ABSTRACT Objective: To determine the performance of groups of pediatric residents from a Buenos Aires hospital, in terms of correct recognition and communication of a medical error (ME), in a high-fidelity simulation scenario. To describe the reactions and communication attempts following the ME and the self-perception by the trainees before and after a debriefing. Methods: Quasi-experimental uncontrolled study conducted in a simulation center. First- and third-year pediatric residents participated. We designed a simulation case in which an ME occurred and the patient deteriorated. During the simulation, participants had to provide information on communicating the ME to the patient’s father. We assessed communication performance and, additionally, participants completed a self-perception survey about ME management before and after a debriefing. Results: Eleven groups of residents participated. Ten (90.9%) identified the ME correctly, but only 27.3% (n=3) of them reported that a ME had occurred. None of the groups told the father they were going to give him important news concerning his son’s health. All 18 residents who actively participated in this communication completed the self-perception survey, with an average score before and after debriefing of 5.00 and 5.05 (out of 10) (p=0.88). Conclusions: We observed a high number of groups that recognized the presence of a ME, but the communication action was substantially low. Communication skills were insufficient and residents’ self-perception of error management was regular and not modified by the debriefing.

RESUMO Objetivo: Determinar o desempenho de grupos de residentes pediátricos de um hospital de Buenos Aires, em termos de reconhecimento e comunicação correta de um erro médico (EM),em cenário de simulação. Descrever as reações e tentativas de comunicação após o EM e a autopercepção pelos estagiários antes e depois de um questionário. Métodos: Estudo quase experimental não controlado realizado em centro de simulação. Participaram residentes pediátricos do primeiro e terceiro anos. Concebeu-se um caso de simulação em que ocorreu um EM com deterioração de um paciente. Durante a simulação, os participantes tiveram que fornecer informações relacionadas à comunicação do EM ao pai do paciente. Avaliou-se o desempenho da comunicação e, adicionalmente, os participantes completaram um inquérito de autopercepção sobre a gestão da EM, antes e depois de um questionário. Resultados: Onze grupos de residentes participaram. Dez (90,9%) identificaram corretamente o EM, mas apenas 27,3% (n=3) deles comunicaram que havia ocorrido o EM. Nenhum dos grupos disse ao pai que iria dar notícias importantes sobre a saúde do seu filho. Todos os 18 residentes que participaram ativamente da comunicação completaram o questionário de autopercepção com uma pontuação média antes e depois do questionário de 5,00 e 5,05 (máximo: 10 pontos) (p=0,88). Conclusões: Observamos elevado número de grupos que reconheceram a presença de um EM, mas a ação de comunicação foi rara. A capacidade de comunicação foi insuficiente e a autopercepção da gestão de erros por parte dos residentes foi regular, não sendo modificada pelo debriefing.

Resumen Este artículo analiza el reposicionamiento de Ecuador entre 2017 y 2020. Se toma en cuenta la existencia de una estructura histórica competitiva previa que permite comprender dicha reorientación. Como introducción se revisarán las matrices de los proyectos nacionales en competencia desde perspectiva de larga duración (longue dureé), con énfasis en las dos últimas administraciones gubernamentales, sin dejar de lado el precedente histórico. El posicionamiento del presidente Moreno se analizará específicamente en su relación dinámica con lo político y económico; además de la competencia en el ámbito de las ideas. Asimismo se analizará la continuidad a nivel de dimensión interna y el reposicionamiento ecuatoriano frente al orden mundial, el cual puede ser observado a través de su diplomacia, tipo de integración, seguridad y defensa, y articulación con los grandes jugadores globales. Finalmente, a modo de conclusión, se presentará una caracterización del reposicionamiento de Ecuador en el periodo propuesto y se presentarán algunos de los elementos presentes a nivel estructural.

Abstract This article analyzes Ecuador's newly assumed position in the international system between 2017 and 2020. In that regard, the country's historical competitive structure is considered key to understanding this shift. We begin by analyzing the competing national projects from a historical perspective, emphasizing the two recent administrations. President Lenin Moreno's positioning will be analyzed specifically in its relation with political and economic elements, as well as with regards to the ideational realm. We also study the continuities in Ecuador's internal politics and the country's repositioning within the world order through diplomacy, integration type, security, and defense strategies, as well as its linkages to major global players. To conclude, we characterize the country's repositioning and reflect upon some structural elements.

