Promoción de la salud mental por medio de la siembra de huertas en Cali / Promotion of mental health through planting orchards in Cali

Investigaciones previas sobre la promoción de la salud por medio de la siembra consideran co-mo resultados el fortalecimiento de los lazos sociales, la práctica de hábitos de vida saludables y la atención a dificultades psicológicas. Así, se hace importante para este proyecto partir des-de una perspectiva sistémica y multidisciplinar de la salud que busca fortalecer aspectos de la salud mental (el apoyo social, el bienestar psicológico y calidad de vida) y de conocimientos en agroecología urbana (seguridad alimentaria, siembra y sostenimiento de cultivos), con personas habitantes de Cali, vinculados a la estrategia de la siembra de huertas caseras. Se basa en un enfoque cualitativo-transformativo, con un diseño de investigación-acción participativa. Con los resultados se espera promover aspectos de la salud y el bienestar de las relaciones consigo mismo, con los demás y con el entorno inmediato, así como el conocimiento básico para el cui-dado de la huerta. (AU)

Previous research on health promotion through planting considers the strengthening of social ties, the practice of healthy lifestyle habits, and attention to psychological difficulties as re-sults. Thus, it is important for this project to start from a systemic and multidisciplinary per-spective of health that seeks to strengthen aspects of mental health (social support, psycho-logical well-being and quality of life) and knowledge in urban agroecology (food security, planting and crop maintenance), with people from Cali, linked to the strategy of planting home gardens. It is based on a qualitative-transformative approach, with a participatory ac-tion research design. The results are expected to promote aspects of health and well-being in relationships with oneself, with others and with the immediate environment, as well as basic knowledge for caring for the garden. (AU)

Social representations of cancer in patients from Medellín, Colombia: a qualitative study.

Background: Cancer has different explanatory theories that address its etiology and treatment. It is usually associated with pain and suffering. Recently, new technologies, knowledge, and therapies have been developed, which may have transformed the classic social representations of the disease. This study aimed to understand the social representations (SRs) of cancer in patients from Medellín, Colombia. Methods: This study used a grounded theory in 16 patients with cancer. The information was collected between June 2020 and May 2021. Information was analyzed following the open, axial, and selective coding stages. Results: SRs of cancer at the time of diagnosis evoke negative connotations. However, cancer is redefined as a positive event as the clinical course of the disease progresses, and patients interact with health professionals and respond to treatment. The resignification of the disease depends on the etiological models of the patients, which include genetic, socio-anthropological, psychosocial, and psychogenic factors. In line with the SRs of etiology, patients seek out treatments complementary to the biomedical ones that can be socio-anthropological and psychogenic. Conclusion: In this group negative representations about cancer persist, this way of understanding the disease is determined by the convergence of cultural meanings and personal experiences. The causal representation is connected to the actions and willingness of the patients to face their diagnosis. In this sense, two categories stand out: the first expresses that cancer is the consequence of a body subjected to excessive productivity; the second subsumes a psychogenic predisposition caused by the context where the ideology of happiness appears to be a social norm. This double saturation in which an individual is immersed results in new burdens that are not visible to caregivers and healthcare workers.

Influence of Positive Thinking Ideology on Physician Representations of Cancer.

To understand the influence of positive thinking ideology on cancer representations among physicians in the city of Medellín. METHODS: This qualitative study was conducted on the basis of the theoretical and methodological elements of Corbin and Strauss's grounded theory. Fourteen physicians were included and selected according to the criteria of maximum variation for education, years of study, and personal and family history of cancer. The information was collected through semi-structured interviews and analyzed with open, axial, and selective coding. RESULTS: the ideology of positive thinking has managed to permeate the medical discourse and the representations that they form about the etiology and treatment of cancer. Physicians place the mind, emotions, attitude, and positive thinking as determinants of the origin of the disease and the response to therapy. To argue this link, they use two strategies: (i) a sophisticated and specialized discourse that involves relationships among thoughts, genetics, the neurological, immune and endocrine system and (ii) a mystical and less rational discourse that emphasizes the omnipotence of the mind and thoughts. In no case was the idea of positive thinking rejected or in disagreement with this style of thinking expressed. CONCLUSION: The fact of linking the disease with mental factors refers to the mind-body dualism and generates a responsibility of the patients on the etiology and therapeutics of the disease, as well as an erasure of the social and political determinants of cancer. The technical discourse and the symbolic capital of physicians offer scientific legitimacy to these ideas and can become performative for patients.

