Epidemiological characterization of clubfoot: a population-based study of a surveillance program in Colombia.

Clubfoot is a common musculoskeletal congenital abnormality, with a prevalence of 5-20 cases per 10 000 live births in low to middle-income countries. If left untreated, clubfoot causes severe consequences for the child: gait disturbances, reduced quality of life, and limited work opportunities. Our objective was to characterize clubfoot and determine its prevalence and associated risk factors in Bogotá and Cali, Colombia, from 2002 to 2020. A retrospective case-control study design was employed, analyzing data from birth defect reports provided by the Program for the Prevention and Follow-up of Congenital Defects and Orphan Diseases surveillance system. Cases included live births or stillbirths with clubfoot, while controls consisted of infants without congenital abnormalities, matched in terms of birth date and hospital. Prevalence was calculated considering a 95% confidence interval using Poisson distribution, and risk factors were assessed through adjusted odds ratios obtained by logistic regression model. Of 558 255 births, 861 cases of clubfoot were identified, 48.20% were postural clubfoot, and 15 cases were syndromic clubfoot. In Bogota, prevalence rate was 15.1 per 10 000 live births, whereas in Cali it was 17.29 per 10 000 live births. Family history of clubfoot within first-degree relatives was identified as a risk factor for clubfoot. Investigating risk factors for clubfoot holds significant importance in terms of preventing and reducing morbidity within this population. Helping to drive government and healthcare initiatives aimed at providing timely and effective treatment.

A case-control study characterizing polydactyly risk factors in Bogotá and Cali, Colombia between 2002 and 2020.

BACKGROUND: Polydactyly is a congenital abnormality characterized by the presence of additional fingers on one or more extremities. In Colombia, polydactyly accounted for 17% of musculoskeletal congenital abnormalities in 2021, with a prevalence of 6.03 per 10,000 live births. The purpose of this study was to determine the prevalence of polydactyly and identify associated risk factors in Bogotá and Cali, Colombia, from 2002 to 2020. METHODS: A retrospective case-control study design was employed, analyzing data from birth defect reports provided by the Program for the Prevention and Follow-up of Congenital Defects and Orphan Diseases surveillance system. Cases included live births or stillbirths with polydactyly, while controls consisted of infants without congenital abnormality, matched in terms of birth date and hospital. Prevalence of polydactyly was calculated and risk factors were assessed through odds ratios obtained by logistic regression models, considering a 95% confidence interval. RESULTS: Among the 558,255 births included in the study, 848 cases of polydactyly were identified, resulting in a prevalence rate of 15.19 per 10,000 live births. Risk factors associated with polydactyly included male newborn sex, pregestational diabetes, and a family history of malformation among first-degree relatives. CONCLUSION: These findings highlight the importance a surveillance system aimed to characterize populations with congenital abnormalities, providing a better option for analyzing risk factors, help improving prevention, diagnosis, notification, and optimal treatment in patients.

Atrial approaches in mitral valve surgery: a propensity analysis of differences in the incidence of clinically relevant adverse effects.

BACKGROUND: The lack of evidence on complications using mitral valve approaches leaves the choice of risk exposure to the surgeon's preference, based on individual experience, speed, ease, and quality of exposure. METHODS: The present study analysed patients undergoing mitral valve surgery using a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first-time elective mitral valve procedures, isolated, or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. The primary endpoint was the association between the superior transeptal approach and clinically significant adverse outcomes, including arrhythmias, need for a permanent pacemaker, cerebrovascular events, and mortality. RESULTS: A total of 652 patients met the inclusion criteria; 391 received the left atrial approach, and 261 received the superior transseptal approach. After matching, 96 patients were compared with 69 patients, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias or the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, but the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period or in the long-term follow-up. CONCLUSION: We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome. Therefore, the superior transeptal approach is useful and safe for mitral valve exposure.

Evaluación etológica del enriquecimiento con grillos (Acheta domesticus) y gusanos rey (Zophobas morio) en monos Churucos (Lagothrix lagotricha) mantenidos en cautiverio / Ethological evaluation of enrichment with crickets (Acheta domesticus) and king worms (Zophobas morio) in Churucos monkeys (Lagothrix lagotricha) kept in captivity / Avaliação etológica do enriquecimento com grilo-doméstico (Acheta domesticus) e superverme (Zophobas morio) em Macaco-Barrigudo (Lagothrix lagotricha) mantidos em cativerio

