Certification exams evaluated with serial case reports: theoretical and problematic approach.

The objective of this issue is a theoretical approach to the disadvantages involved in taking the certification exams of medical specializations through serial case reports and analyzing them with the Classical Test Theory (TCT). The certification exams of medical specializations correspond to criterial summative exams with high consequences. Therefore, it is imperative to maintain the highest quality standards in all the processes involved in preparing the exam. At present, it has been detected that some councils of medical specialties conduct the certification exams with tests that contain serial case reports and the psychometric analysis that they conduct is supported by the TCT; however, the structure of this type of test violates the fundamental assumptions of the TCT. The violation of the fundamental assumptions of the TCT in the tests constructed through serial case reports can lead to biases or misinterpretations of the results. Due to the above, it is advisable to use other psychometric models for the analysis of this type of test, or to avoid the use of serial case reports in the certification exams of medical specialties.

Se presenta un planteamiento teórico de las desventajas de realizar los exámenes de certificación de las especializaciones médicas mediante casos clínicos seriados y analizarlos con la Teoría Clásica del Test (TCT). Los exámenes de certificación de las especializaciones médicas corresponden a exámenes sumativos criteriales de altas consecuencias, por lo tanto, es imperativo mantener los máximos estándares de calidad en todos los procesos implicados en su elaboración. Actualmente, se ha detectado que algunos consejos de especialidades médicas realizan los exámenes de certificación con pruebas que incluyen casos clínicos seriados y que el análisis psicométrico está sustentado en la TCT; sin embargo, la estructura de este tipo de pruebas infringe los supuestos fundamentales de dicha teoría. La violación de los supuestos fundamentales de la TCT en las pruebas construidas mediante casos clínicos seriados puede conducir a sesgos o interpretación errónea de los resultados. Por lo anterior, es recomendable utilizar otros modelos psicométricos para el análisis de este tipo de pruebas, o evitar el uso de los casos clínicos seriados en los exámenes de certificación de las especialidades médicas.

Challenges of Congenital Heart Surgery in Brazil: It is Time to Designate Pediatric Congenital Heart Surgery Subspecialty.

Congenital heart disease (CHD) affects eight to ten out of every 1,000 births, resulting in approximately 23,057 new cases in Brazil in 2022. About one in four children with CHD requires surgery or other procedures in the first year of life, and it is expected that approximately 81% of these children with CHD will survive until at least 35 years of age. Professionals choosing to specialize in CHD surgery face numerous challenges, not only related to mastering surgical techniques and the complexity of the diseases but also to the lack of recognition by medical societies as a separate subspecialty. Furthermore, families face difficulties when access to services capable of providing treatment for these children. To address these challenges, it is essential to have specialized hospitals, qualified professionals, updated technologies, sustainable industry, appropriate financing, quality assessment systems, and knowledge generation. The path to excellence involves specialization across all involved parties. As we reflect on the importance of Pediatric Cardiovascular Surgery and Congenital Heart Diseases establishing themselves as a subspecialty of Cardiovascular Surgery, it is essential to look beyond our borders to countries like the United States of America and United Kingdom, where this evolution is already a reality. This autonomy has led to significant advancements in research, education, and patient care outcomes, establishing a care model. By following this path in Brazil, we not only align our practice with the highest international standards but also demonstrate our maturity and the ability to meet the specific needs of patients with CHD and those with acquired childhood heart disease.

Quantitative detection of cassava common mosaic virus for health certification of cassava (Manihot esculenta Crantz) germplasm using qPCR analysis.

Cassava (Manihot esculenta Crantz) is a crop of global economic and food safety importance, used for human consumption and in various industrial applications. The genebank of the Genetic Resources Program of the Alliance of Bioversity International and CIAT currently holds the world's largest cassava collection, with 5965 in vitro accessions from 28 countries. Managing this extensive collection involves indexing quarantine pathogens as a phytosanitary certification requirement for safely distributing cassava germplasm. The study therefore aimed to optimize a quantitative diagnostic protocol to detect cassava common mosaic virus (CsCMV) using quantitative PCR (qPCR) as a better alternative to other molecular techniques. This was done through designing primers and a probe in the RdRP region of CsCMV, and optimizing the qPCR conditions of the diagnostic protocol using primer concentration assays, and reaction amplification conditions such as volume and reaction time. We also evaluated the qPCR protocol by comparing the results of 140 cassava accession evaluations using three diagnostic methodologies (DAS-ELISA, end-point PCR, and qPCR) for CsCMV. Our protocol established that qPCR technique analysis is ten-times more sensitive in detecting CsCMV compared to end-point PCR, showing a maximum detection level of 77.97 copies/µL of plasmid, with 76 min of reaction time. The comparison allowed us to verify the level of CsCMV detection through the techniques evaluated, concluding that qPCR was more sensitive and allowed the quantification of viral concentration. The optimized qPCR protocol will be used to accelerate diagnostic screening of cassava germplasm for the presence or absence of CsCMV to ensure safe movement and distribution of disease-free germplasm.

Design and Development of Learning Management System Huemul for Teaching Fast Healthcare Interoperability Resource: Algorithm Development and Validation Study.