Effect of Retrofit Design Modifications on the Macroturbulence of a Three-Phase Flotation Tank-Flow Characterization Using Positron Emission Particle Tracking (PEPT).

Turbulence in stirred tank flotation tanks impacts the bulk transport of particles and has an important role in particle-bubble collisions. These collisions are necessary for attachment, which is the main physicochemical mechanism enabling the separation of valuable minerals from ore in froth flotation. Modifications to the turbulence profile in a flotation tank, therefore, can result in improvements in flotation performance. This work characterized the effect of two retrofit design modifications, a stator system and a horizontal baffle, on the particle dynamics of a laboratory-scale flotation tank. The flow profiles, residence time distributions, and macroturbulent kinetic energy distributions were derived from positron emission particle tracking (PEPT) measurements of tracer particles representing valuable (hydrophobic) mineral particles in flotation. The results show that the use of both retrofit design modifications together improves recovery by increasing the rise velocity of valuable particles and decreasing turbulent kinetic energy in the quiescent zone and at the pulp-froth interface.

Digital divide, e-government and trust in public service: The key role of education.

The Italian public administration (PA) has always had problems with slowness and inefficiency. In 2021, the Italian government made a massive investment in digitizing PA as part of an extraordinary recovery plan, with more than 200 billion euro to revitalize the country. This paper aims to investigate how educational inequalities affect the relationship between Italian citizens and PA in this phase of the digital transition. The study is based on a web survey conducted in March and April 2022 among a national sample of 3,000 citizens aged 18-64. The data shows that more than three-quarters of respondents have already used a public service at least once via an online channel. Few are aware of the reform plan, however, and more than one-third fear that the digitization of public services will make things worse for citizens. Through a regression analysis, the study confirms the centrality of the influence of education on the use of digital public services compared to the other spatial and social variables considered. Trust in PA is also correlated with education and employment status and is higher among those who have used digital public services. The survey thus highlights that the educational and cultural dimension is a crucial aspect as a lever to counter the digital divide and promote digital citizenship rights. It reveals the need to activate facilitation and accompaniment processes for citizens with less digital skills and experience who risk being excluded or penalized by the new arrangement and having their distrust toward the PA and state exacerbated.

The Relation of Ideology of Positive Thinking with the Perception of Cancer Risk and Ways of Treating It in Medellin, Colombia.

Purpose: This study has the following objectives: i) to construct an instrument to measure positive thinking ideology (PTI) regarding cancer, and to evaluate its psychometric properties, ii) to describe the effects of PTI on cancer risk and its treatment, and iii) to identify the associated factors with PTI in the study group. Methods: A cross-sectional study was conducted with 611 people from the Medellin, Colombia. Participants were selected through stratified sampling with proportional assignment. A survey with three constructs was applied: the role of negative emotions in cancer etiology, cancer as a redeeming event, and the effects of PTI in cancer treatment. Results: In negative emotions construct 47% considered that holding anger, resentment, and hatred represent a moderate or high risk of generating cancer. In redeeming power construct 46.5% found that cancer is a battle that the best warriors win. Concerning the treatment, 77.3% considered that facing the disease with a fighting spirit had a moderate to high positive effect in response to the treatment. The associated factors with PTI were reading self-help books and education level. Conclusion: The results show that PTI affects perceptions about the cancer, its etiology and treatment. This effect is greater in undereducated people and in self-help book readers. The instrument showed excellent reliability, internal consistency, discriminating power, content, and construct validity properties.

Healthcare Inequities Experienced by Patients with Cancer: A Qualitative Study in Medellín, Colombia.