Resumen El cautiverio de animales silvestres produce importantes alteraciones conductuales y fisiológicas, derivadas, entre otras, de la restricción de espacio y limitada variedad alimenticia, por lo que resulta necesario el establecimiento continuo de estrategias de compensación como los enriquecimientos. La investigación tuvo como objetivo la evaluación etológica de enriquecimientos con grillos (Acheta domesticus) y gusano rey (Zophobas morio) en especímenes de monos churuco (Lagothrix lagotricha) albergados en la Unidad de Apoyo Hogar de Paso para Fauna Silvestre de la Universidad de la Amazonía, ubicada en el perímetro rural de Florencia - Caquetá, Colombia. Para su desarrollo se implementó un bioterio para la reproducción de los invertebrados utilizados en los enriquecimientos, y se trabajó con 16 especímenes primates (ocho machos y ocho hembras), para cuyo seguimiento conductual se instauraron etogramas durante 11 semanas, de las cuales, en las cuatro primeras no se aplicaron enriquecimientos con el fin de identificar el patrón conductual inicial. El análisis de las interacciones entre las variables conductuales estudiadas (alimentación, locomoción, interacciones sociales, descanso, alerta, cuidado y actividades varias), se realizó mediante la prueba LSD de Fisher (α=0,05); para identificar diferencias entre los factores fijos para cada una de las variables se empleó un análisis de varianza y se desarrolló adicionalmente un análisis de componentes principales. Como resultado principal se encontró que la implementación de los enriquecimientos generó un incremento en el tiempo de inversión para las categorías de alimentación, locomoción, interacciones sociales y actividades varias; y una disminución en la categoría de descanso, logrando así una efectiva motivación para la aparición de conductas naturales de la especie.

Abstract The captivity of wild animals produces important behavioral and physiological alterations, derived, among others, from the restriction of space and limited food variety, for which the continuous establishment of compensation strategies such as enrichment is necessary. The objective of the research was the ethological evaluation of enrichment with crickets (Acheta domesticus) and king worm (Zophobas morio) in specimens of churuco monkeys (Lagothrix lagotricha) housed in the support unit, Hogar de Paso para Fauna Silvestre of the Universidad de la Amazonía, located in the rural area of Florencia - Caquetá, Colombia. For its development, a vivarium was implemented for the reproduction of the invertebrates used in the enrichments, and work was done with 16 primate specimens (eight males and eight females), for whose behavioral monitoring ethograms were established for 11 weeks, of which, in the first four were not enriched to identify the initial behavioral pattern. The analysis of the interactions between the behavioral variables studied (feeding, locomotion, social interactions, rest, alertness, care and various activities), was performed using Fisher's LSD test (α=0.05); to identify differences between the fixed factors for each of the variables studied, an analysis of variance was used, and a principal components analysis was also developed. As a main result, it was found that the implementation of the enrichments generated an increase in the investment time for the categories of food, locomotion, social interactions and various activities; and a decrease in the category of rest, thus achieving an effective motivation for the appearance of natural behaviors of the species.

Resumo O cativeiro de animais silvestres gera importantes alterações comportamentais e fisiológicas, resultante, entre outras, pela restrição do espaço e a limitada variedade alimentar, para as quais foi necessário o desenvolvimento contínuo de estratégias de compensação como o enriquecimento nutricional. O objetivo desta pesquisa foi a avaliação etológica do enriquecimento com grilos-domésticos (Acheta domesticus) e superverme (Zophobas morio) em espécimes de macacos-barrigudos (Lagothrix lagotricha) alojados na unidade de apoio, Hogar de Paso para Fauna Silvestre, da Universidade da Amazônia, localizada na zona rural de Florência - Caquetá, Colômbia. Para o seu desenvolvimento, foi implementado um biotério para a reprodução dos invertebrados utilizados nos enriquecimentos, e trabalhou-se com 16 espécimes de macacos (oito machos e oito fêmeas), nos quais os etogramas de acompanhamento comportamental foram estabelecidos durante 11 semanas, das quais, as quatro primeiras não foram enriquecidos para identificar o padrão comportamental inicial. A análise das interações entre as variáveis comportamentais estudadas (alimentação, locomoção, interações sociais, repouso, estado de alerta, cuidados e atividades diversas), foram realizadas por meio do teste LSD de Fisher (α=0,05); para identificar diferenças entre os fatores fixos para cada uma das variáveis estudadas, foi utilizada a análise de variância e realizou-se análise de componentes principais. Como principal resultado, se estabeleceu que a implementação dos enriquecimentos gerou um aumento no tempo utilizado para as categorias de alimentação, locomoção, interações sociais e atividades diversas; e uma diminuição na categoria de recuperação, conseguindo assim uma motivação efetiva para o desenvolvimento de comportamentos naturais dessa especie.

Factores asociados: características clínicas, microbiológicas y perfiles de resistencia en infecciones urinarias asociadas a catéter en dos hospitales de alta complejidad / Associated factors clinical and microbiological characteristics and resistance profiles in catheter-associated urinary tract infections in two highly complex hospitals

