Readiness for Integrated Care of Older People: A Cross-Sectional Study in Mexico.

AIM: To evaluate the readiness of the Mexican healthcare system to implement the integrated care for older people (ICOPE) approach into an existing healthcare model. METHODS: We conducted a cross-sectional study with data from 2473 healthcare workers analyzed using the model for understanding success in quality (MUSIQ) framework to gather data from healthcare professionals. Their perceptions regarding the readiness for ICOPE were assessed across five dimensions: team, microsystem, infrastructure, organization, and external environment. RESULTS: Only 717 (29%) of the participants believed ICOPE could be successfully implemented in Mexico without any modifications. A total of 1261 (51%) participants rated the readiness of ICOPE with some barriers. The main barriers were reallocating resources and the external environment. OBSERVATION: Mexico's healthcare system faces barriers to innovation that could hinder the successful integration of the ICOPE approach. A systematic identification of these barriers provides an opportunity to suggest adaptations and refinements to increase the probability of success. Using the contextual factors identified as facilitators and the proposal of interventions such as the ICOPE app could improve the chances of success. CONCLUSION: The participants of this study evaluated ICOPE as ready to implement, with some contextual barriers. The readiness evaluation supports the stakeholders' and policymakers' decisions in implementing and monitoring the program in a natural setting. Evaluating the readiness of the intervention increases the possibility of aligning the innovation with contextual factors, increasing the chances of its successful adoption and implementation.

How stable is the intelligence over time?: evidence from Brazilian data / Quão estável é a inteligência?: evidência a partir de dados brasileiros / ¿Cómo de estable es la inteligencia?: evidencias a partir de datos brasileños

There is strong scientific evidence that intelligence remains stable from childhood to adulthood; however, no study has examined the generalizability of these findings for native Brazilian samples. Here we present a study carried out in 2002 and from 2014-2017 (average timespan of 15 years) in order to verify the stability of psychometric intelligence. A sample of 120 participants (mean age Time 1 = 10.0 yrs, mean age Time 2 = 23.6 yrs) was assessed using the Raven's Progressive Matrices and verbal subtests from the WISC-III and WAIS-III. The results indicated a moderate coefficient (around .50) for intelligence differential stability independent of the measurement administered. Regarding absolute stability, real cognitive gains were observed from Time 1 to Time 2, despite controlling the effect of the regression toward the mean. Finally, sex (female) and intelligence were statistically significant predictors of rapid educational progression. (AU)

Existe sólida evidência científica que a inteligência permanece estável desde a infância até a idade adulta, embora não existam estudos que verifique a generalidade desse pressuposto para amostra de nativos brasileiros. Aqui um estudo desenvolvido em 2002 e 2014/2017 (intervalo médio de 15 anos) que verifica a estabilidade da inteligência psicométrica é apresentado. Uma amostra de 120 participantes (Tempo 1 = 10,0 anos, Tempo 2 = 23,6 anos) foi avaliada com o uso das Matrizes Progressivas de Raven e as escalas verbais do WISC-III e do WAIS-III. Os resultados indicaram um coeficiente de estabilidade diferencial da inteligência moderado (aproximadamente 0,50), independentemente do tipo de medida administrada. Com relação à estabilidade absoluta, observaram-se ganhos cognitivos do Tempo 1 para o Tempo 2, apesar do controle do efeito da regressão à média. Finalmente, o sexo (feminino) e a inteligência foram os preditores estatisticamente significativos de uma rápida progressão educacional. (AU)

Existen fuertes evidencias científicas de que la inteligencia permanece estable desde la niñez hasta la edad adulta; sin embargo, no hay estudios que verifiquen la generalización de este supuesto para muestra de brasileños nativos. Aquí presentamos un estudio realizado en 2002 y de 2014 a 2017 (intervalo de tiempo promedio de 15 años) que comprueba la estabilidad de la inteligencia psicométrica. Se evaluó el desempeño de 120 participantes (Tiempo 1 = 10,0 años y Tiempo 2 = 23,6 años) con las Matrices Progresivas de Raven y escalas verbales del WISC-III y del WAIS-III. Los resultados indicaron un coeficiente de la estabilidad diferencial intelectual moderada (aproximadamente .50), independiente del tipo de medida administrada. En cuanto a la estabilidad absoluta, se observaron ganancias cognitivas del Tiempo 1 al Tiempo 2, a pesar de controlar el efecto de la regresión hacia la media. Por último, el sexo (femenino) y la inteligencia fueron predictores estadísticamente significativos de una rápida progresión educativa. (AU)

Factors associated with tetanus vaccination in pregnant women living in Minas Gerais State, Brazil: A cross-sectional study.