BACKGROUND: Interoperability between health information systems is a fundamental requirement to guarantee the continuity of health care for the population. The Fast Healthcare Interoperability Resource (FHIR) is the standard that enables the design and development of interoperable systems with broad adoption worldwide. However, FHIR training curriculums need an easily administered web-based self-learning platform with modules to create scenarios and questions that the learner answers. This paper proposes a system for teaching FHIR that automatically evaluates the answers, providing the learner with continuous feedback and progress. OBJECTIVE: We are designing and developing a learning management system for creating, applying, deploying, and automatically assessing FHIR web-based courses. METHODS: The system requirements for teaching FHIR were collected through interviews with experts involved in academic and professional FHIR activities (universities and health institutions). The interviews were semistructured, recording and documenting each meeting. In addition, we used an ad hoc instrument to register and analyze all the needs to elicit the requirements. Finally, the information obtained was triangulated with the available evidence. This analysis was carried out with Atlas-ti software. For design purposes, the requirements were divided into functional and nonfunctional. The functional requirements were (1) a test and question manager, (2) an application programming interface (API) to orchestrate components, (3) a test evaluator that automatically evaluates the responses, and (4) a client application for students. Security and usability are essential nonfunctional requirements to design functional and secure interfaces. The software development methodology was based on the traditional spiral model. The end users of the proposed system are (1) the system administrator for all technical aspects of the server, (2) the teacher designing the courses, and (3) the students interested in learning FHIR. RESULTS: The main result described in this work is Huemul, a learning management system for training on FHIR, which includes the following components: (1) Huemul Admin: a web application to create users, tests, and questions and define scores; (2) Huemul API: module for communication between different software components (FHIR server, client, and engine); (3) Huemul Engine: component for answers evaluation to identify differences and validate the content; and (4) Huemul Client: the web application for users to show the test and questions. Huemul was successfully implemented with 416 students associated with the 10 active courses on the platform. In addition, the teachers have created 60 tests and 695 questions. Overall, the 416 students who completed their courses rated Huemul highly. CONCLUSIONS: Huemul is the first platform that allows the creation of courses, tests, and questions that enable the automatic evaluation and feedback of FHIR operations. Huemul has been implemented in multiple FHIR teaching scenarios for health care professionals. Professionals trained on FHIR with Huemul are leading successful national and international initiatives.

Challenges of Congenital Heart Surgery in Brazil: It is Time to Designate Pediatric Congenital Heart Surgery Subspecialty

ABSTRACT Congenital heart disease (CHD) affects eight to ten out of every 1,000 births, resulting in approximately 23,057 new cases in Brazil in 2022. About one in four children with CHD requires surgery or other procedures in the first year of life, and it is expected that approximately 81% of these children with CHD will survive until at least 35 years of age. Professionals choosing to specialize in CHD surgery face numerous challenges, not only related to mastering surgical techniques and the complexity of the diseases but also to the lack of recognition by medical societies as a separate subspecialty. Furthermore, families face difficulties when access to services capable of providing treatment for these children. To address these challenges, it is essential to have specialized hospitals, qualified professionals, updated technologies, sustainable industry, appropriate financing, quality assessment systems, and knowledge generation. The path to excellence involves specialization across all involved parties. As we reflect on the importance of Pediatric Cardiovascular Surgery and Congenital Heart Diseases establishing themselves as a subspecialty of Cardiovascular Surgery, it is essential to look beyond our borders to countries like the United States of America and United Kingdom, where this evolution is already a reality. This autonomy has led to significant advancements in research, education, and patient care outcomes, establishing a care model. By following this path in Brazil, we not only align our practice with the highest international standards but also demonstrate our maturity and the ability to meet the specific needs of patients with CHD and those with acquired childhood heart disease.

Deforestation, certification, and transnational palm oil supply chains: Linking Guatemala to global consumer markets.

Although causal links between tropical deforestation and palm oil are well established, linking this land use change to where the palm oil is actually consumed remains a distinct challenge and research gap. Supply chains are notoriously difficult to track back to their origin (i.e., the 'first-mile'). This poses a conundrum for corporations and governments alike as they commit to deforestation-free sourcing and turn to instruments like certification to increase supply chain transparency and sustainability. The Roundtable on Sustainable Palm Oil (RSPO) offers the most influential certification system in the sector, but whether it actually reduces deforestation is still unclear. This study used remote sensing and spatial analysis to assess the deforestation (2009-2019) caused by oil palm plantation expansion in Guatemala, a major palm oil source for international consumer markets. Our results reveal that plantations are responsible for 28% of deforestation in the region and that more than 60% of these plantations encroach on Key Biodiversity Areas. RSPO-certified plantations, comprising 63% of the total cultivated area assessed, did not produce a statistically significant reduction in deforestation. Using trade statistics, the study linked this deforestation to the palm oil supply chains of three transnational conglomerates - Pepsico, Mondelez International, and Grupo Bimbo - all of whom rely on RSPO-certified supplies. Addressing this deforestation and supply chain sustainability challenge hinges on three measures: 1) reform of RSPO policies and practices; 2) robust corporate tracking of supply chains; and 3) strengthening forest governance in Guatemala. This study offers a replicable methodology for a wide-range of investigations that seek to understand the transnational linkages between environmental change (e.g. deforestation) and consumption.

In Vitro-Based Production of Virus-Tested Babaco (Vasconcellea x heilbornii, syn. Carica pentagona) in Ecuador: An Integrated Approach to an Endangered Crop.

Babaco (Vasconcellea x heilbornii), a fruit-bearing vegetatively propagated crop native to Ecuador, is appreciated for its distinctive flavor and nutritional properties. The aim of this research was to determine a functional protocol for tissue culture propagation of virus-free babaco plants including in vitro establishment, multiplication, rooting, and acclimation. First, symptomless babaco plants from a single commercial nursery were analyzed for virus detection and cared for using different disinfection treatments in the greenhouse to reduce contamination during the in vitro establishing step, and three cytokinins, 6-(γ,γ-Dimethylallylamino) purine (2IP), 6-Benzylaminopurine (BAP), and Thidiazuron (TDZ), were used to determine the best hormone for multiplication. The best treatment for plant disinfection was the weekly application of copper sulfate at the greenhouse and a laboratory disinfection using ethanol (EtOH) (70%), Clorox (2%), and a solution of povidone iodine (2.5%), with an 80% survival during in vitro plant establishment. TDZ showed a better multiplication rate when compared with other hormones, and 70% of the rooted plants were successfully acclimated at the greenhouse. Generated plants were virus-free when tested against babaco mosaic virus (BabMV) and papaya ringspot virus (PRSV), two of the most important viruses that can affect babaco. An efficient protocol to produce virus-free babaco plants was elaborated with an integrated use of viral diagnostic tools to ensure the production of healthy start material to farmers.