Resumen Objetivo: Determinar los factores asociados, las características clínicas, microbiológicas y perfiles de resistencia en las infecciones sintomáticas de tracto urinario asociado a catéter (ISTU-AC) en los dos Instituciones de alto nivel de complejidad. Materiales y métodos: Se llevó a cabo un estudio de casos y controles. Se incluyeron todos los pacientes con más de 48 horas de hospitalización con inserción de catéter urinario y se recolectaron todas las variables clínicas y microbiológicas de cada paciente. Se incluyeron 446 pacientes, 223 con infección sintomática del tracto urinario asociado a catéter. El análisis multivariado se realizó por medio de regresión logística. Resultados: Se evidenció una mayor proporción de hombres en los controles (60,5%) en comparación con los casos (51,1%), la mediana de la edad fue muy similar para los dos grupos de estudio. Se evidenció por el análisis de regresión logística multivariado que la estancia en UCI (OR 2,176; IC de 95% 1,332 - 3,555), más de 10 días de catéter urinario (OR 2,907; IC de 95% 1,744 - 4,846) y la terapia antibiótica previa (OR 0,060; IC de 95% 0,037 - 0,103) fueron los principales factores asociados con la ocurrencia de ISTU-AC. No se encontró asociación entre presentar el evento de interés y la edad, esta variable no está relacionada con la pre sencia de infecciones intrahospitalarias. Es probable que las comorbilidades, presentes con más frecuencia en el adulto mayor, hayan sobrepasado el efecto de la edad en esos estudios. La asociación con género no fue identificada como un factor de riesgo, lo cual podría esperarse, dado que el uso de la sonda vesical hace equiparable el riesgo entre los hombres y las mujeres. Conclusiones: Este estudio mostró que la infecciones sintomáticas de tracto urinario asociado a catéter sigue siendo la entidad más frecuente) en el ámbito hospi talario, poniendo en riesgo la seguridad de los pacientes y aumentando tanto las tasas de morbi-mortalidad

Summary Objective: To determine the associated factors, clinical and microbiological characteristics, and resistance profiles in symptomatic urinary tract infections associated with catheters in the two institutions with a high level of complexity. Materials and methods: A case-control study was carried out. All patients with more than 48 hours of hospitalization with urinary catheter insertion were included and all the clinical and microbiological variables of each patient were collected. 446 patients were included, 223 with symptomatic urinary tract infection associated with a catheter. The multivariate analysis was carried out by means of logistic regression. Results: A greater proportion of men was evidenced in the controls (60.5%) compared to the cases (51.1%), the median age was very similar for the two study groups. It was evidenced by the multivariate logistic regression analysis that the stay in the ICU (OR 2.176; 95% CI 1.322 - 3.555), more than 10 days of urinary catheter (OR 2.907; 95% CI 1.744 - 4.846) and antibiotic therapy previous (OR 0.060; 95% CI 0.037 - 0.103) were the main factors associated with the occurrence of CA-UTI. No association was found between presenting the event of interest and age, this variable is not related to the presence of intrahospital infections. Co morbidities, which are more frequently present in the elderly, are likely to have outweighed the effect of age in these studies. The association with gender was not identified as a risk factor, which could be expected, since the use of the urinary catheter makes the risk comparable between men and women. Conclusions: This study showed that symptomatic urinary tract infections associated with catheters are still a frequent entity in the hospital setting, putting the safety of patients at risk and increasing both morbidity and mortality rates

Standardized Nutritional Intervention in Patients with COVID-19 Admitted to a Hospital in Bogotá, Colombia / Intervención nutricional estandarizada en pacientes hospitalizados por COVID-19 admitidos en un Hospital en Bogotá, Colombia

Summary Background: Patients with coronavirus disease 2019 (COVID-19) present an increase in oxidative stress, characterized by the production of reactive oxygen species and a concomitant deficiency of antioxidants. There are multiple defense mechanisms including enzymatic scavengers and non-enzymatic molecules (glutathione and vitamins A, C, D, E, and zinc). Methods: In this observational, cross-sectional, retrospective study, we aimed to describe the clinical behavior of patients hospitalized due to COVID-19 (those trea ted with a standardized nutritional intervention versus those who received the COVID-19 standard treatment available at the time). A total of 214 medical records of patients hospitalized due to COVID-19 who required nutritional intervention were analyzed. Descriptive analyses of continuous and categorical variables were performed, and an ANOVA test was performed for numerical variables. A logistic regression model and a propensity score matching determined the differences between the matched groups. Findings: 33·6% of the patients were admitted to the Intensive Care Unit (ICU), 28·5% required invasive mechanical ventilation, and the overall mortality was 19·6%. 44·8% of the patients received the standardized nutritional intervention. There were no statistically significant differences between intervention groups, except for the intervention time, in which the standardized nutritional intervention (days) was identified as a protective factor OR=0·550 (p <0·05; CI=0·324-0·936). Conclusions: This is the first study in Colombia to consider a standardized nutritional intervention in patients hospitalized due to COVID-19. Despite not being able to meet the primary objectives, controlled experiments must be carried out to determine the role and possible therapeutic effects of micro and macronutrients in patients with COVID-19.