Purpose: This study aimed to understand the lived experiences of patients with cancer that facing inequities in oncological care in the city of Medellín. Patients and Methods: A qualitative study was conducted based on the theoretical and methodological elements of the grounded theory, specifically the description and conceptual ordering of Corbin and Strauss. Sixteen patients with cancer, who belonged to low (n=5), middle (n=4) and high (n=7) social classes, were included by theoretical sampling with category saturation. Data were collected using semi-structured interviews and analyzed in a category system based on the three social classes. Results: The patients were aged between 23 and 71 years old, and they were diagnosed with different types of cancer such as breast, cervical, prostate, stomach, leukemia and lymphoma. Patients' experiences showed that diagnosis, specialized care, treatment and hospital discharge were different based on their social class. Conclusion: Patients' lived experiences associated with cancer reflect complex social situations, in which social determinants affect the level of citizens' empowerment and self-management against the risks of get disease and die. Being part of low and middle social classes meant being subjected to a dehumanized, cold, impersonal and discontinuous treatment, in which healthcare was focused on the disease instead of individuals' preferences and values. In contrast, patients belonging to the high class had the resources necessary to face risks, which ensured access to more humanized and individualized healthcare.

Air Pollution and Cardiorespiratory Changes in Older Adults Living in a Polluted Area in Central Chile.

One recognized cause of cardiorespiratory diseases is air pollution. Older adults (OA) are one of the most vulnerable groups that suffer from its adverse effects. The objective of the study was to analyze the association between exposure to air pollution and changes in cardiorespiratory variables in OA. Observational prospective cohort study. Health questionnaires, blood pressure (BP) measurements, lung functions, respiratory symptoms, physical activity levels, and physical fitness in high and low exposure to air pollution were all methods used in evaluating OAs in communes with high contamination rates. Linear and logistic models were created to adjust for variables of interest. A total of 92 OA participated in this study. 73.9% of the subjects were women with 72.3 ± 5.6 years. 46.7% were obese, while 12.1% consumed tobacco. The most prevalent diseases found were hypertension, diabetes, and cardiovascular disease. Adjusted linear models maintained an increase for systolic BP of 6.77 mmHg (95% CI: 1.04-12.51), and diastolic of 3.51 mmHg (95% CI: 0.72-6.29), during the period of high exposure to air pollution. The adjusted logistic regression model indicated that, during the period of high exposure to air pollution increase the respiratory symptoms 4 times more (OR: 4.43, 95% CI: 2.07-10.04) in the OA. The results are consistent with an adverse effect on cardiorespiratory variables in periods of high exposure to air pollution in the OA population.

Standard method for performing positron emission particle tracking (PEPT) measurements of froth flotation at PEPT Cape Town.

Positron emission particle tracking (PEPT) is a technique for measuring the motion of tracer particles in systems of flow such as mineral froth flotation. An advantage of PEPT is that tracer particles with different physical properties can be tracked in the same experimental system, which allows detailed studies of the relative behaviour of different particle classes in flotation. This work describes the standard operating protocol developed for PEPT experiments in a flotation vessel at PEPT Cape Town in South Africa. A continuously overflowing vessel with constant air recovery enables several hours of data acquisition at steady state flow and consistent flotation conditions. Tracer particles are fabricated with different coatings to mimic mineral surface hydrophobicity and size, and a data treatment derived from a rotating disk study is utilized to produce high frequency (1 kHz) location data relative to the tracer activity. Time averaging methods are used to represent the Eulerian flow field and occupancy of the tracer behaviour based on voxel schemes in different co-ordinate systems. The average velocity of the flow in each voxel is calculated as the peak of the probability density function to represent the peak of asymmetrical or multimodal distributions.•A continuously overflowing flotation vessel was developed for extended data acquisition at steady state flow.•The data treatment enabled the direct comparison of different particle classes in the flotation vessel.•The solids flow fields was described by the probability density function of tracer particle velocity measured in different voxel schemes.

Preferences in a Group of Patients with Cancer: A Grounded Theory.