Distribution and characteristics of the certification of rheumatologists in Mexico.

OBJECTIVE: Describe the distribution of adult and pediatric rheumatologists with current certification in Mexico and the factors associated with this distribution. METHODS: The databases of the Mexican Council of Rheumatology and the Mexican College of Rheumatology for 2020 were reviewed. The rate of rheumatologists per 100,000 inhabitants by state of the Mexican Republic was calculated. To find out the number of inhabitants by state, the results of the 2020 population census of the National Institute of Statistics and Geography were consulted. The number of rheumatologists with current certification by state, age, and sex was analyzed. RESULTS: In Mexico, there are 1002 registered adult rheumatologists with a mean age of 48.12 ±â€¯13 years. The male gender prevailed with a ratio of 1.18:1. Ninety-four pediatric rheumatologists were identified with a mean age of 42.25 ±â€¯10.4 years, with a predominance of the female gender with a ratio of 2.2:1. In Mexico City and Jalisco, more than one rheumatologist/100,000 inhabitants were reported in the specialty of adults and only in Mexico City in pediatrics. The current certification is 65%-70% on average and the factors associated with a higher prevalence were younger age, female gender and geographic location. CONCLUSIONS: There is a shortage of rheumatologists in Mexico and in the pediatric area there are underserved regions. It is important that health policies apply measures that allow a more balanced and efficient regionalization of this specialty. Although most rheumatologists have current certification, it is necessary to establish strategies to increase this proportion.

[Comparative analysis of the accreditation of medical facilities in Canada, Chile, the Autonomous Community of Andalusia, Denmark, and MexicoAnálise comparativa da acreditação de estabelecimentos de saúde no Canadá, Chile, Comunidade Autônoma da Andaluzia, Dinamarca e México]. / Análisis comparativo de la acreditación de unidades médicas en Canadá, Chile, la Comunidad Autónoma de Andalucía, Dinamarca y México.

Objective: To compare and contrast the characteristics of the accreditation process for health care facilities in Canada, Chile, the Autonomous Community of Andalusia (Spain), Denmark, and Mexico, in order to identify shared characteristics, differences, and lessons learned that may be useful for other countries and regions. Methods: An observational, analytical, retrospective study using open-access secondary sources on the accreditation and certification of health care facilities in 2019-2021 in these countries and regions. The general characteristics of the accreditation processes are described and comments are made on key aspects of the design of these programs. Additionally, analytical categories were created for degree of implementation and level of complexity, and the positive and negative results reported are summarized. Results: The operational components of the accreditation processes are country-specific, although they share similarities. The Canadian program is the only one that involves some form of responsive evaluation. There is a wide range in the percentage of establishments accredited from country to country (from 1% in Mexico to 34.7% in Denmark). Notable lessons learned include the complexity of application in a mixed public-private system (Chile), the risk of excessive bureaucratization (Denmark), and the need for clear incentives (Mexico). Conclusions: The accreditation programs operate in a unique way in each country and region, achieve varying degrees of implementation, and have an assortment of problems, from which lessons can be learned. Elements that hinder their implementation should be considered and adjustments made for the health systems of each country and region.

Objetivo: Comparar as características do processo de acreditação de estabelecimentos de saúde no Canadá, Chile, Comunidade Autônoma da Andaluzia, Dinamarca e México, a fim de identificar elementos comuns e diferenças, bem como lições aprendidas que podem ser úteis para outros países e regiões. Métodos: Estudo observacional, analítico e retrospectivo usando fontes secundárias de livre acesso sobre acreditação e certificação de estabelecimentos de saúde durante o período 2019-2021 nos países e regiões supracitados. As características gerais do processo de acreditação e suas respostas a pontos-chave no delineamento de tais programas foram descritas. Além disso, foram geradas categorias de análise para o andamento de sua implantação e seu grau de complexidade, e os desfechos favoráveis e desfavoráveis relatados foram resumidos. Resultados: Os componentes operacionais do processo de acreditação são peculiares a cada país, embora compartilhem certas semelhanças. O programa canadense é o único que contempla algum tipo de avaliação responsiva. Houve grande variação entre países no percentual de estabelecimentos acreditados (de 1% no México a 34,7% na Dinamarca). Entre as lições aprendidas, destacam-se a complexidade da aplicação do sistema misto público-privado (Chile), o risco de burocratização excessiva (Dinamarca) e a necessidade de incentivos claros (México). Conclusões: Os programas de acreditação operam de forma peculiar em cada país ou região, têm diferentes escopos e também apresentam diversos problemas a partir dos quais podemos aprender. É preciso considerar os elementos que dificultam a implementação e realizar as adequações necessárias para os sistemas de saúde de cada país ou região.