Resumen Antecedentes: los pacientes con enfermedad por coronavirus 2019 (COVID-19) presentan un aumento del estrés oxidativo, caracterizado por la producción de especies reactivas de oxígeno y una deficiencia concomitante de antioxidantes. Existen múltiples mecanismos de defensa que incluyen eliminadores enzimáticos y moléculas no enzimáticas (glutatión y vitaminas A, C, D, E y zinc). Métodos: En este estudio observacional, transversal y retrospectivo, el objetivo fue describir el comportamiento clínico de los pacientes hospitalizados por CO VID-19 (aquellos tratados con una intervención nutricional estandarizada versus aquellos que recibieron el tratamiento estándar COVID-19 disponible en el tiempo). Un total de 214 historias clínicas de los pacientes hospitalizados por COVID-19 que requirieron intervención nutricional. Se realizaron análisis descriptivos de variables continuas y categóricas. Se realizó una prueba de ANOVA para las variables numéricas. Un modelo de regresión logística y un emparejamiento por puntuación de propensión determinaron las diferencias entre los grupos emparejados. Resultados: el 33,6% de los pacientes ingresaron en la Unidad de Cuidados Intensivos (UCI), el 28,5% requirió ventilación mecánica invasiva y la mortalidad global fue del 19,6%.44 · 8% de los pacientes recibieron la intervención nutricional estandarizada. No hubo diferencias estadísticamente significativas entre los grupos de intervención, excepto por el tiempo de intervención, en el que la intervención nutricional estandarizada (días) se identificó como factor protector OR = 0 · 550 (p <0 · 05; IC = 0 · 324-0 · 936). Conclusiones: Este es el primer estudio en Colombia que considera una intervención nutricional estandarizada en pacientes hospitalizados por COVID-19. A pesar de no poder alcanzar los objetivos primarios, se deben realizar experimentos controlados para determinar el papel y los posibles efectos terapéuticos de los micro y macronutrientes en pacientes con COVID-19

Frequency, risk factors, and outcomes of hospital readmissions of COVID-19 patients.

To determine the proportion of patients with COVID-19 who were readmitted to the hospital and the most common causes and the factors associated with readmission. Multicenter nationwide cohort study in Spain. Patients included in the study were admitted to 147 hospitals from March 1 to April 30, 2020. Readmission was defined as a new hospital admission during the 30 days after discharge. Emergency department visits after discharge were not considered readmission. During the study period 8392 patients were admitted to hospitals participating in the SEMI-COVID-19 network. 298 patients (4.2%) out of 7137 patients were readmitted after being discharged. 1541 (17.7%) died during the index admission and 35 died during hospital readmission (11.7%, p = 0.007). The median time from discharge to readmission was 7 days (IQR 3-15 days). The most frequent causes of hospital readmission were worsening of previous pneumonia (54%), bacterial infection (13%), venous thromboembolism (5%), and heart failure (5%). Age [odds ratio (OR): 1.02; 95% confident interval (95% CI): 1.01-1.03], age-adjusted Charlson comorbidity index score (OR: 1.13; 95% CI: 1.06-1.21), chronic obstructive pulmonary disease (OR: 1.84; 95% CI: 1.26-2.69), asthma (OR: 1.52; 95% CI: 1.04-2.22), hemoglobin level at admission (OR: 0.92; 95% CI: 0.86-0.99), ground-glass opacification at admission (OR: 0.86; 95% CI:0.76-0.98) and glucocorticoid treatment (OR: 1.29; 95% CI: 1.00-1.66) were independently associated with hospital readmission. The rate of readmission after hospital discharge for COVID-19 was low. Advanced age and comorbidity were associated with increased risk of readmission.

Ectoderm to mesoderm transition by down-regulation of actomyosin contractility.

Collective migration of cohesive tissues is a fundamental process in morphogenesis and is particularly well illustrated during gastrulation by the rapid and massive internalization of the mesoderm, which contrasts with the much more modest movements of the ectoderm. In the Xenopus embryo, the differences in morphogenetic capabilities of ectoderm and mesoderm can be connected to the intrinsic motility of individual cells, very low for ectoderm, high for mesoderm. Surprisingly, we find that these seemingly deep differences can be accounted for simply by differences in Rho-kinases (Rock)-dependent actomyosin contractility. We show that Rock inhibition is sufficient to rapidly unleash motility in the ectoderm and confer it with mesoderm-like properties. In the mesoderm, this motility is dependent on two negative regulators of RhoA, the small GTPase Rnd1 and the RhoGAP Shirin/Dlc2/ArhGAP37. Both are absolutely essential for gastrulation. At the cellular and tissue level, the two regulators show overlapping yet distinct functions. They both contribute to decrease cortical tension and confer motility, but Shirin tends to increase tissue fluidity and stimulate dispersion, while Rnd1 tends to favor more compact collective migration. Thus, each is able to contribute to a specific property of the migratory behavior of the mesoderm. We propose that the "ectoderm to mesoderm transition" is a prototypic case of collective migration driven by a down-regulation of cellular tension, without the need for the complex changes traditionally associated with the epithelial-to-mesenchymal transition.

Social engagement within the facility increased life expectancy in nursing home residents: a follow-up study.