Resumo Este artigo analisa o reposicionamento do Equador no período entre 2017 e 2020. É considerada a existência prévia de uma estrutura histórica competitiva, o que nos permite compreender tal reorientação. Como introdução, as matrizes de projetos nacionais concorrentes serão revisadas em uma perspectiva de longo prazo (longue dureé), com ênfase nas duas últimas administrações governamentais, porém verificando o precedente histórico. O posicionamento do presidente Moreno será analisado especificamente em sua relação dinâmica com a política, a economia e a competição no campo das ideias. A continuidade no nível da dimensão interna e o reposicionamento equatoriano frente à ordem mundial, que pode ser observada por meio de sua diplomacia, tipo de integração, segurança e defesa, e articulação com os grandes atores globais. Por fim, como conclusão, será apresentada uma caracterização do reposicionamento do Equador no período proposto, e alguns dos elementos presentes no nível estrutural.

ABSTRACT The main objective of the research that allows elaborating this theoretical reflection is to know the processes of violence towards children and adolescents that occurred or detected in the Ecuadorian educational context, carrying out a school ethnography, to determine a series of recommendations to reduce their incidence to the regional and global level. The methodology used focused on using qualitative research techniques since the Ministry of education had quantitative data that deserved to be correlated to obtain significantly and not only representative results. Therefore, analyzing the previous statistical data and the qualitative results obtained from a school ethnography (participant observation, interviews, discussion groups, documentary) allows a series of conclusions and recommendations to influence the public policies that prevent violence in the education system.

RESUMEN El objetivo principal de la investigación que permite elaborar esta reflexión teórica es conocer los procesos de violencia hacia niños, niñas y adolescentes ocurridos o detectados en el contexto educativo ecuatoriano, realizando una etnografía escolar, con el fin de determinar una serie de recomendaciones para reducir su incidencia a nivel regional y global. La metodología utilizada se centró en el uso de técnicas cualitativas de investigación dado que el Ministerio de Educación contaba con datos cuantitativos que merecían ser correlacionados para obtener resultados significativos y no solo representativos. El análisis de los datos estadísticos previos más los resultados cualitativos obtenidos de una etnografía escolar (observación participante, entrevistas, grupos de discusión, documental) permiten elaborar una serie de conclusiones y recomendaciones orientadas a influir en las políticas públicas que previenen las situaciones de violencia en el sistema educativo.

Objective: To evaluate the performance of resident physicians in diagnosing and treating a case of anaphylaxis, six months after participating in simulation training exercises. Methods: Initially, a group of pediatric residents were trained using simulation techniques in the management of critical pediatric cases. Based on their performance in this exercise, participants were assigned to one of 3 groups. At six months post-training, 4 residents were randomly chosen from each group to be re-tested, using the same performance measure as previously used. Results: During the initial training session, 56 of 72 participants (78%) correctly identified and treated the case. Six months after the initial training, all 12 (100%) resident physicians who were re-tested successfully diagnosed and treated the simulated anaphylaxis case. Conclusions: The training through simulation techniques allowed correction or optimization of the treatment of simulated anaphylaxis cases in resident physicians evaluated after 6 months of the initial training.

Objetivo. Evaluar el desempeno logrado por médicos residentes en el diagnóstico y tratamiento de un caso simulado de anafilaxia luego de 6 meses de haber recibido capacitación con técnicas de simulación. Material y método. Un grupo de residentes de Pediatría fueron capacitados a través de técnicas de simulación en diferentes emergencias pediátricas (primera etapa) y luego clasificados según su grado de desempeno en 3 subgrupos. Se seleccionaron, posteriormente, 4 médicos al azar de cada subgrupo para ser reevaluados luego de 6 meses (segunda etapa). Resultados. Participaron 72 médicos de la primera etapa, 56 (77,8%) resolvieron el caso correctamente. A los 6 meses, los 12 (100%) médicos evaluados trataron en forma adecuada el nuevo caso de anafilaxia. Conclusiones. La capacitación a través de técnicas de simulación permitió corregir u optimizar el tratamiento de casos simulados de anafilaxia en médicos residentes evaluados luego de 6 meses de la capacitación inicial.