La educación de postgrado actual en la neurocirugía de Argentina. Estrategias para su mejoramiento a partir de un análisis FODA / Current postgraduate education in neurosurgery in Argentina. Strategies for its improvement from a SWOT analysis

La educación de postgrado de la neurocirugía en Argentina ha sido una preocupación constante desde el inicio de la especialidad. Actualmente las organizaciones activas en educación de postgrado son la Asociación Argentina de Neurocirugía y el Colegio Argentino de Neurocirujanos. Ambas consideran que la residencia médica es el sistema de formación más apropiado para que un médico recién graduado pueda convertirse en un especialista. Para regular y organizar el desarrollo pedagógico de las mismas se diseñó un marco de referencia en donde se establecieron los estándares a alcanzar, junto con un programa de acreditación para lograr la homogeneidad de los parámetros de calidad, y además se crearon becas junto con el reglamento para su acreditación, para completar la formación en aquellos aspectos que durante la residencia no fueron suficientemente desarrollados. Como la certificación profesional es obligatoria para ejercer se crearon cursos ad hoc que constituyen la base teórica tanto para neurocirugía general como la cirugía de columna. Los postulantes deben completar una serie de requisitos y transitar por diferentes instancias de formación que incluyen, además, la residencia. Para mantener la calidad de la atención médica se creó un programa de revalidación o recertificación periódica. Toda la situación actual fue sometida a un análisis de sus fortalezas, oportunidades, debilidades y amenazas para diseñar las estrategias que permitan mejorarla(AU)

Postgraduate education in neurosurgery has been a constant concern since the beginning of the specialty. Currently active organizations in postgraduate education are the Asociación Argentina de Neurocirugía y el Colegio Argentino de Neurocirujanos. Both consider that medical residency is the most appropriate training system for a recently graduated doctor to become a specialist. To regulate and organize their pedagogical development, a reference framework was designed where the standards to be achieved were established, along with an accreditation program to achieve homogeneity of quality parameters, and fellowships were also created along with the regulations. for its accreditation, to complete the training in those aspects that were not sufficiently developed during the residency. Since professional certification is mandatory to practice, ad hoc courses were created that constitute the theoretical basis for both general neurosurgery and spinal surgery. Applicants must complete a series of requirements and go through different training instances that also include residence. To maintain the quality of medical care, a periodic revalidation or recertification program was created. The entire current situation was subjected to an analysis of its strengths, opportunities, weaknesses and threats to design strategies to improve it(AU)

Artisanal minas cheese parameters associated with regions of origin in Minas Gerais, Brazil / Determinação de parâmetros do queijo minas artesanal associados com as regiões de origem em Minas Gerais, Brasil

Artisanal cheese production involves a centuries-old tradition in the state of Minas Gerais in Brazil, playing an important historical and social role. The aim of this study was to evaluate the characteristics of artisanal Minas cheeses from seven regions certified for their production in relation to their physical-chemical and centesimal composition to identify parameters that are useful to differentiate them. There were differences among the cheeses from different regions for the soluble nitrogen variables, extension and depth of ripening indexes, ash, oxidation, fat and pH. The highest values for the ripening length and depth index were observed in the Cerrado region. The cheeses from the Canastra region were different due to the higher moisture content, and the cheeses from Campo das Vertentes presented higher pH and nitrogen compound values. Despite the similarities among cheeses in each region, they had dispersed positions in the principal components analysis. There are differences in the physicochemical and centesimal composition among the artisanal Minas cheeses from the distinct regions in Minas Gerais, and the analyzed parameters can be used to differentiate them. The contents of ash, fat, oxidation index, soluble nitrogen and pH were the parameters that were associated with greater differences in cheeses.

A produção artesanal de queijos envolve uma tradição secular no estado de Minas Gerais, no Brasil, exercendo importante papel histórico e social. Objetivou-se, com este estudo, avaliar as características de queijos minas artesanal de sete regiões certificadas para sua produção em relação à sua composição físico-química e centesimal, a fim de se identificarem parâmetros que sejam úteis para diferenciá-los. A composição físico-química e centesimal revelou diferença entre os queijos das diferentes regiões para as variáveis nitrogênio solúvel, índices de extensão e profundidade de maturação, cinzas, oxidação, gordura e pH. Os maiores valores para os índices de extensão e profundidade de maturação foram observados na região do Cerrado. Os queijos da região da Canastra se mostraram diferentes daqueles das demais regiões em razão do maior teor de umidade, assim como os queijos de Campo das Vertentes, que apresentaram maiores valores de pH e compostos nitrogenados. Apesar das semelhanças entre os queijos em cada região, esses apresentaram posicionamentos dispersos na análise de componentes principais. Existem diferenças na composição físico-química e centesimal entre os queijos minas artesanais oriundos das distintas regiões em Minas Gerais, e os parâmetros analisados podem ser utilizados para diferenciá-los. Os teores de cinzas, gordura, índice de oxidação, teores de nitrogênio solúvel e pH foram os parâmetros que estiveram associados a maiores diferenças dos queijos conforme sua região de origem.

Improving the quality of external cause of death data in Brazil: evaluation and validation of a new form to investigate garbage codes / Melhorando a qualidade dos dados de causa externa de morte no Brasil: avaliação e validação de um novo formulário para investigar códigos garbage / Mejora en la calidad de los datos de causa externa de muerte en Brasil: evaluación y validación de un nuevo formulario para investigar códigos garbage

Garbage codes, such as external causes with no specific information, indicate poor quality cause of death data. Investigation of garbage codes via an effective instrument is necessary to convert them into useful data for public health. This study analyzed the performance and suitability of the new investigation of deaths from external causes (IDEC) form to improve the quality of external cause of death data in Brazil. The performance of the IDEC form on 133 external garbage codes deaths was compared with a stratified matched sample of 992 (16%) investigated deaths that used the standard garbage codes form. Consistency between these two groups was checked. The percentage of garbage codes from external causes reclassified into valid causes with a 95% confidence interval (95%CI) was analyzed. Reclassification for specific causes has been described. Qualitative data on the feasibility of the form were recorded by field investigators. Investigation using the new form reduced all external garbage codes by -92.5% (95%CI: -97.0; -88.0), whereas the existing form decreased garbage codes by -60.5% (95%CI: -63.5; -57.4). The IDEC form presented higher effectivity for external-cause garbage codes of determined intent. Deaths that remained garbage codes mainly lacked information about the circumstances of poisoning and/or vehicle accidents. Despite the fact that field investigators considered the IDEC form feasible, they suggested modifications for further improvement. The new form was more effective than the current standard form in improving the quality of defined external causes.