Background: Immunization in pregnant women is essential to help controlling and avoiding preventable diseases. Aim: Analyzing some factors associated with non-vaccination against tetanus in pregnant women who gave birth in maternity hospitals in Belo Horizonte City, Minas Gerais State, Brazil. Methods: Cross-sectional study carried out with database deriving from the research titled "Born in Belo Horizonte: Survey on childbirth", which was developed in public and private hospitals. Sample was calculated by taking into consideration the total number of births recorded in each investigated maternity hospital - the final sample comprised 481 mothers. Descriptive population statistics were used for data analysis purposes, whereas Poisson regression model was used to estimate factors associated with non-vaccination against tetanus during pregnancy. Results: The prevalence of puerperal women subjected to at least 2 doses of tetanus vaccine reached 59.2%. Adjusted analyses have shown that not living with a partner has increased by 1.58 times the prevalence of women who did not take tetanus vaccine, on average; that the prevalence of women who were not vaccinated has decreased by 0.65 times after each prenatal consultation, on average; that prenatal consultations with nurses have reduced by 0.52 times the prevalence of women who did not take the tetanus vaccine, on average. Conclusion: Almost half of puerperal women were not vaccinated against tetanus during pregnancy. It is essential identifying specific groups to help implementing and expanding preventive actions, such as immunization for pregnant women. Despite advances in public health policies, authorities still face challenges to expand vaccination coverage in the investigated state, as well as to strengthen the national immunization program to help increasing tetanus vaccination rates among pregnant women.

Mind-Body Therapies From Traditional Chinese Medicine: Evidence Map.

Background: The mind-body therapies of traditional Chinese medicine include several intervention types and combine physical poses with conscious relaxation and breathing techniques. The purpose of this Evidence Map is to describe these different interventions and report related health outcomes. Methods: This evidence map is based on the 3iE Evidence Gap Map methodology. We searched seven electronic databases (BVS, PUBMED, EMBASE, PEDro, ScienceDirect, Web of Sciences, and PschyInfo) from inception to November 2019 and included systematic reviews only. Systematic reviews were analyzed based on AMSTAR 2. We used Tableau to graphically display quality assessment, the number of reviews, outcomes, and effects. Results: The map is based on 116 systematic reviews and 44 meta-analyses. Most of the reviews were published in the last 5 years. The most researched interventions were Tai Chi and Qi Gong. The reviews presented the following quality assessment: 80 high, 43 moderate, 23 low, and 14 critically low. Every 680 distinct outcome effect was classified: 421 as potential positive; 237 as positive; 21 as inconclusive/mixed; one potential negative and none no effect. Positive effects were related to chronic diseases; mental indicators and disorders; vitality, well-being, and quality of life. Potential positive effects were related to balance, mobility, Parkinson's disease, hypertension, joint pain, cognitive performance, and sleep quality. Inconclusive/mixed-effects justify further research, especially in the following areas: Acupressure as Shiatsu and Tuiná for nausea and vomiting; Tai Chi and Qi Gong for acute diseases, prevention of stroke, stroke risk factors, and schizophrenia. Conclusions: The mind-body therapies from traditional Chinese medicine have been applied in different areas and this Evidence Map provides a visualization of valuable information for patients, professionals, and policymakers, to promote evidence-based complementary therapies.

Pain: the impulse in the search for health by means of integrative and complementary practices / Dor: o impulso na busca pela saúde por meio de práticas integrativas e complementares

ABSTRACT BACKGROUND AND OBJECTIVES: This study investigated the relations between the playful component and the process of rehabilitation, treatment, and promotion of health in the context of a group that treats the pain, located in Florianópolis (Brazil). METHODS: The research followed a qualitative approach, a descriptive-exploratory field research. A matrix-guided systematic observation was conducted for two months by the group leader, two volunteers and about 15 participants. A field diary was used to register complementary information. Besides two semi-structured interview guides were used, applied to four members and the person responsible for the group after the two-month observational period. The data were organized and analyzed in three topics: "Characterization of the investigated group and dynamics of the meetings," "The group as healing potential" and "Lian Gong/Qi Gong as a possibility to look at the pain." RESULTS: The participants pointed out that working on Lian Gong/Qi Gong, meditation and auriculotherapy contemplating the playful component the group becomes a place of recognition of each one's pain subjectivity, by the individual that suffers and by the collective, which has fostered the recovery of specific pain and good sensations to those involved, such as happiness, enthusiasm and pleasure. CONCLUSION: The creation of the group and people's engagement has decreased the number of specific requests for physiotherapy sessions and provided greater autonomy to the participants to handle their own pain.

RESUMO JUSTIFICATIVA E OBJETIVOS: Este estudo investigou as relações estabelecidas entre o componente lúdico e o processo de reabilitação, tratamento e promoção da saúde no contexto de um grupo que trata da dor, localizado em Florianópolis (SC). MÉTODOS: A pesquisa seguiu uma abordagem qualitativa, tendo sido realizada por meio de uma investigação de campo, configurando-se como descritivo-exploratória. Foi realizada observação sistemática, durante dois meses, guiada por uma matriz, envolvendo a responsável pelo grupo, duas voluntárias e cerca de 15 integrantes. Para o registro de informações complementares, utilizou-se um diário de campo. Além disso, foram utilizados dois roteiros de entrevistas semiestruturadas, aplicados com quatro integrantes e com a responsável pelo grupo, ao final do período dos dois meses de observações. Os dados foram organizados e analisados em três tópicos: "Caracterização do grupo investigado e dinâmica dos encontros", "O grupo como potencial de cura" e "Lian Gong/Qi Gong como uma possibilidade de olhar para a dor". RESULTADOS: Os participantes indicaram que ao trabalhar Lian Gong/Qi Gong, meditação e auriculoterapia, contemplando o elemento lúdico, o grupo tornou-se um local de reconhecimento da subjetividade da dor de cada um, pelo indivíduo que sentia e pelo coletivo, gerando melhoras nas dores específicas e trazendo boas sensações aos que estão envolvidos, como alegria, entusiasmo e prazer. CONCLUSÃO: A criação do grupo e o engajamento das pessoas diminuiu o número de pedidos específicos de sessões de fisioterapia e proporcionou maior autonomia do participante em atender a sua própria dor.