Introduction. Physicians are frequently victims of both physical and verbal violence. Specific training is required for staff so that they are able to deal with these situations. Objective. To assess the clinical management and behavior of pediatric medical residents towards a violent mother during a pediatric emergency simulation. Materials and methods. Observational, retrospective and descriptive study. Video recordings of a pediatric emergency simulation with the participation of medical residents working at a public children's hospital between March and July 2014 were reviewed. The case mother was verbally violent and interfered with participants, both physically and orally. During debriefing, discussions were recorded. Results. Sixty-eight pediatric medical residents divided into 15 groups were observed. Twelve handled the episode appropriately; only two groups asked the security staff to remove the mother from the scene (recommended behavior). Other two groups managed to remove the mother from the clinical scenario but in the midst of struggles. Out of all physicians, 54.4% (n = 37) came into physical contact with the mother, and 95.6% had not previously received guidelines on how to manage violent situations. Conclusions. Only a few groups managed to remove the violent mother from the scene. Unconsented physical contact with the mother was one of the most commonly observed behaviors. A lack of institutional guidelines on how to handle violent situations was detected.

Introducción. Los médicos son víctimas frecuentes de violencia tanto física como verbal. Se requiere capacitación específica para preparar al personal para enfrentar estas situaciones. Objetivo. Evaluar, en médicos residentes de Pediatría, durante una simulación de una emergencia pediátrica, el manejo clínico y la conducta ante una madre violenta. Materiales y método. Estudio observacional, retrospectivo y descriptivo. Se revisaron los videos de simulaciones de un caso de emergencia pediátrica, en los que participaron residentes de un hospital público pediátrico, de marzo a julio de 2014. La madre del caso agredía verbalmente e interfería física y oralmente con los participantes. Se registró lo conversado durante el debriefing (la reunión grupal de evaluación). Resultados. Se observaron un total de 68 médicos residentes divididos en 15 grupos. Doce trataron de manera adecuada el caso; solo 2 de ellos retiraron a la madre a través del personal de vigilancia (conducta recomendada). Otros 2 grupos lograron retirar a la madre del escenario clínico, pero con forcejeos. El 54,4% de los médicos (n= 37) mantuvo contacto físico con la madre. El 95,6% de los médicos no contaba con pautas previas para enfrentar estas situaciones de violencia. Conclusiones. Pocos grupos lograron retirar a la madre violenta de la escena. El contacto físico con la madre sin su consentimiento fue una de las conductas más frecuentemente observadas. Se detectó la falta de pautas institucionales para manejar situaciones de violencia.

Cardiopulmonary resuscitation (CPR) courses meet all the definitions of an educational activity for prevention of cardiac arrest death by risk patients' parents and/or the general population. The aim is to improve patients' home care and turn parents confident before their children are discharged from hospital, mainly from intensive care units. Currently these courses are part of discharge protocols in many neonatologist services although there are offers that exceed this target, and extend to other areas such as education and caregivers. Locally the experience of neonatal CPR at the Sociedad Argentina de Pediatría stands out in connection with delivering courses to high risk patients' parents as well as designing and spreading learning material.

Los cursos de reanimación cardiopulmonar (RCP), cumplen todas las definiciones de una actividad educativa dirigida hacia la prevención, por parte de los padres, de la muerte por paro cardiorrespiratorio de pacientes de riesgo y/o población general. Su finalidad es principalmente la de mejorar el cuidado hogareño de los pacientes y brindar confianza antes del alta de los sectores de internación, sobre todo de cuidados intensivos. En la actualidad, forman parte del protocolo de alta de muchos servicios de neonatología, aunque hay propuestas que superan este objetivo y se extienden a otras áreas, tales como los distintos ámbitos educativos y cuidadores. A nivel local, se destaca la experiencia del grupo de RCP neonatal de la Sociedad Argentina de Pediatría en sus funciones de dictado regular de cursos a grupos familiares de pacientes de alto riesgo, así como también en la creación y difusión de contenidos.