PURPOSE: This study was conducted to understand the preferences of patients with cancer in Medellin, Colombia. METHODS: A qualitative approach based on the theoretical and methodological resources of the grounded theory was conducted. Between June 2020 and March 2021, patients over 18 years old with a confirmed diagnosis of cancer within the past 2 years treated in Medellin, Colombia, were selected. Theoretical saturation sampling was performed. Each participant was interviewed between 2 and 3 times in accordance with the open, axial, and selective coding of the grounded theory. RESULTS: A common preference set emerged in all patients related to the attributes of healthcare professionals and is a category that unites their scientific and humanistic aspects. On the other hand, very heterogeneous preferences were presented that were associated with the doctor-patient relationship and the therapeutic objectives. In the doctor-patient relationship, there are those who adhere to a paternalistic model and those who opt for an informative model. In therapeutic objectives, two subcategories emerged: those who are inclined to preserve life and those who accord more value to the quality of life. CONCLUSION: The categories that emerged illustrate the complexity and challenges of the preferences of patients with cancer in theoretical and experiential terms for social studies of medicine, philosophy, and bioethics. From medical social studies, it's emphasized that the experiences of dehumanization are constant, which generates shared preferences in the patients related to the ideal of the medical professional. From the philosophical perspective, the care received by patients coincides with what was called medicine for slaves in ancient Greece, insofar as patients are not assumed to be free subjects. With respect to bioethics, some ideas are raised contrary to the support of individual autonomy; relational autonomy and the respect for the person above the autonomy itself are advocated.

Tendencias en la formación y praxis médicas en colombia

En la formación en medicina existen múltiples textos sobre el futuro de la disciplina, la mayoría realizan la prospectiva a partir de temáticas específicas como las limitaciones en el conocimiento fisiopatológico, etiológico o terapéutico de algunas enfermedades, los usos de la investigación científica, la articulación con las ingenierías y el desarrollo tecnológico, la necesidad de una enseñanza y praxis que vincule los desarrollos científicos con consideraciones éticas y humanistas, entre otros. Sin embargo, son poco analizadas las tendencias de la formación y praxis médica con base en teorías de mayor amplitud o alcance. Por ello, este ensayo describe brevemente tres cuerpos teóricos que resultan útiles para pensar el presente y futuro de la medicina, estos son: la medicina basada en la evidencia y centrada en la persona, las humanidades médicas y los determinantes sociales de la salud, como tres grupos de teorías sólidas para la formación y praxis médicas en Colombia.

Problemas en la práctica clínica: los retos de la medicina basada en la evidencia / Problems in clinical practice: the challenges of evidence-based medicine

Resumen El desarrollo de este artículo de reflexión surge tras el análisis de la práctica médica cotidiana donde se evidencian discrepancias entre estudiantes de medicina, docentes clínicos, médicos generales y especialistas en áreas médicas, en lo que corresponde a la marcada variabilidad en los enfoques terapéuticos en el personal clínico asistencial. Adicionalmente los conflictos derivados de la no aplicación de la medicina basada en evidencia por resistencia de ciertos profesionales de la salud, junto a las limitaciones de aplicabilidad de la misma en nuestro contexto socio-económico en particular, conduce al desarrollo de conflictos que dificultan la atención de los pacientes, distancian el personal médico, limitan el aprendizaje en las áreas clínicas, además de producir una perspectiva no integral ya que en la mayoría de las ocasiones se impone la decisión clínica sobre los valores y preferencias de los usuarios, cuestión además poco explorada dentro del ámbito académico. MÉD.UIS.2020;33(1): 59-65.

Abstract The development of this reflexion article emerges after the analysis of everyday medical praxis, where disagreements between medical students, clinical teachers, general practitioners and specialists in clinical areas are noted, which corresponds to the strong variability between therapeutic approaches from the clinical assistance personnel. Additionally, the conflicts deriving from the non-application of the Evidence-based Medicine due to the resistance of certain health professionals, along with the limitations in its applicability in our particular socioeconomic context, drives to the development of conflicts that make difficult the patient's attention, create distances between the medical staff, limit learning in clinical areas, and produce a non-integral perspective, because in the majority of occasions, clinical decision is imposed over the values and preferences of users, a matter that is rarely explored inside the academic scope. MÉD. UIS.2020;33(1): 59-65.

Ensuring electronic medical record simulation through better training, modeling, and evaluation.