Changes in Heart Rate Variability in Patients with Spleen-Qi Deficiency Syndrome.

Many functional diseases are related to dysautonomia, and heart rate variability has been used to assess dysautonomia. However, heart rate variability has not been studied in Spleen-Qi deficiency syndrome (SQDS). Healthy volunteers (n = 37) and patients with SQDS (n = 67), recruited from the Clinic of the State University of Ecatepec Valley were included in the study. Outcome measures were average heart rate, standard deviation of the normal-to-normal heartbeat intervals, low frequency (LF), high frequency (HF) power, and the LF/HF ratio. Also, intestinal peristalsis, gastrointestinal symptoms (GSs), fatigue, and level of attention were measured. Standard deviation of the normal-to-normal heartbeat intervals (17 ± 2.3%) and HF (14 ± 3.1%) were lower in SQDS patients (17 ± 1.3%) than in healthy volunteers. SQDS patients had higher heart rate, LF power, LF/HF ratio, and fatigue scores (9.6 ± 1.12%, 16 ± 2.1%, 22 ± 3.8%, and 21 ± 4.1%). The fatigue correlated positively with the LF/HF ratio and negatively with HF power. The SQDS group had lower concentration performance (16.2 ± 1.9%) in the d2 test. The intestinal peristalsis showed a reduction (15 ± 1.3%) as compared with control. GS score and peristalsis correlated negatively with HF. Our results suggest that the pathology of SDQS could be associated with a low vagal tone which causes a decrease in peristalsis, increased fatigue, reduced attention, and appearance of GSs.

Perceptions of Health Care Executives on Leadership Development Skills for Residents After Participating in a Longitudinal Mentorship Program.

Despite the fact that physicians are being asked to lead and enact change to improve a myriad of quality of care measures, there is little focus on leadership skills development during their training. One strategy to address this gap is to focus on trainees during graduate medical education, specifically those residents aspiring to careers as physician leaders in quality. The authors designed a leadership curriculum for self-selected residents who are pursuing a certificate in health care leadership in quality. Residents were surveyed and focus groups were conducted with health system executives who participated in the curriculum as part of an evaluation designed to inform improvements in the program and to provide guidance to others who direct physician leadership training programs. The findings support the need to invest in young physician leaders who are focused on quality with the ultimate goal of improving population health in the ever-changing health care environment.

Working memory and intelligence quotient: which best predicts on school achievement? / Memória de trabalho e quociente de inteligência: o que melhor prevê o desempenho escolar? / Memoria de trabajo y cociente de inteligencia: ¿cuál predice mejor el logro escolar?

Working memory (WM) refers to ability to store and manipulate information for a period of time. There is evidence of a close relationship between WM and learning. The aim of this study was to investigate the relationship between WM, intelligence quotient (IQ) on school achievement. Individual neuropsychological assessment was conducted following a specific protocol. The study included 227 children aged 7 to 12 years (M=9.87, SD=1.34), of which 119 were females, from private and public schools in Salvador, Bahia, Brazil. The data analysis included descriptive and inferential statistics. Academic achievement was evaluated using the Academic Performance Test (TDE), with subtests in reading, writing and arithmetic. The components of WM were evaluated using backward and forward Digit Span tasks and the backward and forward Corsi block-tapping task. The estimated IQ was assessed using tasks vocabularies and block design of the Wechsler scales. The statistical tests used were linear regression analysis (stepwise) and Pearson correlation. The results showed that the best predictors of academic performance were Digit Span Forward, Corsi Block Backward and Digit Span Backward task. The hypothesis of non-multicollinearity was tested, and it was verified that the constructs were independent (VIF <10 and Tolerance >0.20). The variance in academic performance explained by WM model was ΔR=0.36. High and significant correlations were observed between the components of WM and the TDE. The WM score (Digit Span Backward + Corsi Block Backward) and the TDE were correlated (r=0.54**). These results indicate that WM is a good predictor of academic achievement than IQ and are consistent with other findings showing WM as a predictor of learning or the potential for learning. This result has important implications for education, particularly with respect to intervention.

Memória de trabalho (MT) refere-se a capacidade de armazenar e manipular informações por um período de tempo. Há evidências de uma estreita relação entre MT e aprendizado. O objetivo deste estudo foi investigar a relação entre MT, quociente de inteligência (QI) no desempenho acadêmico. A avaliação neuropsicológica individual foi realizada seguindo um protocolo específico. O estudo incluiu 227 crianças com idades entre 7 a 12 anos (M=9.87, SD=1.34), das quais 119 eram do sexo feminino, de escolas privadas e públicas em Salvador, Bahia, Brasil. A análise de dados incluiu estatística descritiva e inferencial. O desempenho acadêmico foi avaliado usando o Teste de Desempenho Escolar (TDE), com subtestes de leitura, escrita e aritmética. Os componentes da MT foram avaliados usando tarefas de Span de Digitos e direta e inversa e a tarefa de Blocos de Corsi versão direta e inversa. O IQ estimado foi avaliado usando as tarefas de vocabulário e cubos das escalas Wechsler. Os testes estatísticos utilizados foram análise de regressão linear (enter) e correlação de Pearson. Os resultados mostraram que os melhores preditores de desempenho escolar foram as tarefas Digitos span direto, invertido e Cubos de Corsi direto e inverso. A hipótese de não-multicolinearidade foi testada, e verificou-se que os construtos foram independentes (VIF <10 e tolerância> 0,20). A variância no desempenho acadêmico explicado pelo modelo WM foi ΔR=0,12. Correlações significativas foram observadas entre os componentes da MT e do TDE. O escore da MT (Dígito span do inverso + Corsi Block inverso) e o TDE foram correlacionados (r=0,28 **). Estes resultados indicam que a MT é um bom preditor de realização escolar do que o QI e são consistentes com outros achados mostrando MT como um preditor de aprendizagem ou o potencial de aprendizagem. Este resultado tem implicações importantes para a educação, particularmente no que diz respeito à intervenção.