Códigos garbage (códigos inespecíficos ou incompletos), como causas externas sem informações específicas, indicam dados de má qualidade sobre a causa da morte. É necessário investigar os códigos garbage com um instrumento efetivo para convertê-los em dados úteis para a saúde pública. Este estudo analisou o desempenho e a adequação do novo formulário de investigação de óbitos por causas externas (IDEC) para melhorar a qualidade dos dados de causa externa de morte no Brasil. O desempenho deste formulário em 133 óbitos com códigos garbage de causas externas foi comparado com uma amostra estratificada e pareada de 992 (16%) óbitos investigados que utilizaram o formulário padrão de códigos garbage existente. A consistência entre esses dois grupos foi verificada. Analisou-se o percentual de códigos garbage de causas externas reclassificados em causas válidas com um intervalo de 95% de confiança (IC95%). A reclassificação para causas específicas foi descrita. Dados qualitativos sobre a viabilidade do formulário foram registrados por pesquisadores de campo. A investigação com o novo formulário reduziu todos os códigos garbage de causas externas em -92,5% (IC95%: -97,0; -88,0) enquanto o formulário existente diminuiu os códigos garbage em -60,5% (IC95%: -63,5; -57,4). O formulário IDEC foi mais eficaz para os códigos garbage de causa externa sem intenção indeterminada. As mortes que permaneceram como códigos garbage careciam principalmente de informações detalhadas sobre as circunstâncias do envenenamento e dos acidentes de trânsito. O formulário IDEC foi considerado viável pelos investigadores de campo, no entanto, eles sugeriram modificações para um maior aperfeiçoamento. O novo formulário foi mais eficaz do que o formulário padrão atual na melhoria da qualidade das causas externas definidas.

Códigos garbage (códigos inespecíficos o incompletos), como causas externas inespecíficas, son los indicadores de datos de mala calidad sobre la causa de muerte. Es necesario investigar los códigos garbage con un instrumento eficaz para convertirlos en datos útiles para la salud pública. Este estudio analizó el desempeño y la adecuación del nuevo formulario de investigación de muertes por causas externas (IDEC) para mejorar la calidad de los datos de causa externa de muerte en Brasil. El desempeño de este formulario en 133 muertes con códigos garbage de causas externas se comparó con una muestra estratificada y emparejada de 992 (16%) muertes investigadas que usaron el formulario estándar de códigos garbage existente. Se comprobó la consistencia entre estos dos grupos. Se analizó el porcentaje de códigos garbage por causas externas reclasificados en causas válidas con un intervalo del 95% de confianza (IC95%). Se procedió a una reclasificación por causas específicas. Los datos cualitativos sobre la viabilidad del formulario fueron registrados por investigadores de campo. La investigación con el nuevo formulario tuvo una reducción de todos los códigos garbage de causas externas en -92,5% (IC95%: -97,0; -88,0), mientras que el formulario existente redujo todos los códigos garbage de causas externas en -60,5% (IC95%: -63,5; -57,4). El formulario IDEC fue el más efectivo para códigos garbage de causa externa sin intención indeterminada. Las muertes que quedaron como códigos garbage carecían principalmente de información detallada sobre las circunstancias de envenenamiento y de accidentes de tránsito. Los investigadores de campo confirmaron la viabilidad del formulario IDEC, además de sugerir modificaciones para mejorarlo. El nuevo formulario fue el más efectivo que el formulario estándar actual en cuanto a la mejora de la calidad de las causas externas definidas.

Análisis comparativo de la acreditación de unidades médicas en Canadá, Chile, la Comunidad Autónoma de Andalucía, Dinamarca y México / Comparative analysis of the accreditation of medical facilities in Canada, Chile, the Autonomous Community of Andalusia, Denmark, and Mexico / Análise comparativa da acreditação de estabelecimentos de saúde no Canadá, Chile, Comunidade Autônoma da Andaluzia, Dinamarca e México

RESUMEN Objetivo. Contrastar las características del proceso de acreditación de establecimientos de salud en Canadá, Chile, la Comunidad Autónoma de Andalucía, Dinamarca y México, con el fin de identificar elementos comunes y diferencias, y las lecciones aprendidas que puedan ser de utilidad para otros países y regiones. Métodos. Estudio observacional, analítico y retrospectivo en el que se usaron fuentes secundarias de libre acceso sobre acreditación y certificación de establecimientos de salud durante el período 2019-2021 en estos países y regiones. Se describen las características generales del proceso de acreditación y sus respuestas a puntos clave del diseño de estos programas. Además, se generaron categorías de análisis para el avance en su implementación y su nivel de complejidad, y se resumen los resultados favorables y desfavorables informados. Resultados. Los componentes operativos del proceso de acreditación son peculiares de cada país, aunque comparten similitudes. El programa de Canadá es el único que contempla algún tipo de evaluación responsiva. Hay una amplia variación en la cobertura de establecimientos acreditados entre países (desde 1% en México a 34,7% en Dinamarca). Entre las lecciones aprendidas, se destacan la complejidad de aplicación del sistema mixto público-privado (Chile), el riesgo de una excesiva burocratización (Dinamarca) y la necesidad de incentivos claros (México). Conclusiones. Los programas de acreditación operan de forma peculiar en cada país o región, logran alcances diferentes y presentan problemáticas también diversas, de las que podemos aprender. Es necesario considerar los elementos que obstaculizan la implementación y generar adecuaciones para los sistemas de salud en cada país o región.

