão internacional que promovem o conhecimento da identidade de uma perspectiva europeia e internacional, por meio de projetos e iniciativas exclusivas que têm a participação ativa dos alunos. Este artigo expõe várias experiências que, no âmbito do programa Erasmus + da União Europeia, promovem o conhecimento do patrimônio cultural entre idosos em um contexto internacional.(AU)