La memoria de trabajo (WM) se refiere a la capacidad de almacenar y manipular información durante un período de tiempo, y existe evidencia de una relación cercana entre la memoria de trabajo y el aprendizaje. El objetivo de este estudio fue investigar la relación entre la memoria de trabajo, la inteligencia (IQ) y el rendimiento escolar. La evaluación individual se realizó siguiendo un protocolo específico. El logro escolar se evaluó mediante la prueba de Logro escolar (TDE), con subpruebas en lectura, escritura y aritmética. Los componentes de la memoria de trabajo se evaluaron utilizando versiones anteriores y posteriores de Digit Span y las pruebas de bloqueo de tapado de Corsi. El IQ estimado se evaluó mediante las subpruebas Vocabulary and Block Design de Wechsler Intelligence Scale for Children III. El estudio incluyó a 227 niños de 7 a 12 años (M=9.87, SD=1.34), de los cuales 119 eran mujeres, de escuelas privadas y públicas en Salvador, Bahía, Brasil. El análisis de los datos incluyó estadística descriptiva e inferencial. Las pruebas estadísticas utilizadas fueron el análisis de regresión lineal (enter) y la correlación de Pearson. Los resultados mostraron que los mejores predictores de Logros Escolares fueron el Digit Span hacia adelante, hacia atrás y Corsi bloquean las tareas hacia adelante y hacia atrás. Se probó la hipótesis de no multicolinealidad y se verificó que las construcciones eran independientes (VIF <10 y Tolerancia >0.20). La variación en el rendimiento académico explicada por el modelo de memoria de trabajo fue ΔR=0.12. Se observaron correlaciones significativas entre los componentes de la memoria de trabajo y el TDE. La puntuación de la memoria de trabajo (Digit Span Backward + Corsi Block Backward) y el TDE se correlacionaron (r=0.28 **). Estos resultados indican que la memoria de trabajo es un buen predictor del rendimiento escolar que el coeficiente intelectual y es consistente con otros hallazgos que muestran que la memoria de trabajo es un predictor del aprendizaje o el potencial de aprendizaje. Este resultado tiene implicaciones importantes para la educación, particularmente con respecto a la intervención.

Incidencia de Mindfulness y Qi Gong sobre el Estado de Salud, Bienestar Psicológico, Satisfacción Vital y Estrés Laboral / Incidence of Mindfulness and Qi Gong on the State of Health, Psychological Well-Being, Life Satisfaction and Work Stress / Incidência de Mindfulness e Qi Gong sobre o Estado de Saúde, Bem-estar Psicológico, Satisfação Vital e Estresse no Trabalho

Resumen El presente estudio se realizó a través de un abordaje metodológico pre-experimental con medidas de tipo pre-test y post-test. Participaron 52 trabajadores de la Universidad de la Costa (Barranquilla, Colombia), quienes asistieron por invitación al taller de ocho horas de mindfulness y qi gong para el mejoramiento de la salud, bienestar psicológico, satisfacción vital y reducción del estrés. Los instrumentos utilizados fueron el Cuestionario de Salud sf-11, Escala de Bienestar Psicológico (Ryff & Keyes, 1995), Escala de Satisfacción Vital (Cortés, 2013) y Escala Numérica de Estrés Laboral. La combinación de mindfulness y qi gong produjo una mejoría en el estado de salud de los trabajadores -salud general, energía, eficiencia, actividades domésticas y disminución del dolor-, cambios importantes en el bienestar psicológico -adaptación, confianza, claridad, apertura y autoestima-, y mejoramiento de la satisfacción vital -salud y productividad-. No se encontraron diferencias significativas en los niveles de estrés laboral.

Abstract This study was conducted through a pre-experimental methodological approach with pre-test and post-test measurements. 52 workers from the Universidad de la Costa participated were invited to attend the eight-hour mindfulness and qi gong workshop for improving health, psychological well-being, life satisfaction and stress reduction. The instruments used were the Health Survey sf-11, Scale of Psychological Well-Being (Ryff & Keyes, 1995), Life Satisfaction Scale (Cortés, 2013) and Occupational Stress Numerical Scale. The combination of mindfulness and qi gong produced an improvement in the health of the workers -general health, energy, efficiency, domestic activities and diminution of pain, important changes in the psychological well-being - adaptation, confidence, clarity, openness and self-esteem, and improvement in satisfaction- health and productivity. No significant differences in work stress levels were found.