OBJECTIVE: Electronic medical records (EMRs) can support medical research and discovery, but privacy risks limit the sharing of such data on a wide scale. Various approaches have been developed to mitigate risk, including record simulation via generative adversarial networks (GANs). While showing promise in certain application domains, GANs lack a principled approach for EMR data that induces subpar simulation. In this article, we improve EMR simulation through a novel pipeline that (1) enhances the learning model, (2) incorporates evaluation criteria for data utility that informs learning, and (3) refines the training process. MATERIALS AND METHODS: We propose a new electronic health record generator using a GAN with a Wasserstein divergence and layer normalization techniques. We designed 2 utility measures to characterize similarity in the structural properties of real and simulated EMRs in the original and latent space, respectively. We applied a filtering strategy to enhance GAN training for low-prevalence clinical concepts. We evaluated the new and existing GANs with utility and privacy measures (membership and disclosure attacks) using billing codes from over 1 million EMRs at Vanderbilt University Medical Center. RESULTS: The proposed model outperformed the state-of-the-art approaches with significant improvement in retaining the nature of real records, including prediction performance and structural properties, without sacrificing privacy. Additionally, the filtering strategy achieved higher utility when the EMR training dataset was small. CONCLUSIONS: These findings illustrate that EMR simulation through GANs can be substantially improved through more appropriate training, modeling, and evaluation criteria.

El fitness: estilo de vida saludable o biopolítica sobre el cuerpo desde la racionalidad neoliberal / Fitness: healthy lifestyle or biopolitics on body from neoliberal rationality

RESUMEN Dentro de la salud pública y la práctica médica se ha pasado por alto consideraciones importantes referentes a la filosofía de la técnica en los estilos de vida y el fitness. Esto ha llevado a que dichas nociones suelan vincularse con perspectivas individualistas en las que se hace notorio un "vacío social". En este artículo presentamos una reflexión en torno a las tecnologías de optimización corporal. Dicho constructo busca resaltar la articulación de elementos técnicos, discursivos, simbólicos y políticos en la producción social del cuerpo; especialmente en el ámbito del fitness y los estilos de vida saludables. Realizamos un desarrollo conceptual de estos términos para efectos de explicitar el trasfondo político que los moviliza. Este trabajo reviste importancia para la salud pública y la medicina en la medida en que permite indagar por las concepciones individualistas subyacentes a la noción de estilos de vida vinculándolas a mecanismos biopolíticos más amplios que operan dentro de la agenda neoliberal.

SUMMARY Inside Public Health and Medicine have been ignored important considerations about philosophy of technique in lifestyles and fitness. This has meant that such notions be linked to individualistic perspectives where a social vacuum is highlighted. In this paper we present a reflection about Body Improvement Technology. This construct seeks to highlight the articulation of technical, discursive, symbolic and political elements in the social production of the body, especially in the field of fitness and healthy lifestyles. We carry out a conceptual development of these terms in order to make explicit the political mechanism that mobilizes them. This work is important for Public Health and Medicine insofar as it allows us to investigate the individualist conceptions underlying the notion of lifestyles, linking them to broader biopolitical forces that operate within the neoliberal agenda.

A Distributed Framework for the Construction of Transport Maps.

The need to reason about uncertainty in large, complex, and multimodal data sets has become increasingly common across modern scientific environments. The ability to transform samples from one distribution P to another distribution Q enables the solution to many problems in machine learning (e.g., Bayesian inference, generative modeling) and has been actively pursued from theoretical, computational, and application perspectives across the fields of information theory, computer science, and biology. Performing such transformations in general still leads to computational difficulties, especially in high dimensions. Here, we consider the problem of computing such "measure transport maps" with efficient and parallelizable methods. Under the mild assumptions that P need not be known but can be sampled from and that the density of Q is known up to a proportionality constant, and that Q is log-concave, we provide in this work a convex optimization problem pertaining to relative entropy minimization. We show how an empirical minimization formulation and polynomial chaos map parameterization can allow for learning a transport map between P and Q with distributed and scalable methods. We also leverage findings from nonequilibrium thermodynamics to represent the transport map as a composition of simpler maps, each of which is learned sequentially with a transport cost regularized version of the aforementioned problem formulation. We provide examples of our framework within the context of Bayesian inference for the Boston housing data set and generative modeling for handwritten digit images from the MNIST data set.