BACKGROUND: Social engagement (SE) has been consistently shown to improve survival among community-dwelling older people, but the evidence in nursing home residents is inconclusive and prone to short-term reverse causation and confounding by major health determinants. Our main objective was to study the potential causal effect of within-the-facility social engagement (SE) on long-term all-cause mortality in care home residents. METHODS: A representative cohort of 382 nursing home residents in Madrid without severe physical and cognitive impairments at baseline was followed up for 10-year all-cause mortality. Standardized mortality curves for residents with low/null, moderate, and high levels of SE at baseline were estimated using Kaplan-Meier methods and spline-based survival models with inverse probability of exposure weights conditional on baseline sociodemographic characteristics, facility features, comorbidity, and disability. Standardized 5-year mortality risks and median survival times were compared across levels of SE. RESULTS: The baseline prevalences of low/null, moderate, and high SE were 36, 44, and 20%, respectively. Compared with residents with low/null SE at baseline, the standardized differences (95% confidence intervals) in 5-year mortality risk were - 2.3% (- 14.6 to 10.0%) for moderately engaged residents and - 18.4% (- 33.8 to - 2.9%) for highly engaged residents. The median survival time increased by 0.4 (- 1.4 to 2.2) and 3.0 (0.8 to 5.2) years, respectively. CONCLUSION: Residents with high SE within the nursing home had an 18% lower 5-year mortality risk and a 3-year increase in their median survival, as compared with residents with similar health determinants but low/null SE. The development of adequate tailored intervention programs, addressed to increase SE in nursing home residents, could improve their long-term survival, in addition to expected gains in quality of life.

Características clínicas, bioquímicas y complicaciones de los pacientes sometidos a la cirugía bariátrica con 18 meses de seguimiento en un hospital de alta complejidad / Clinical, biochemical characteristics and complications in bariatric surgery patients in 18 months of follow-up in a highly complex hospital

RESUMEN Objetivo: el objetivo de este estudio fue describir los cambios en las características clínicas, bioquímicas y las complicaciones de los pacientes sometidos a la cirugía bariátrica en 18 meses de seguimiento en un hospital de alta complejidad entre 2012 y 2016. Métodos: se realizó un estudio descriptivo, retrospectivo para evaluar las variables clínicas y bioquímicas, antes y después de la realización de la cirugía bariátrica (el bypass gástrico o manga gástrica). Resultados: se estudiaron 59 pacientes, el 89,8 % fueron mujeres, con edad promedio de 41,8 ± 10,8 años. El 76,3 % se sometieron a bypass gástrico y el 23,7 % a manga gástrica. La media del porcentaje de peso perdido a los 18 meses fue de 81 % ± 22. Se presentó una reducción significativa de la circunferencia abdominal. El 100 % de los pacientes experimentaron cambios en las multimorbilidades. Conclusión: se encontró una disminución significativa del porcentaje de exceso del índice de masa corporal, además se observó un cambio en las comorbilidades y modificación en los biomarcadores. No se presentó mortalidad a los 18 meses postquirúrgicos.

SUMMARY Objective: To determine the clinical and biochemical characteristics, as well as the complications of bariatric surgery in 18 months of follow-up in a highly complex hospital, between 2012 and 2016. Methods: A descriptive, retrospective study was performed in patients undergoing bariatric surgery (gastric by-pass or gastric sleeve), where the clinical and biochemical characteristics, as well as the complications and post-intervention changes were evaluated in a before-after analysis. Results: Fifty nine patients were studied, 89.8 % were women, with an average age of 41.8 ± 10,8. The 76,3 % underwent gastric bypass and 23.7 % gastric sleeve. The mean percentage of weight lost at 18 months was 81 % ± 22. There was a significant reduction in abdominal circumference. 100 % of patients experienced changes in multimorbidities. Conclusion: We found a significant decrease in the percentage of body mass index. In addition, a change in comorbidities and modification in biomarkers was observed. There was no post-operative mortality 18 months after surgery.

Sobre el poder, la autoridad y el sometimiento / On power, authority and submission

El poder produce sujetos, sería una manera de enunciar una de las tesis foucaultianas que abren un horizonte crítico más allá del esquema de la soberanía, el cual Judith Butler describe de forma precisa cuando afirma "estamos acostumbrados a concebir el poder como algo que ejerce presión sobre el sujeto desde fuera, algo que subordina, coloca por debajo y relega a un orden inferior" (2010, p. 12). La representación del poder como fuerza externa que se impone, como represión por parte de un grupo, un individuo o el Estado, se desplaza, en la analítica foucaultiana, hacia una teoría de la sujeción, en el doble sentido de este término, como sometimiento y como subjetivación (Álvarez, 2015; Butler, 2010). Así, el problema central para Foucault no sería el origen, naturaleza o legitimación del poder sino su ejercicio sobre otros, la pregunta precisa que se plantea Foucault al respecto es, justamente, "¿qué ocurre cuando los individuos ejercen, como se dice, su poder sobre otros?" (Álvarez, 2015, p. 329). Para Foucault la respuesta a esta cuestión no es evidente ni inmediata, pues la aparición en el siglo XVI del Estado en Occidente (Álvarez, 2015) se configuró como causa de la extendida concepción del poder investido para someter. Ahora bien, lejos está el filósofo francés de desconocer la importancia de estos análisis, no obstante, su reflexión apunta hacia la constitución del sujeto como quien ejerce y sobre el que se ejerce el poder y, por tanto, de las estrategias que se usan para ello.