ABSTRACT Objective. To compare and contrast the characteristics of the accreditation process for health care facilities in Canada, Chile, the Autonomous Community of Andalusia (Spain), Denmark, and Mexico, in order to identify shared characteristics, differences, and lessons learned that may be useful for other countries and regions. Methods. An observational, analytical, retrospective study using open-access secondary sources on the accreditation and certification of health care facilities in 2019-2021 in these countries and regions. The general characteristics of the accreditation processes are described and comments are made on key aspects of the design of these programs. Additionally, analytical categories were created for degree of implementation and level of complexity, and the positive and negative results reported are summarized. Results. The operational components of the accreditation processes are country-specific, although they share similarities. The Canadian program is the only one that involves some form of responsive evaluation. There is a wide range in the percentage of establishments accredited from country to country (from 1% in Mexico to 34.7% in Denmark). Notable lessons learned include the complexity of application in a mixed public-private system (Chile), the risk of excessive bureaucratization (Denmark), and the need for clear incentives (Mexico). Conclusions. The accreditation programs operate in a unique way in each country and region, achieve varying degrees of implementation, and have an assortment of problems, from which lessons can be learned. Elements that hinder their implementation should be considered and adjustments made for the health systems of each country and region.

RESUMO Objetivo. Comparar as características do processo de acreditação de estabelecimentos de saúde no Canadá, Chile, Comunidade Autônoma da Andaluzia, Dinamarca e México, a fim de identificar elementos comuns e diferenças, bem como lições aprendidas que podem ser úteis para outros países e regiões. Métodos. Estudo observacional, analítico e retrospectivo usando fontes secundárias de livre acesso sobre acreditação e certificação de estabelecimentos de saúde durante o período 2019-2021 nos países e regiões supracitados. As características gerais do processo de acreditação e suas respostas a pontos-chave no delineamento de tais programas foram descritas. Além disso, foram geradas categorias de análise para o andamento de sua implantação e seu grau de complexidade, e os desfechos favoráveis e desfavoráveis relatados foram resumidos. Resultados. Os componentes operacionais do processo de acreditação são peculiares a cada país, embora compartilhem certas semelhanças. O programa canadense é o único que contempla algum tipo de avaliação responsiva. Houve grande variação entre países no percentual de estabelecimentos acreditados (de 1% no México a 34,7% na Dinamarca). Entre as lições aprendidas, destacam-se a complexidade da aplicação do sistema misto público-privado (Chile), o risco de burocratização excessiva (Dinamarca) e a necessidade de incentivos claros (México). Conclusões. Os programas de acreditação operam de forma peculiar em cada país ou região, têm diferentes escopos e também apresentam diversos problemas a partir dos quais podemos aprender. É preciso considerar os elementos que dificultam a implementação e realizar as adequações necessárias para os sistemas de saúde de cada país ou região.

Validación de Actividades Profesionales Confiables (APROC) para la Certificación de Ginecología y Obstetricia / Validation of Entustable Professional Activities (EPAs) for Gynecology and Obstetrics Certification

Resumen Como parte del diseño de un instrumento para la evaluación de la certificación ante el Consejo Mexicano de Ginecología y Obstetricia en México se llevó a cabo el proceso de validación del constructo a evaluar. De acuerdo con la bibliografía consultada, la educación médica se basa en competencias, por lo que es coherente practicar una evaluación en el mismo tenor. Se decidió utilizar el concepto de Actividades Profesionales Confiables (APROC) porque son un puente entre la competencia y la actividad observable que puede llevar a cabo el sustentante. Se aplicó una metodología de cuatro fases que se inicia con una revisión bibliográfica con la que se definió una lista de APROC para validarla en el contexto mexicano. La fase dos consistió en aplicar la técnica de grupos focales que representarán las regiones médicas definidas por la FEMECOG, después de recabar y analizar la información de los grupos en la fase tres. La última fase consistió en una validación por parte de 10 expertos en Ginecología y Obstetricia para conseguir un nivel de acuerdo mayor al 80% en cada APROC. Como resultados de este proceso de validación de constructo a evaluar se obtuvo una lista de 15 APROC con alcances (definición de las delimitaciones de las APROC, dónde inician y dónde terminan) con un nivel de aceptación superior al 80%. Además, se corroboró la eficacia de la metodología cualitativa para realizar validaciones en donde las partes interesadas que podrían participar para definir áreas o temas no cuenten con disponibilidad debido a sus actividades laborales.

Abstract As part of the design of an instrument to evaluate the certification of the Mexican Council of Gynaecology and Obstetrics in Mexico, the validation process of the construct to be evaluated was carried out. According to the literature consulted, medical education is based on competencies, so it is coherent to carry out an evaluation in the same vein. It was decided to use Entrustable Professional Activities (EPA), as they provide a link between the competence and the observable activity that the supporter can perform. A four-phase methodology was carried out, starting with a bibliographic review that defined a list of EPAs in order to validate them for the Mexican context. The second phase consisted of using the technique of focus groups, representing the medical regions defined by FEMECOG in the country, once the information from the groups had been collected and analysed in the third phase, and the final phase consisted of validation by 10 experts in gynaecology and obstetrics, in order to achieve a level of agreement of more than 80% in each EPA. As a result of this validation process of the construct to be evaluated, a list of 15 EPAs with scopes (definition of the boundaries of the EPAs, where they start and how far they end) was obtained with a level of acceptance greater than 80%, in addition to confirming the effectiveness of the qualitative methodology to carry out validations when the interested parties who could participate in defining areas or topics are not available due to their work activities.