The Use of Cardiac Orienting Responses as an Early and Scalable Biomarker of Alcohol-Related Neurodevelopmental Impairment.

BACKGROUND: Considered the leading cause of developmental disabilities worldwide, fetal alcohol spectrum disorders (FASD) are a global health problem. To take advantage of neural plasticity, early identification of affected infants is critical. The cardiac orienting response (COR) has been shown to be sensitive to the effects of prenatal alcohol exposure and is an inexpensive, easy to administer assessment tool. The purpose of this study was to evaluate the COR effectiveness in assessing individual risk of developmental delay. METHODS: As part of an ongoing longitudinal cohort study in Ukraine, live-born infants of women with some to heavy amounts of alcohol consumption in pregnancy were recruited and compared to infants of women who consumed low or no alcohol. At 6 and 12 months, infants were evaluated with the Bayley Scales of Infant Development-II. CORs were also collected during a habituation/dishabituation learning paradigm. Using a supervised logistic regression classifier, we compared the predictive utility of the COR indices to that of the 6-month Bayley scores for identification of developmental delay based on 12-month Bayley scores. Heart rate collected at each second (Standard COR) was compared to key features (Key COR) extracted from the response. RESULTS: Negative predictive values (NPV) were 85% for Standard COR, 82% for Key COR, and 77% for the Bayley, and positive predictive values (PPV) were 66% for Standard COR, 62% for Key COR, and 43% for the Bayley. CONCLUSIONS: Predictive analysis based on the COR resulted in better NPV and PPV than the 6-month Bayley score. As the resources required to obtain a Bayley score are substantially more than in a COR-based paradigm, the findings are suggestive of its utility as an early scalable screening tool based on the COR. Further work is needed to test its long-term predictive accuracy.

Representaciones sociales sobre el cuerpo en estudiantes de Medicina, Medellín, 2014 / Social representations of the body in medical students, Medellín, 2014 / Representações sociais sobre o corpo em estudantes de Medicina, Medellín, 2014

Introducción: los discursos filosóficos y socioantropológicos sobre el cuerpo no han sido objeto de interés en la formación médica. Objetivo: caracterizar las representaciones sociales del cuerpo en estudiantes de Medicina, Medellín, 2014. Métodos: etnografía con 11 estudiantes seleccionados mediante muestreo teórico. Las representaciones sociales se estudiaron desde el enfoque procesual. Se aplicaron los criterios de rigor metodológico de credibilidad, auditabilidad y transferibilidad. Resultado: se describen tres categorías analíticas: 1) concepciones del cuerpo que incluyó las subcategorías ''dominio material'' y ''dominio simbólico''; 2) importancia del cuerpo descrita a partir de las subcategorías ''cuerpo como medio y objeto'' y ''cuerpo como definición del yo''; 3) cuidado del cuerpo con tres subcategorías: ''importancia del autocuidado'', ''el cuerpo de los otros'' y ''prácticas de autocuidado''. Conclusión: la concepción organicista del cuerpo pone al descubierto cómo los estudiantes de Medicina comprenden al otro a partir de principios estrictamente biológicos; epistemológicamente se muestra que los estudiantes son vectores de tradiciones cartesianas carentes de una conciencia histórica en torno a las representaciones del cuerpo; política y socialmente las ideas del grupo se alinean con racionalidades neoliberales que vindican la mercantilización, tecnificación e individuación del cuerpo.