Resumo Este estudo foi realizado por meio de uma abordagem metodológica pré-experimental com medidas de tipo pré-teste e pós-teste. Participaram 52 trabalhadores da Universidad de la Costa (Barranquilla, Colômbia), os quais foram convidados a participar da oficina de oito horas de mindfulness e qi gong para o melhoramento da saúde, do bem-estar psicológico, da satisfação vital e da redução do estresse. Os instrumentos realizados foram: Questionário de Saúde sf-11, Escala de Bem-estar Psicológico (Ryff & Keyes, 1995), Escala de Satisfação Vital (Cortés, 2013) e Escala Numérica de Estresse no Trabalho. A combinação de mindfulness e qi gong produziu uma melhora no estado de saúde dos trabalhadores -adaptação, confiança, clareza, abertura e autoestima- e melhora da satisfação vital -saúde e produtividade-. Não foram encontradas diferenças significativas nos níveis de estresse no trabalho.

Antropologia Médica Vitalista: uma ampliação ao entendimento do processo de adoecimento humano / Vital Medical Anthropology: an extension to the understanding of the process of human illness

Antropologia é a ciência que tem como objetivo estudar o homem em sua pluralidade de modos de vida e de pensamento, incorporando os diversos aspectos da individualidade às suas modalidades de estudo (biológica, social, cultural e filosófica). Por sua vez, a Antropologia Médica estuda os fatores que influenciam o processo saúde-doença, incluindo os aspectos biossocioculturais e os variados sistemas de saúde. Seguindo o objetivo intrínseco de estudar o homem em sua pluralidade, a Antropologia Médica Vitalista fornece subsídios filosóficos para uma ampliação do entendimento do processo de adoecimento, analisando o mecanismo saúde-doença em conformidade com a estrutura ontológica humana. Fundamentando o diagnóstico e o tratamento das doenças em diversas racionalidades médicas não convencionais (Medicina Tradicional Chinesa, Medicina Tradicional Indiana, Medicina Homeopática e Medicina Antroposófica), a concepção vitalista é uma doutrina filosófica que considera a existência de uma força (princípio) vital responsável pela manutenção da saúde e da vida, unida substancialmente ao corpo físico. Além disso, valorizando a interação de outras instâncias superiores da individualidade humana (mente, alma e espírito) no equilíbrio fisiológico-vital, a concepção vitalista inclui a influência dos pensamentos, sentimentos e emoções na etiopatogenia e na evolução das doenças, aspectos difundidos pela dinâmica psicossomática moderna e pelo recente campo de pesquisas que relaciona a saúde à espiritualidade. (AU)

Effects of warming yang and invigorating qi prescription on renin-angiotensin-aldosterone system in rats with heart failure after myocardial infarction

This study investigated the effects of warming yang and invigorating qi prescription on renin-angiotensin-aldosterone system (RAAS) in rats with heart failure after myocardial infarction. 126 rats were randomly divided into model group, sham operation, warming yang, invigorating qi, warming yang+invigorating qi, digoxin and captopril group for respective treatment. After intervention for 6, 8 and 10 weeks, the left ventricular ejection fraction (LVEF) was calculated, and the plasma renin, angiotensin II and aldosterone levels were measured. Results showed that, after 6, 8 and 10 weeks, LVEF in warming yang, invigorating qi, warming yang+invigorating qi and captopril group was significantly higher than model group (P < 0.05), and the plasma renin, angiotensin II and aldosterone levels in warming yang, invigorating qi, warming yang+invigorating qi and captopril groups were significantly lower than model group (P < 0.05). Renin angiotensin II and aldosterone levels in invigorating qi, warming yang+invigorating qi and captopril groups after 10 weeks was significantly lower than after 6 weeks (P < 0.05); aldosterone level in captopril groups after 10 weeks was significantly lower than after 6 weeks (P < 0.05). Warming yang and invigorating qi prescription can improve LVEF in rats with heart failure after myocardial infarction, which may be related with the inhibition of RAAS activation.(AU)

Ataque cerebrovascular isquémico: fisiopatología desde el sistema biomédico y su equivalente en la medicina tradicional china / Stroke: pathophysiology from the biomedical system perspective and its equivalent in the traditional Chinese medicine

En la actualidad, el ataque cerebrovascular (ACV) es una de las principales causas de muerte a nivel mundial. Desde su comprensión fisiopatológica, este es desencadenado por la hipoxia tisular cerebral, que produce una alteración funcional y estructural de la red celular y no celular interconectada, la cual está conformada por la unidad neurovascular y la matriz extracelular. En respuesta al daño, esta red activa y dirige el proceso de reparación tisular. A pesar de lo anterior, el ACV no se limita a una perspectiva molecular, sino que es parte de la historia de vida del paciente que la padece e integra su aspecto físico, emocional y mental. Desde esta visión, la necesidad en el enfoque y tratamiento puede ser suplida por otros sistemas médicos como la medicina tradicional china, que considera los signos y síntomas del ACV como el resultado de una desarmonía gestada y perpetuada por causas medioambientales, emocionales, mentales y en los hábitos de vida.