Power produces subjects, it would be a way to state one of the Foucaultian theses that open a critical horizon beyond the scheme of sovereignty, which Judith Butler describes precisely when she affirms "we are accustomed to conceive of power as something that puts pressure on the subject from outside, something that subordinates, places below and relegates to a lower order "(2010, p. 12). The representation of power as an external force that is imposed, as repression by a group, an individual or the State, moves, in Foucaultian analytics, towards a theory of subjection, in the double sense of this term, as submission and as subjectivation (Álvarez, 2015; Butler, 2010). Thus, the central problem for Foucault would not be the origin, nature or legitimation of power but its exercise over others, the precise question that Foucault asks about it is, precisely, "what happens when individuals exercise, as they say, their power over others? "(Álvarez, 2015, p. 329). For Foucault, the answer to this question is neither evident nor immediate, since the appearance in the 16th century of the State in the West (Álvarez, 2015) was configured as the cause of the extended conception of the power vested to submit. Now, the French philosopher is far from ignoring the importance of these analyzes, however, his reflection points to the constitution of the subject as who exercises and over which power is exercised and, therefore, of the strategies used to it.

Politica de limpieza y desinfección de materiales y equipo / No disponible

No disponible

Ortopedia del alma. Degeneracionismo e higiene mental en la Casa de Corrección de Menores y Escuela de Trabajo San José, Colombia 1914-1947 / Ortopedia da Alma. Degeneracionismo e Higiene Mental na Casa de Correção de Menores e Escola de Trabalho San Jose, Colômbia, 1914-1947 / The orthopedics of the Soul. Degeneration and Mental Hygiene in the San Jose Juvenile Correctional Facility and Work School, Colombia 1914-1947 / Orthopédie de l’âme. Dégénerationisme et hygiène mentale à la Maison de correction pour mineurs et de l›École de travail San José, Colombie, 1914-1947 / Orthopädie der Seele. Degenerationstheorie und Mentale Hygiene in der Jugendstrafanstalt / Ausbildungszentrum San José, Kolumbien, 1914-1947 / 1914-1947年哥伦比亚未成年人矫正所和圣胡安工读学校里的精神病治疗，退化和精神健康

Objetivo Comprender las prácticas y la formación experimental de la psicopedagogía de la infancia anormal en Colombia, llevadas a cabo en la “Casa de Corrección de Menores y Escuela de Trabajo San José”, entre 1914 y 1947. Métodos y materiales: estudio cualitativo, de enfoque histórico-hermenéutico, mediante investigación documental, heurística de archivos de patrimonio documental e historiografía institucional del periodo de estudio. Conclusiones el surgimiento de un nuevo régimen de educación especial (médico-psico-pedagógico) estableció un cambio relevante del modelo reformatorio de castigo al de intervención pedagógica, influida por el cruce de doctrinas científicas de finales del siglo XIX y principios del XX, como la regla de lo normal y lo patológico, la teoría de la degeneración y la eugenesia, para el perfeccionamiento de un sujeto moderno capaz de ser útil por sí mismo y para la sociedad.

Objetivo Compreender as práticas e a formação experimental da psicopedagogia da infância anormal na Colômbia, realizadas na Casa de Correção de Menores e Escola de Trabalho San José, entre 1914 e 1947. Métodos e materiais: estudo qualitativo, de abordagem histórico-hermenêutica, mediante pesquisa documental, heurística de arquivos de patrimônio documental e historiografia institucional do período de estudo. Conclusões O surgimento de um novo regime de educação especial (médico e psicopedagógico) estabeleceu uma relevante mudança do modelo de reformatório de castigo ao de intervenção pedagógica, influenciada pelo cruzamento de doutrinas científicas de fins do século XIX e inícios do século XX, como a regra do normal e do patológico, a teoria da degeneração e a eugenia, para o aperfeiçoamento de um sujeito moderno capaz de ser útil a si mesmo e à sociedade.

Objective To understand the practices and the experimental formation of the psychopedagogy of abnormal childhood in Colombia, carried out in the San Jose Juvenile Correctional Facility and Work School, Colombia, between 1914 and 1947. Methods and materials: qualitative study, of a historical-hermeneutic approach, using documentary research, and file heuristics of document heritage and institutional historiography within the study period. Conclusions The emergence of a new special education regime (medical and psychopedagogical) established an important change in the model of punishing reformatory to pedagogical intervention, influenced by crossing scientific doctrines of the late nineteenth and early twentieth centuries, such as the rule of normal and pathological, the degeneration theory and eugenics, for perfecting a modern subject who can be useful to itself and to society.

Objectif Comprendre les pratiques et la formation expérimentale de la psychopédagogie de l'enfance anormale en Colombie, réalisées à la Maison de correction et l’École de travail San José, entre 1914 et 1947. Méthodes et matériaux : étude qualitative, approche historique-herméneutique, par le biais d’une recherche documentaire, heuristique de fichiers de patrimoine documentaire et historiographie institutionnelle de la période d'étude. Conclusions L'émergence d'un nouveau régime d'éducation spécialisée (médicale et psychopédagogique) a établi un changement pertinent du modèle de maison de correction à celui d'intervention pédagogique, influencé par le croisement de doctrines scientifiques de la fin du XIXe et début du XXe siècles, comme la règle du normal et du pathologique, la théorie de la dégénérescence et l'eugénisme, pour le perfectionnement d'un sujet moderne capable d'être utile à lui-même et à la société.