Introduction: Philosophical and socio-anthropological discourses about the body have not been of interest in medical formation. Objective: To understand the social representations of the body in medical students, Medellin, 2014. Methods: Ethnography with 11 students selected by theoretical sampling. Social representations were studied with the procedural approach. Methodological rigor criteria of credibility, auditability and transferability were applied. Results: Three analytical categories were analyzed: 1) conceptions of the body which included the subcategories ''biological'' and ''symbolic'' dimensions of the body''; 2) importance of the body described from the subcategories ''body as medium and object'' and ''body as definition of Ego''; 3) care of the body with three subcategories: ''importance of self-care'', ''the body of the other'', ''self-care practices''. Conclusion: The organismic conception of the body reveals how medical students understand the other from strictly biological principles; epistemologically it is evident that students are Cartesian vectors lacking historical awareness about the representations of the body; politically and socially the group is aligned with neoliberal rationalities that vindicate marketization, modernization and individuation of the body.

Introdução: os discursos filosóficos e sócio-antropológicos sobre o corpo não foram objeto de interesse na formação médica. Objetivo: caracterizar as representações sociais do corpo em estudantes de Medicina, Medellín, 2014. Métodos: etnografia com 11 estudantes selecionados mediante amostragem teórica. As representações sociais se estudaram desde o enfoque processual. Aplicaram- se os critérios de rigor metodológico de credibilidade, audibilidade e transferibilidade. Resultado: descrevem-se três categorias analíticas: 1) concepções do corpo que incluiu as subcategorias ''domínio material'' e ''domínio simbólico''; 2) importância do corpo descrito a partir das subcategorias ''corpo como meio e objeto'' e ''corpo como definição do eu''; 3) cuidado do corpo com três subcategorias: ''importância do autocuidado'', ''o corpo dos outros'' e ''práticas de autocuidado''. Conclusão: a concepção organicista do corpo põe ao descoberto como os estudantes de Medicina compreendem ao outro a partir de princípios estritamente biológicos; epistemologicamente se mostra que os estudantes são vectores de tradições cartesianas carentes de uma consciência histórica em torno das representações do corpo; política e socialmente as ideias do grupo se alinham com racionalidades neoliberais que vindicam a mercantilização, tecnificação e individuação do corpo.

Hematoma retroperitoneal tras punción lumbar diagnóstica. Caso clínico / Retroperitoneal haematoma following diagnostic lumbar puncture. Clinical case

Introduction: Iatrogenic retroperitoneal haematoma is an infrequent but serious complication of certain surgical procedures. Case presentation: We present the case of a female who developed retroperitoneal haemorrhage after an intradural lumbar puncture, resulting in multiple-organ failure. The diagnosis and treatment of this complication was more difficult than usual because of the presence of bilateral subclavian artery stenosis. Conclusion: Early diagnosis and prompt treatment with either conservative or interventional management is essential in order to decrease associated morbidity. Bilateral non-invasive arterial pressure measurements should be routinely performed in all cases, especially in patients with peripheral artery disease.

Introducción: El hematoma retroperitoneal iatrogénico es una complicación infrecuente pero, en ocasiones, de consecuencias fatales. Presentación del caso: En este artículo describimos el caso de una mujer que sufrió una hemorragia retroperitoneal secundaria a una punción lumbar intradural con evolución hacia el fallo multiorgánico, agravado en su manejo por la presencia de estenosis bilateral de arterias subclavias que dificultó el diagnóstico y el tratamiento. Conclusión: Un diagnóstico precoz y certero del hematoma retroperitoneal, unido a las medidas de soporte necesarias y a un abordaje quirúrgico eficiente cuando se requiera, se antojan fundamentales para evitar un desenlace mortal. Por otro lado, la medición de la presión arterial de forma bilateral debe ser una medida rutinaria en todos los pacientes, pero más aún en aquellos casos con enfermedad arterial periférica.

Efficacy of different doses of sugammadex after continuous infusion of rocuronium.