Experiencias de los adultos mayores en la pr ctica del Tai Chi Qi Gong. Tumbes, Perú / Experiences of older adults in the practice of Tai Ji Qi Gong, Tumbes, Peru

El tai-chi qi gong es una combinación de ejercicio físico y técnicas de relajación, utilizado para mejorar la salud física y mental de sus practicantes. Objetivos: develar y analizar comprehensivamente las experiencias de los adultos mayores en la práctica del tai chi qi gong en una posta médica de EsSalud, Tumbes–Perú. Material y métodos: investigación cualitativa, desarrollada bajo el enfoque acción participación. Los sujetos de investigación fueron los adultos mayores que asisten al Programa del Adulto Mayor. La información fue recogida mediante entrevistas a profundidad considerando en todo momento los principios éticos del Informe de Belmont; el tamaño de la muestra se determinó por el método de saturación; obteniéndose siete discursos representativos, el tratamiento de los datos fue mediante el método de análisis de contenido. Resultados: Tai chi qi gong: una experiencia positiva. II. Experimentado los beneficios del tai chi con las siguientes sub categorías disminuyendo dolencias corporales, aumentado la agilidad corporal, mejorando el estado de ánimo, liberando tensiones mentales. III. Practicando los ejercicios del tai chi en casa. Conclusiones: la práctica del tai chi qi gong tiene consecuencias muy favorables para la salud de los adultos mayores porque permite desarrollar en gran manera el sentido de equilibrio, con un importante mejoramiento de su condición física, funcional y emocional y un claro aumento del nivel de calidad de vida.

Tai ji qi gong is a combination of exercise and relaxation techniques used to improve physical and mental health of its practitioners. Objectives: unmasking and comprehensively analyze the experiences of older adults in the practice of tai chi qi gong at a health post EsSalud, Tumbes - Peru. Material and Methods: qualitative research, developed under the action approach participation. Research subjects were older adults who attend the Elderly Program. The information was collected through in-depth interviews at all times considering the ethical principles of the Belmont Report; the sample size was determined by the method of saturation; yielding seven representative speeches, treatment of data was by the method of content analysis. Results: Tai chi qi gong: A positive experience. II. Experienced the benefits of tai chi with the following sub categories decreasing bodily ailments, increased body agility, improving mood, releasing mental stress. III. Practicing tai chi exercises at home. Conclusions: the practice of tai chi qi gong has very favorable to the health of older adults consequences because it allows develop greatly the sense of balance, with a significant improvement in their physical, functional and emotional condition and a clear increase in the level of quality of life.

Impact of an Emergency Triage Assessment and Treatment (ETAT)-based triage process in the paediatric emergency department of a Guatemalan public hospital.

BACKGROUND: Triage process implementation has been shown to be effective at improving patient outcomes. This study sought to develop, implement and assess the impact of an Emergency Triage Assessment and Treatment (ETAT)-based emergency triage process in the paediatric emergency department (PED) of a public hospital in Guatemala. METHODS: The study was a quality improvement comparison with a before/after design. Uptake was measured by percentage of patients with an assigned triage category. Outcomes were hospital admission rate, inpatient length of stay (LOS), and mortality as determined by two distinct medical record reviews for 1 year pre- and post-intervention: a random sample (RS) of all PED patients and records for all critically-ill (CI) children [serious diagnoses or admission to the paediatric intensive care unit (PICU)]. Demographics, diagnoses and disposition were recorded. RESULTS: The RS totalled 1027 (51.4% male); median ages pre- and post-intervention were 2.0 and 2.4 years, respectively. There were 196 patients in the CI sample, of whom 56.6% were male and one-third were neonates; median ages of the CI group pre- and post-intervention were 3.1 and 5.6 months, respectively. One year after implementation, 97.5% of medical records had been assigned triage categories. Triage categories (RS/CI) were: emergency (2.9%/54.6%), priority (47.6%/44.4%) and non-urgent (49.4%/1.0%). The CI group was more frequently diagnosed with shock (25%/1%), seizures (9%/0.5%) and malnutrition (6%/0.5%). Admission rates for the RS (8% vs 4%, P=0.01) declined after implementation. For the CI sample, admission rate to the PICU (47% vs 24%, P=0.002) decreased and LOS (7.3 vs 5.7 days, P=0.09) and mortality rates (12% vs 6%, P=0.15) showed trends toward decreasing post-implementation. CONCLUSIONS: Paediatric-specific triage algorithms can be implemented and sustained in resource-limited settings. Significant decreases in admission rates (both overall and for the PICU) and trends towards decreased LOS and mortality rates of critically ill children suggest that ETAT-based triage systems have the potential to greatly improve patient care in Latin America.

Performance of a sample of patients with Mild Cognitive Impairment (MCI), Alzheimer's Disease (AD) and healthy elderly on a lexical decision test (LDT) as a measure of pre-morbid intelligence / Desempenho de uma amostra de pacientes com Comprometimento Cognitivo Leve (CCL), doença de Alzheimer (DA) e idosos saudáveis em Teste de Decisão Lexical (TDL) como medida de QI pré-mórbido

Objective:The objective of this study was to describe the performance of healthy elderly patients with aging-related pathologies (MCI) and patients with AD on a lexical decision test.Methods:The study included 38 healthy elderly subjects, 61 MCI and 26 AD patients from the Neurology Department of the Hospital das Clinicas, Behavioral and Cognitive Neurology Group. The neuropsychological instruments included the episodic memory test (RAVLT), subtests from the WAIS-III (Matrix Reasoning and Vocabulary) to determine estimated IQ, the Boston naming test (BNT) and Lexical Decision Test (LDT).Results:All groups differed on the MMSE, as expected according to their pathologies, memory tests, naming and estimated IQ. For the vocabulary and the LDT - measures of crystalized intelligence no differences were found.Conclusion:The LDT demonstrated that lexical decision can be used as a measure of pre-morbid IQ among the individuals assessed in a Brazilian sample.