El objetivo del trabajo fue identificar los factores de riesgo asociados a la seroprevalencia de Brucelosis y Leptospirosis en los operarios de la planta de beneficio de la ciudad de Pasto. La seropositividad para Brucella abortus se determinó mediante la prueba diagnóstica de Rosa de Bengala (RB) y para Leptospira spp, mediante la prueba diagnóstica de Microaglutinación (MAT). De los 37 sueros procesados, 3 (8%) fueron positivos a RB y no se encontraron respuestas positivas a los serovares de Leptospira spp evaluados con MAT. Para identificar los factores de riesgo se realizó una encuesta epidemiológica a cada operario, incluyendo variables relacionadas con la transmisión de las enfermedades estudiadas, las cuales fueron analizadas mediante regresión logística binaria para establecer el Odds Ratio (OR). Los factores de riesgo asociados a Brucelosis fueron: no usar guantes (OR = 3.11; IC95% 1.09-11.52) y no usar delantal (OR = 2.94; IC95% 1.12-43.04) como elementos de protección personal durante el proceso de beneficio de bovinos y porcinos. Por lo tanto, se recomienda aumentar las medidas de control sobre el uso de los elementos de protección personal en el trabajo dentro del programa de salud ocupacional para minimizar el riesgo de transmisión de enfermedades zoonóticas.

The aim of this study was to identify the risk factors associated with seroprevalence of Brucellosis and Leptospirosis in operators of the slaughterhouse in Pasto, Nariño. Seropositivity for Brucella abortus was determined by the diagnostic test Rose Bengal (RB) and Leptospira sp, through diagnostic Microagglutination Test (MAT).From the 37 serum processed, 3 (8%) were positive for RB and there were no positive responses to Leptospira sp serovars evaluated with MAT test. The risk factors were identified conducting an epidemiological survey to each operator, including variables related to the transmission of the diseases in study, which were analyzed by binary logistic regression to establish the odds ratio (OR). The biological risk factors associated with brucellosis were not wearing gloves (OR = 3.11, 95% CI 1.09-11.52) and not using apron (OR = 2.94, 95% CI 1.12-43.04) like personal protective equipment during cattle and pigs slaughter. Therefore, it is recommended to increase control measures on the use of personal protective equipment at work in the occupational health program to minimize the risk of transmission of zoonotic diseases.

Introduction. Internet has become, since its beginning, the ideal media for information access. Children and adolescents use it frequently, and they usually reach inappropriate material, and their parents are not aware of this situation. The objective of the study was to evaluate the family perception of the use at home of the Internet by children and adolescents. Population, material and methods. A web survey coordinated by the Working Group of Medical Informatics at the Sociedad Argentina de Pediatría was conducted between 09/01/2007 and 03/01/2008, and evaluated the household characteristics (number of children and their age) and their user internet profile. Results. The survey was completed by 857 of the 1055 registered users. A total of 1380 children and adolescents were included, 83.5% were from Argentina. 25.8% of the children informed the adults about an unpleasant experience while using the web, 30.8% of the adults did not know their child's online nickname and only 28.6% used parental control software. 53.4% of the surveyed individuals reported talking with their children about their online activities. Conclusion. The results obtained from our survey show that children frequently have unpleasant experiences while using the web and there is very little supervision from parents, who underestimate the risk of the web access.

Introducción. Internet se ha constituido desde su nacimiento en un medio ideal para recibir información. Los niños y adolescentes lo utilizan con frecuencia y es habitual que se topen con material indebido, situación que muchas veces, es desconocida por sus padres. El objetivo del presente estudio fue evaluar la percepción familiar del uso que los niños y jóvenes hacen de Internet en el hogar. Población, material y métodos. Se realizó una encuesta coordinada por el Grupo de Informática de la Sociedad Argentina de Pediatría para ser contestada a través de Internet entre el 01/09/2007 y el 01/ 03/2008, que evaluaba características del hogar (número de hijos y edades) y el perfil de usuario con su patrón de navegación por Internet. Resultados. La encuesta fue completada por 857 de los 1.055 usuarios registrados. El número de niños y adolescentes abarcados fue de 1.380. El 83,5% de los encuestados provino de Argentina. El 25,8% de los niños informó a los adultos acerca de alguna experiencia desagradable que le tocó vivir durante el uso de Internet. Un 30,8% de los adultos desconocía el apodo que su hijo utiliza en la Web y sólo el 28,6% aplicaba filtros de contenidos parentales. Un 53,4% de los encuestados refirió que conversa siempre con sus hijos acerca de las actividades en línea. Conclusiones. Los datos obtenidos en nuestra encuesta muestran que es frecuente que los niños tengan experiencias desagradables durante el uso de Internet y que existe poca supervisión de los padres, quienes subestiman los riesgos de acceso a la Web.