Certificação subnacional da eliminação da transmissão vertical de HIV e/ou sífilis: relato da experiência brasileira / Subnational certification of elimination of mother-to-child transmission of HIV and/or syphilis: a Brazilian experience report / Certificación subnacional de la eliminación de la trasmisión vertical de VIH y/o sífilis: relato de la experiencia brasileña

Objective: to describe the subnational implementation process of the certification for elimination of mother-to-child transmission of HIV and/or syphilis, its main barriers, challenges and opportunities. Methods: in 2022, indicators from the last full year for impact targets and the last two full years for process targets, available in national information systems, were evaluated; descriptive reports were analyzed and actions were acknowledged within four thematic axes, according to PAHO/WHO recommendations. Results: 43 municipalities ≥ 100,000 inhabitants were certified, covering 24.6 million inhabitants; one municipality achieved dual elimination (HIV-syphilis), 28 municipalities achieved elimination of HIV and 10 received silver tiers; regarding syphilis, one elimination was observed, along with 4 gold tiers, 13 silver tiers and 4 bronze tiers; a higher number of certifications was identified in the Southeast and South regions. Conclusion: barriers and challenges of the process were overcome through tripartite collaboration; the experience provided better integration of surveillance with care and improved actions aimed at preventing mother-to-child transmission.

Objetivo: descrever o processo de implantação subnacional da certificação da eliminação da transmissão vertical de HIV e/ou sífilis, suas principais barreiras, desafios e oportunidades. Métodos: em 2022, foram avaliados indicadores do último ano completo para meta de impacto, e dos dois últimos anos completos para metas de processo, disponíveis nos sistemas nacionais de informações; foram analisados relatórios descritivos e reconhecidas ações em quatro eixos temáticos, conforme recomendações da OPAS/OMS. Resultados: 43 municípios ≥ 100 mil habitantes foram certificados, abrangendo 24,6 milhões de habitantes; um município alcançou dupla eliminação (HIV-sífilis), 28 alcançaram eliminação para HIV e 10, selos prata; para sífilis, houve uma eliminação, 4 selos ouro, 13 prata e 4 bronze; identificou-se maior número de certificações nas regiões Sudeste e Sul. Conclusão: barreiras e desafios do processo foram superados pela colaboração tripartite; a experiência proporcionou melhor integração da vigilância com a assistência e qualificação das ações para prevenção da transmissão vertical.

Objetivo: describir el proceso de implementación subnacional de la certificación de eliminación de la transmisión vertical (TV) de sífilis y/o VIH, barreras, oportunidades y desafíos. Métodos: en 2022, se evaluaron indicadores del último año completo para la meta de impacto y de los dos últimos años para las de proceso en los sistemas de información; se analizaron informes descriptivos y se reconocieron acciones de cuatro ejes, según las recomendaciones de la OPS/OMS. Resultados: se certificaron 43 municipios ≥ 100.000 mil habitantes, cubriendo 24,6 millones de habitantes; un municipio logró la doble eliminación (VIH-sífilis), 28 la eliminación del VIH y 10 sellos plata; para sífilis, hubo una eliminación, 4 sellos oro, 13 plata y 4 bronce; las regiones Sudeste y Sur obtuvieron más certificaciones. Conclusión: barreras y desafíos fueron superados mediante la colaboración tripartita; la experiencia permitió la integración de la vigilancia con la atención y la cualificación de acciones para la prevención de la TV.

Validation of physician certified verbal autopsy using conventional autopsy: a large study of adult non-external causes of death in a metropolitan area in Brazil.

BACKGROUND: Reliable mortality data are essential for the development of public health policies. In Brazil, although there is a well-consolidated universal system for mortality data, the quality of information on causes of death (CoD) is not even among Brazilian regions, with a high proportion of ill-defined CoD. Verbal autopsy (VA) is an alternative to improve mortality data. This study aimed to evaluate the performance of an adapted and reduced version of VA in identifying the underlying causes of non-forensic deaths, in São Paulo, Brazil. This is the first time that a version of the questionnaire has been validated considering the autopsy as the gold standard. METHODS: The performance of a physician-certified verbal autopsy (PCVA) was evaluated considering conventional autopsy (macroscopy plus microscopy) as gold standard, based on a sample of 2060 decedents that were sent to the Post-Mortem Verification Service (SVOC-USP). All CoD, from the underlying to the immediate, were listed by both parties, and ICD-10 attributed by a senior coder. For each cause, sensitivity and chance corrected concordance (CCC) were computed considering first the underlying causes attributed by the pathologist and PCVA, and then any CoD listed in the death certificate given by PCVA. Cause specific mortality fraction accuracy (CSMF-accuracy) and chance corrected CSMF-accuracy were computed to evaluate the PCVA performance at the populational level. RESULTS: There was substantial variability of the sensitivities and CCC across the causes. Well-known chronic diseases with accurate diagnoses that had been informed by physicians to family members, such as various cancers, had sensitivities above 40% or 50%. However, PCVA was not effective in attributing Pneumonia, Cardiomyopathy and Leukemia/Lymphoma as underlying CoD. At populational level, the PCVA estimated cause specific mortality fractions (CSMF) may be considered close to the fractions pointed by the gold standard. The CSMF-accuracy was 0.81 and the chance corrected CSMF-accuracy was 0.49. CONCLUSIONS: The PCVA was efficient in attributing some causes individually and proved effective in estimating the CSMF, which indicates that the method is useful to establish public health priorities.

Physiological quality of irrigated rice seeds benefited in different UBSin the internal coastal plain of Lagoa dos Patos / Qualidade fisiológica de sementes de arroz irrigado beneficiadas em diferentes UBS’sda planície litorânea interna da Lagoa dos Patos

The objective of the study is to evaluate the evolution of the physical and physiological quality of rice seeds throughout the processing process, analyzing the efficiencyof the equipment used in three Seed Processing Units (UBS) to produce certified seeds, located in the region of the inner coastal plain of Lagoa dos Patos. We know that the seed has to be made in the field, starting with the choice of the area, providing a good management and controlling invaders, pests and diseases, but we believe that UBS has a very important role in seed quality, and this is the purpose of this study. Each unit with its equipment on its production line was analyzed. The cultivar IRGA 424 RI was used in the three units, samples were taken at the exit of each equipment, tests for seedling emergence, germination, physical purity and determination of other contaminatingspecies were carried out. A gradual increase in purity and germination was observed along the processing line in the three UBS’s, except for the determination of weedy rice, where equipment was not efficient.