AIM: To evaluate the effects of two different doses of sugammadex after maintenance anesthesia with sevofluorane and remifentanil and deep rocuronium-induced neuromuscular blockade (NMB). METHODS: Patients between 20 and 65 years of age, with American Society of Anesthesiologists physical status classification I-II, undergoing gynecological surgery were included in a prospective, comparative and randomized study. NMB was induced with an injection of 0.6 mg/kg of rocuronium followed by continuous infusion of 0.3-0.6 mg/kg per hour to maintain a deep block. Anesthesia was maintained with sevofluorane and remifentanil. Finally, when surgery was finished, a bolus of 2 mg/kg (group A) or 4 mg/kg (group B) of sugammadex was applied when the NMB first response in the train-of-four was reached. The primary clinical endpoint was time to recovery to a train-of-four ratio of 0.9. Other variables recorded were the time until recovery of train-of-four ratio of 0.7, 0.8, hemodynamic variables (arterial blood pressure and heart rate at baseline, starting sugammadex, and minutes 2, 5 and 10) and adverse events were presented after one hour in the post-anesthesia care unit. RESULTS: Thirty-two patients were included in the study: 16 patients in group A and 16 patients in group B. Only 14 patients each group were recorded because arterial pressure values were lost in two patients from each group in minute 10. The two groups were comparable. Median recovery time from starting of sugammadex administration to a train-of-four ratio of 0.9 in group A and B was 129 and 110 s, respectively. The estimated difference in recovery time between groups was 24 s (95%CI: 0 to 45 s, Hodges-Lehmann estimator), entirely within the predefined equivalence interval. Times to recovery to train-of-four ratios of 0.8 (group A: 101 s; group B: 82.5 s) and 0.7 (group A: 90 s; group B: 65 s) from start of sugammadex administration were not equivalent between groups. There was not a significant variation in the arterial pressure and heart rate values between the two groups and none of the patients showed any clinical evidence of residual or recurrent NMB. CONCLUSION: A dose of 2 mg/kg of sugammadex after continuous rocuronium infusion is enough to reverse the NMB when first response in the Train-Of-Four is reached.

Representaciones del cuerpo en la era de la tecnociencia: una reflexión ética / Representations of the body in the age of techno science: an ethical reflection / Representações do corpo na era datecnociência: reflexão ética

Tres cuestiones se analizan en el presente artículo. Primero, la formación del cuerpo-máquina del mundo moderno, es decir, el modelamiento de la existencia conforme a una racionalidadtecnológica agenciada y administrada por instituciones modernas como la familia, la escuela, el trabajo y la clínica. Segundo, la implantación en la vida del dualismo sujeto-objeto, cuestiónque será gestionada por la medicina y la razón técnico-científica, pilares primordiales de la época moderna. Culturalmente el hombre pasará a tener una relación antagónica con las cosasy con los otros. A partir de esto se establecerá una relación vertical con el “mundo de la vida”, donde lo importante es el control, la manipulación y el dominio de la naturaleza a través de la técnica. Por último, se evidencia el problema ético que surge ante el establecimiento de esta forma de racionalidad, poderosos dispositivos que encubren, ocultan y desvían el existir deese “mundo vital”...

Three things are analyzed in this text. First, the formation of the machine-body of the modern world, it means, the modeling of the existence according to a technologic rationality wangled andadministered by modern institutions like the family, the school, the job and the clinic. Second, the implantation in the life of subject-object dualism, matter which will be administered and initiated by medicine and scientific technical reason, main pillars of the modern age. Culturally the humankind will have an antagonistic relationship with the things, the nature and the others. With this, it will be established a vertical relationship with “world of life” where really important is the control, manipulation, the domain and the maintenance of order trough thetechnique. Finally, it becomes evident the ethic problem which comes out before the establishment of a way of rationality that covers up, hide and changes the existing of that “vital world”...

Três questões são analisadas no presente artigo. Primeiro, a formação do corpo-máquina do mundo moderno, isto é, a modelização da existência em conformidade com uma racionalidadetecnológica agenciada e administrada por instituições modernas como a família, a escola, o trabalho e a clínica. Segundo, a implantação na vida do dualismo sujeito-objeto, questão queserá gerida e controlada pela medicina e a razão técnico-científica, pilares primordiais da época moderna. Culturalmente o homem passará a ter uma relação antagônica com as coisas e com os outros. A partir disto se estabelecerá uma relação vertical com o “mundo da vida”, onde o importante é o controle, a manipulação e o domínio da natureza através da técnica. Por último,aborda-se o problema ético que surge diante do estabelecimento desta forma de racionalidade, poderosos dispositivos que encobrem, ocultam e desviam o existir desse “mundo vital”...