Objetivo:O objetivo deste artigo é descrever o desempenho de idosos saudáveis, idosos com patologias relacionadas ao envelhecimento (CCL) e de idosos com DA, em teste de decisão lexical.Métodos:Participaram 38 idosos saudáveis, 61 CCL e 26 DA, atendidos no Setor de Neurologia do Hospital das Clínicas (GNCC) e do Centro de Referência em Distúrbios Cognitivos (CEREDIC). Os instrumentos neuropsicológicos incluíram teste de memória episódica (RAVLT), Subtestes do WAIS-III (Vocabulário e Raciocínio Matricial) para estabelecer QI estimado, teste de nomeação (BNT) e o Teste de Decisão Lexical (TDL).Resultados:Todos os grupos diferiram quanto ao MEEM, de acordo com o esperado para as patologias, para os testes de memória, para a nomeação e o QI estimado. No caso do vocabulário e do TDL - medidas de inteligência cristalizada não apresentaram diferença.Conclusão:O TDL permitiu que se mostrasse que a decisão lexical pode ser uma medida de QI pré-mórbido nos indivíduos avaliados em uma amostra da população brasileira.

O movimento Yin e Yáng na cosmologia da medicina chinesa / The Yin and Yang movement in the cosmology of Chinese medicine

Após ter se desenvolvido no Oriente, embasada pela cosmologia taoista, a medicina chinesa vem sendo praticada no Ocidente baseada na fundamentação científica e no paradigma biomédico, abandonando alguns elementos tradicionais dessa racionalidade, como a teoria Yīn e Yáng, conhecimento essencial para o entendimento do processo saúde-doença decorrente da circulação do sopro vital pelo corpo. Este artigo estuda o movimento da dupla Yīn e Yáng na doutrina médica chinesa, buscando conhecer como se desenvolveu essa linha de pensamento e a sua contribuição na elaboração do sistema diagnóstico e terapêutico. A metodologia utilizada foi a análise da literatura que aborda o objeto a partir do referencial teórico do pensamento taoista e da medicina tradicional chinesa.

After being developed in the East, based on Taoist cosmology, Chinese medicine has been practiced in the West based on scientific foundations and biomedical paradigms. Some traditional elements of this philosophy were abandoned, such as the theory of Yin and Yang, knowledge that is essential for understanding the health-disease process resulting from the circulation of the body’s energy flow. This article studies the movement of the dual elements of Yin and Yang in Chinese medical teaching, seeking to understand how this line of thought developed and how it has contributed towards establishing a system of diagnosis and therapy. The methodology employed was to analyze literature on the subject, based on theoretical references to Taoist thought and traditional Chinese medicine.

Revisión del concepto de energía vital entre la Homeopatía y la Medicina Tradicional China / Review of the concept of vital energy between Homeopathy and Traditional Chinese Medicine

En el presente trabajo se revisa el concepto de energía vital en Homeopatía, en relación con el de la Medicina Tradicional China, soportado por la revisión y análisis de textos y traducciones de ambas visiones médicas; con la finalidad de lograr un primer acercamiento sobre el concepto manejado por cada una de ellas. Si bien es cierto en algunos contextos se plantea que el concepto podría llegar a tener algunas aproximaciones, en general no es posible afirmar que el concepto sea el mismo, esto se debe a que una de las mayores dificultades para realizar esta comparación, son las diferencias existentes en la forma de interpretación de los conceptos entre occidente y oriente. La forma de interpretación en occidente es más lógica y precisa, mientras que la especificación en oriente es más diversa encontrando diferencias interpretativas y semánticas como lo son el tono, la grafía, el contexto, las transcripciones y traducciones del pinyin, lo que genera interpretaciones altamente específicas que no son posibles analizar en este trabajo, pero que si dan pie para el desarrollo de futuras investigaciones.

Los desórdenes depresivos mentales desde la óptica de la medicina tradicional china en occidente / Mental depressive disorders from the perspective of traditional Chinese medicine in the West

Los síndromes depresivos mentales, diagnosticados o no, constituyen un padecimiento frecuente que afecta los sistemas de salud y será la segunda causa de discapacidad en 2020. La depresión en un padecimiento en el que la persona presenta un estado de ánimo bajo por causas diversas (Biológicas y Socioambientales) pero con efectos y predisposición individual, que se sostiene en un rango de tiempo y en el que predominan la tristeza desde una intensidad leve hasta una marcada desesperación. Se puede acompañar por un rango de síntomas, que incluyen los trastornos del sueño, déficit de concentración, fatiga, agitación, baja autoestima, somatización, pérdida del interés general y la anhedonia; Es una enfermedad de que puede llegar a la gravedad de los pensamientos de muerte y el suicidio. Desde la visión de la Medicina Tradicional China, los síntomas depresivos parten de la alteración del equilibrio Yin - Yang y la dinámica de la energía, y en el que especialmente el órgano hígado y las funciones espirituales de cada órgano, juegan un papel fundamental en su origen. La depresión se incluye como origen o comorbilidad asociada de las enfermedades crónico degenerativas, en las que múltiples factores confluyen hacia un estado inflamatorio persistente que causa un daño en las estructuras cerebrales que modulan la conducta y los estados de ánimo. Lo cual desde la MTC, se puede explicar como un desbalance entre las energías patógena y la anti patógena. Los tratamientos desde la MTC incluyen la acupuntura corporal, la cráneo acupuntura con enfoque regular la dinámica de las funciones espirituales, la electro acupuntura, entre otros.