O objetivo do estudo, é avaliar a evolução da qualidade física e fisiológica das sementes de arroz ao longo do processo de beneficiamento, analisando a eficiência dos equipamentos utilizados em trêsUnidades de Beneficiamentos de Sementes (UBS), de produção de sementes certificadas, localizadas na região da planície costeira interna da Lagoa dos Patos. Sabemos que asemente tem que ser feita no campo, começando pela escolha da área, proporcionando um bom manejo e controlando as invasoras, pragas e doenças, mas acreditamos que a UBS tem um papel muito importante na qualidade da semente e este é o propósito deste estudo. Foram analisadas cada unidade com seus equipamentos em sua linha de produção. Utilizou-se a cultivar IRGA 424 RI nas três unidades, as amostras foram feitas na saída de cada equipamento, realizou-se os testes de emergência de plântulas, germinação, pureza física e determinação de outras espécies contaminantes. Observou-se um aumento gradativo na pureza e germinação ao longo da linha de beneficiamento nas trêsUBS’s, exceto na determinação de arroz daninho, onde equipamentos não se mostraram eficientes.

Physiological quality of irrigated rice seeds benefited in different UBSin the internal coastal plain of Lagoa dos Patos / Qualidade fisiológica de sementes de arroz irrigado beneficiadas em diferentes UBSsda planície litorânea interna da Lagoa dos Patos

The objective of the study is to evaluate the evolution of the physical and physiological quality of rice seeds throughout the processing process, analyzing the efficiencyof the equipment used in three Seed Processing Units (UBS) to produce certified seeds, located in the region of the inner coastal plain of Lagoa dos Patos. We know that the seed has to be made in the field, starting with the choice of the area, providing a good management and controlling invaders, pests and diseases, but we believe that UBS has a very important role in seed quality, and this is the purpose of this study. Each unit with its equipment on its production line was analyzed. The cultivar IRGA 424 RI was used in the three units, samples were taken at the exit of each equipment, tests for seedling emergence, germination, physical purity and determination of other contaminatingspecies were carried out. A gradual increase in purity and germination was observed along the processing line in the three UBSs, except for the determination of weedy rice, where equipment was not efficient.(AU)

O objetivo do estudo, é avaliar a evolução da qualidade física e fisiológica das sementes de arroz ao longo do processo de beneficiamento, analisando a eficiência dos equipamentos utilizados em trêsUnidades de Beneficiamentos de Sementes (UBS), de produção de sementes certificadas, localizadas na região da planície costeira interna da Lagoa dos Patos. Sabemos que asemente tem que ser feita no campo, começando pela escolha da área, proporcionando um bom manejo e controlando as invasoras, pragas e doenças, mas acreditamos que a UBS tem um papel muito importante na qualidade da semente e este é o propósito deste estudo. Foram analisadas cada unidade com seus equipamentos em sua linha de produção. Utilizou-se a cultivar IRGA 424 RI nas três unidades, as amostras foram feitas na saída de cada equipamento, realizou-se os testes de emergência de plântulas, germinação, pureza física e determinação de outras espécies contaminantes. Observou-se um aumento gradativo na pureza e germinação ao longo da linha de beneficiamento nas trêsUBSs, exceto na determinação de arroz daninho, onde equipamentos não se mostraram eficientes.(AU)

Evaluation of microsatellite allelic patterns to DNA fingerprinting in rubber tree clones

The rubber tree (Hevea brasiliensis) is native to the Amazon region, and it is widely exploited due to natural rubber produced from latex. There are many clonal varieties, without certification tests. In order to determine a genetic certification, 15 clones were genotyped to identify their genetic pattern. Ten microsatellites were used to determine a subset of alleles exclusive for each genetic profile. The genetic estimates obtained were: number of alleles per locus (N), expected (HE) and observed (HO) heterozygosity, Polymorphic Information Content (PIC) and Discriminatory Power (DP). The number of alleles (N) ranged from five to 14, with an average of 9.2. The HE mean (0.80) was higher than HO (0.60), indicating a selection for homozygotes. The locus informativeness was verified with PIC (0.77) and DP (0.90) means showing high polymorphism. The dendrogram represented the formation of three groups related to geographical origin. Clone MDF 180 presented the highest genetic divergence. Two genic pools represented the genetic composition of genotypes. Based on allelic profiles, a set of two microsatellites (A2365 and A2368) was able to distinguish all examined clones. The genetic certification using microsatellite fingerprinting proved to be an alternative to morphological traits.

(Micro)plastics: A possible criterion for beach certification with a focus on the Blue Flag Award.

On the one hand, environmental certifications like the Blue Flag award (BFA) are well-known globally for its role in beach management and tourism attraction. Plastic pollution like microplastics, on the other hand, has become a global concern due to their increasing persistence and negative environmental repercussions. This paper examines and discusses the factors that would lead to (micro)plastics being included to the BFA as a criterion. Thereby, we attempt to maximize BFA's potential as a tool for better understanding (micro)plastics on beaches and implementing strategies to reduce them. The anticipated primary benefits are: 1) knowing the degree of litter disposal and microplastic contamination, 2) conducting close monitoring, 3) having an accessible database for numerous coastlines throughout the world, 4) evaluating management strategies and making improvements, 5) assisting in long-term research, 6) having a responsible entity in charge of issue decision-making, and 7) a larger public/scientific outreach.