Ziel die Praxis und das experimentelle Ausbildungsprogram der Psychopädagogik der abnormalen Kindheit in Kolumbien zu untersuchen, am Fall der Jugendstrafanstalt / Ausbildungszentrum San José, von 1914 bis 1947. Methoden und Materialien: qualitative Studie, historisch-hermeneutischer Ansatz, dokumentarische Forschung, Heuristik der Dokumentdatei und der institutionellen Geschichtsschreibung innerhalb des Untersuchungszeitraumes. Schlussfolgerungen die Entstehung einer neuen (medizinischen und psycho-pädagogischen) Regelung im Bereich der Sonderpädagogik etabliert eine wichtige Wandlung vom Model der 'bestrafenden Erziehungsanstalt' zu jenem der pädagogischen Intervention. Diese Wandlung entsteht durch die Fusion wissenschaftlicher Lehren des späten neunzehnten und frühen zwanzigsten Jahrhundert, wie z.B. die Regel des normalen und des pathologischen, die Degenerationstheorie und die Eugenik. Sie wurde zur Perfektionierung des modernen Subjekts benutzt, das dadurch für sich selbst und für die Gesellschaft von Nutzen wird.

本论文的目的了解1914—1947年哥伦比亚的未成年人矫正所和圣胡安工读学校在异常行为青少年教育心理学方面的试验和实践。 研究方法和材料 对事件的质的分析，从史学和方法论角度，对该时期，两个机构的档案资料和史料进行详细的和整体全面的分析。 结论是 在实践中产生了一个新的特殊教育制度 (医疗和心理教育)，青少年矫正模式也产生了重要的变化，由原来的以惩罚为主的感化院做法，转变为以教育为主的模式，这种转变是由于十九世纪末二十世纪初科学思想和社会思潮的转变，特别是鉴定正常和病态的规则的变化，有关人类退化和优生的理论的传ā...

Validez y confiabilidad del instrumento de satisfacción del paciente con enfermedad crónica no transmisible (ECNT) / Validity and reliability of the patient satisfaction instrument with chronic non-communicable disease (CNCD)

La satisfacción del paciente con enfermedad crónica no transmisible como fenómeno de interés permite considerar los posibles puntos de mejora que guíen al equipo de salud en el fortalecimiento de intervenciones que redunden en la calidad de los servicios de salud. OBJETIVO: determinar la validez y confiabilidad del instrumento de satisfacción del paciente con enfermedad crónica con los cuidados, con la educación y las condiciones del servicio de salud. MÉTODO: Estudio de abordaje metodológico psicométrico. Se llevó a cabo la validez facial y comprensibilidad del ítem, validez de contenido y de constructo, asimismo se estableció la confiabilidad al instrumento de satisfacción del paciente con enfermedad crónica no transmisible (ECNT). RESULTADOS: El instrumento requirió cambios semánticos en algunos ítems. Se estableció un índice de validez de contenido (IVC) entre 0,91 y 0,98 en cada una de las categorías evaluadas. En cuanto a la validez de constructo, se evidenció que la carga factorial de cada uno de los ítems muestran vinculación a un factor estadístico común en ellos, coincidiendo con las dimensiones del instrumento a excepción de tres ítems que presentan un comportamiento tornadizo. Además, se muestra una consistencia interna con el coeficiente del alpha de Cronbach de 0,929. CONCLUSIONES: El instrumento tiene evidencias estadísticas que permiten inferir su validez actual. Por otro lado, se recomienda estudiar los ítems 4, 13 y 16 en términos de fraseología y asociación a unos factores estadísticos con pruebas estadísticas adicionales y, en esta medida, poder atribuir la pertinencia o no con la satisfacción.

The satisfaction of the patient with chronic disease, allows to consider there are points in favor that guides the health team in the strengthening of interventions in the improvement plans that redound to the quality in the health services. OBJECTIVE: To determine the validity and reliability of the instrument of satisfaction with health care, education and health services conditions in patient with chronic disease. METHOD: This is a study with a psychometric method which accomplished the face validity and the item understanding, the content and construct validity, and it was established the reliability of the satisfaction instrument in patient with noncommunicable chronic disease (NCD). RESULTS: The instrument required semantic changes in some items. Besides, it was established a content validity index (CVI) in each one of the evaluated categories between 0.91 and 0.98. Regarding the construct validity, it shows how the factor score, of each one of the items, displays a correlation to a common statistical factor and this coincide with the dimensions of the instrument except for three items that show a changeable behavior. In addition to that, there is an interior consistency in the alpha Cronbach coefficient with 0.929. CONCLUSIONS: The instrument has statistical evidences that allow inferring its current validity. On the contrary, it is recommended to study the 4, 13 and 16 items in the phraseology field and in the association with statistical factors. Hence, it can be attributed the property with the satisfaction.