Análise fatorial confirmatória da escala de inteligência Wechsler abreviada: versão português brasileiro / Confirmatory factor analysis of Wechsler Abbreviated Scale of Intelligence: Brazilian Portuguese Version / Análisis factorial confirmatorio de la escala de inteligencia Wechsler abreviada: versión portuguesa-brasileña

A escala de inteligência Wechsler abreviada (WASI) é um instrumento desenvolvido para avaliar a inteligência de forma rápida. Fornece, além do QI total, os QIs verbal e de execução. O presente estudo visa a investigar se os dados de parte da amostra de normatização da versão brasileira do instrumento se ajustam ao modelo de dois fatores. Foi realizada uma análise fatorial confirmatória com dados de 534 participantes, idade média de 28,78 anos (DP=22,07), com 51,5% do sexo feminino. As análises consideraram as amostras total, de crianças/adolescentes e de adultos. Os resultados indicaram que o modelo de dois fatores se ajusta à amostra analisada. Considerações acerca da validade interna e da proposta conceitual do instrumento são realizadas.(AU)

The Wechsler abbreviated scale of intelligence (WASI) was developed to rapidly assess intelligence, providing Verbal, Performance, and Full Scale IQ scores. This study aimed to investigate whether part of the standardization sample data from the Brazilian version of the instrument fits the two-factor model. Confirmatory factor analysis was conducted with data from 534 participants, average age 28.78 years (SD=22.07), and 51.5% female. The analyses were performed considering the total sample, the children and adolescents sample and the adult sample. Results indicate that the two-factor model fits the analyzed sample. Considerations are presented regarding the internal validity and conceptual proposal of the instrument.(AU)

La escala de inteligencia Wechsler abreviada (WASI) es un instrumento desarrollado para evaluar la inteligencia de forma rápida que aporta además del CI total, los CIs Verbal y de Ejecución. Este estudio pretende investigar si los datos de parte de la muestra de normalización de la versión Brasileña se ajustan a un modelo de dos factores. Se realizó un análisis factorial confirmatorio con datos de 534 participantes, con media de edad de 28,78 años (SD=22,07), siendo 51,5% del sexo femenino. El análisis fue realizado considerándose la muestra total de niños/adolescentes y adultos. Los resultados indicaron que el modelo de dos factores se ajusta a la muestra analisado. Se hacen consideraciones sobre la validez interna y la propuesta conceptual.(AU)

Análise fatorial confirmatória da escala de inteligência Wechsler abreviada: versão português brasileiro / Confirmatory factor analysis of Wechsler Abbreviated Scale of Intelligence: Brazilian Portuguese Version / Análisis factorial confirmatorio de la escala de inteligencia Wechsler abreviada: versión portuguesa-brasileña

A escala de inteligência Wechsler abreviada (WASI) é um instrumento desenvolvido para avaliar a inteligência de forma rápida. Fornece, além do QI total, os QIs verbal e de execução. O presente estudo visa a investigar se os dados de parte da amostra de normatização da versão brasileira do instrumento se ajustam ao modelo de dois fatores. Foi realizada uma análise fatorial confirmatória com dados de 534 participantes, idade média de 28,78 anos (DP=22,07), com 51,5% do sexo feminino. As análises consideraram as amostras total, de crianças/adolescentes e de adultos. Os resultados indicaram que o modelo de dois fatores se ajusta à amostra analisada. Considerações acerca da validade interna e da proposta conceitual do instrumento são realizadas...

The Wechsler abbreviated scale of intelligence (WASI) was developed to rapidly assess intelligence, providing Verbal, Performance, and Full Scale IQ scores. This study aimed to investigate whether part of the standardization sample data from the Brazilian version of the instrument fits the two-factor model. Confirmatory factor analysis was conducted with data from 534 participants, average age 28.78 years (SD=22.07), and 51.5% female. The analyses were performed considering the total sample, the children and adolescents sample and the adult sample. Results indicate that the two-factor model fits the analyzed sample. Considerations are presented regarding the internal validity and conceptual proposal of the instrument...

La escala de inteligencia Wechsler abreviada (WASI) es un instrumento desarrollado para evaluar la inteligencia de forma rápida que aporta además del CI total, los CIs Verbal y de Ejecución. Este estudio pretende investigar si los datos de parte de la muestra de normalización de la versión Brasileña se ajustan a un modelo de dos factores. Se realizó un análisis factorial confirmatorio con datos de 534 participantes, con media de edad de 28,78 años (SD=22,07), siendo 51,5% del sexo femenino. El análisis fue realizado considerándose la muestra total de niños/adolescentes y adultos. Los resultados indicaron que el modelo de dos factores se ajusta a la muestra analisado. Se hacen consideraciones sobre la validez interna y la propuesta conceptual...