Comportamiento de las úlceras cutáneas crónicas entre los años 2010-2012 en Pereira, Colombia / Patterns of cutaneous chronic ulcers between 2010-2012 in Pereira, Colombia

Introducción: La evolución de las úlceras crónicas no ha sido estudiada en Colombia, la identificación de ese comportamiento permitiría orientar procesos diagnósticos y terapéuticos que redunden en acciones más benéficas para los pacientes que consultan por este tipo de problemas. Se identificó la evolución de las características clínicas y epidemiológicas de pacientes con úlceras cutáneas que fueron atendidos en diferentes IPS. Materiales y métodos: Las características de las úlceras se evaluaron según el test RESVESH. Los pacientes se monitorearon en el tiempo hasta que la úlcera cerró o se terminó el estudio. El equipo de investigación analizó la información clínica; y las fotografías del paciente fueron evaluadas independientemente por 2 evaluadores; si se presentaba discordancias, una tercera persona o médico tratante la evaluaba. Resultados: Se evaluaron 39 pacientes, principalmente mujeres, cuyo tiempo en años de las úlceras sumaba 283, los días de seguimiento sumaron 1087. Discusión: Se encontró relación significativa entre actividad de bordes, el exudado y la presencia de dolor con la respuesta clínica. El uso de un apósito de poliamida con silicona, así como de maltodextrina se relacionaron cada uno con una mejor respuesta clínica de los pacientes.

Introduction: The evolution of the chronic ulcers haven’t been studied in Colombia, the identification of the behavior will allow guiding therapeutic and diagnostic processes that benefit these patients and the medical service itself. The clinical and epidemiological characteristics of patients with chronic ulcers were identified from patients of different IPS. Materials and methods: The ulcers characteristic where evaluated with the RESVESH test. Patients where monitored until the ulcer closed or the study finish. The research team analyzed the clinical information and the photos of the patients were evaluated independently from 2 distinct evaluators, if discrepancies were present, a third person or treating medic evaluated. Results: 39 patients were evaluated, mainly women, whose time in years of ulcers totaled 283, and the ensuing days totaled 1087. Discussion: significant relationship between activation of borders, exudates and the presence of pain with clinical response. The use of Poliamida Siliconada and maltodextrin were related with better clinical outcome in the evaluated patients.

Características de los accidentes de tránsito con personas lesionadas atendidas en un hospital de tercer nivel de Medellín, 1999-2008 / Characteristics of traffic accidents with injured persons treated at a third level hospital in Medellin, 1999-2008 / Características de acidentes de trânsito com pessoas feridas tratadas em um hospital terciário, em Medellín, 1999-2008

Los accidentes de tránsito (AT) son un problema social y de salud pública mundial que puede dejar graves consecuencias en las personas y generar altos costos económicos. Entre las causas están el exceso de velocidad, la impericia y distracción del conductor y la falta de distancia entre los vehículos. En Medellín hay pocos estudios sobre AT. El objetivo fue describir características de tiempo, lugar y vehículo de los 25.635 AT ocurridos en Medellín (1999-2008)que ocasionaron lesionados que fueron atendidos en un hospital de tercer nivel. Es un estudio descriptivo retrospectivo con datos secundarios de 29.676 atenciones. Los AT ocurrieron conmás frecuencia en las tardes, los fines de semana, ocasionados en motocicletas y en el centro de la ciudad. La mortalidad global fue 1,5%. El conocimiento de las variables involucradas en los AT puede facilitar la formulación de políticas específicas para reducir la creciente accidentalidadvial en la ciudad...

Traffic accidents (TA) are a problem for global public health and may cause serious consequences on people and generate high economic costs. Causes include excessive speed, inexperience and driver distraction and lack of distance between vehicles. In Medellin, there are few studies on TA. The objective was to describe characteristics of time, place and vehicle of the 25,635 TA occurred in Medellín (1999-2008) that caused injuries that were treated at a third level hospital.It is a retrospective study of 29,676 secondary data attentions. The TA occurred more frequently in the evenings, weekends, resulting in motorcycles and in the center of the city. Overall mortality was 1.5%. Knowledge of the variables involved in the TA can facilitate the formulation of specific policies to reduce the increasing road accidents in the city...

Acidentes de trânsito (AT) são um problema social e de saúde pública global, que pode causar sérias conseqüências sobre as pessoas e geram altos custos econômicos. Principais imprudências incluem velocidade excessiva; inexperiência ou distração do condutor e distancia insuficiente em relação ao veiculo dianteiro. Existem poucos estudos sobre AT em Medellín. O objetivo foidescrever as características de tempo, lugar e veículo envolvido nos 25.635 AT acontecidos em Medellín (1999-2008), que deixaram pessoas feridas tratadas em um hospital terciário. Trata deum estudo descritivo retrospectivo de dados secundários de 29.676 atendimentos. AT ocorreram com maior freqüência de tarde, nos fins de semana, envolvendo motocicletas e no centro dacidade. Mortalidade geral foi de 1,5%. Conhecimento das variáveis envolvidas nos AT pode facilitar a formulação de políticas específicas para reduzir os acidentes rodoviários na cidade....