ABSTRACT BACKGROUND: With the increase in the older adult population, it is essential to identify the living and health conditions that can impact the quality of life of these individuals. OBJECTIVES: To identify the domains and factors associated with the quality of life of older adults under the Family Health Strategy program. DESIGN AND SETTING: This was a cross-sectional analytical study was conducted in the municipality of Palmas, Tocantins, Brazil. METHODS: We assessed 449 older adults enrolled in the Family Health Strategy program. Data were collected between April and July, 2018. World Health Organization Quality of Life Assessment (WHOQOL-OLD) was used to assess the quality of life (QoL) and multiple linear regression was used to estimate the factors associated with QoL. RESULTS: The QoL domain with the highest score was death and dying (mean = 70.4), and the lowest score was for sensory functions (mean = 61.0 points). The factors associated with QoL were single marital status (β = -4.55; P = 0.014), level of independence for daily living activities (β = 4.92; P < 0.001), self-assessment of regular health (β = 5.35; P < 0.001), and poor health (β = -8.67; P < 0.001). CONCLUSION: The death and dying domain of QoL presented the highest score. Marital status, impairment in daily activities, and health self-assessment were associated with QoL.

Resumen Introducción. Los insectos comestibles se presentan como una fuente alternativa de proteína generada con prácticas de producción sostenibles con el medio ambiente y de alto valor nutricional. La producción de alimentos con insectos ha aumentado en los últimos años a nivel mundial y se estima que continuará en crecimiento. Costa Rica cuenta con un pequeño número de productores de insectos comestibles, lo que ha conllevado un creciente interés de la academia y entidades estatales por fomentar el sector. Objetivo. Presentar el mercado actual, las oportunidades, los retos y las perspectivas de la producción, procesamiento y comercialización de insectos comestibles a nivel internacional y en Costa Rica. Desarrollo. Se describe el mercado actual de los insectos comestibles a nivel mundial, los principales retos y oportunidades de su producción, procesamiento y comercialización, así como el desarrollo del sector en Costa Rica. Conclusión. A nivel mundial, los principales retos relacionados con la producción de alimentos con insectos son la baja aceptación del consumidor, la falta de tecnologías de producción de insectos y un deficiente marco regulatorio. En Costa Rica, debido a los esfuerzos conjuntos de la academia, el sector público y privado, existe un marco regulatorio base que permite la producción de tres especies de insectos para consumo humano. Los costarricenses tienen la disposición de incluir los insectos en su dieta, pero aún es necesario desarrollar mejores métodos de producción para facilitar el crecimiento del sector.

Abstract Introduction. Edible insects emerge as an alternative source of protein generated with environmentally sustainable production practices and high nutritional value. The production of insect-based food products has increased globally in recent years and it is expected to continue growing. Costa Rica has a small number of edible insect producers, which has led to growing interest from academia and government entities in promoting the sector. Objective. To present the current market, opportunities, challenges, and perspectives of edible insect production, processing, and marketing internationally and in Costa Rica. Development. The current global market for edible insects is described, the main challenges, and opportunities in their production, processing, and marketing, as well as the sector's development in Costa Rica. Conclusion. Globally, key challenges in edible insect production include low consumer acceptance, lack of insect production technologies, and inadequate regulatory framework. In Costa Rica, collaborative efforts from academia, the public, and private sectors have established a basic regulatory framework allowing the production of three insect species for human consumption. Costa Ricans are willing to include insects in their diet, but there is still a need to develop better production methods to facilitate the sector growth.

Resumen Introducción: existe una amplia variedad de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles. La consulta de información relacionada debe hacerse en las herramientas propias de cada laboratorio, lo que dificulta la visión crítica y la comparativa entre las mismas. Objetivo: describir el desarrollo de NEmecum como la primera web que permite realizar una búsqueda dirigida e independiente de fórmulas de nutrición o preparados infantiles, analizar el abanico nutricional actual en España y evaluar los datos de uso de la herramienta. Métodos: se desarrolló la estructura de una base de datos que unifica los parámetros de todas las fórmulas y se analizó el abanico nutricional español. Posteriormente, se seleccionaron los principales algoritmos de búsqueda dirigida y se codificó la herramienta digital. Se llevó a cabo una intensa difusión y se evaluó el impacto obtenido. Se analizaron el perfil de usuarios y centros registrados y los datos de uso de la herramienta y se evaluó su usabilidad mediante el cuestionario System Usability Scale (SUS). Resultados: se obtuvo una web responsive de acceso gratuito (http://nemecum.com) que permite realizar búsquedas dirigidas en base a unos filtros de búsqueda preestablecidos. La herramienta permitió analizar detalladamente el abanico nutricional en España, observándose la gran variedad de fórmulas disponibles de similares características. La campaña de difusión consiguió incrementar su uso de forma exponencial y cuenta actualmente con 1.370 usuarios y 79 centros registrados. La usabilidad fue valorada como excelente. Conclusión: el desarrollo de NEmecum supone una herramienta valiosa en la búsqueda y consulta de datos de fórmulas o preparados de nutrición enteral y fórmulas o preparados infantiles.

Abstract Introduction: there is a wide variety of enteral nutrition and infant formulas preparations. When there is a need to find infomation on a product, only the infomation from industy is available. Comparison amomg products becomes then ardous. Objective: to describe the development of NEmecum as the first website that allows a directed and independent search for enteral nutrition products and infant formulas, currently available in Spain, and to evaluate the initial use of NEmecum. Methods: the structure of a database that unifies the parameters of all formulas was developed, and the nutritional composition of all formulas was analyzed. Subsequently, the main search algorithms were selected and the digital tool was codified. Intensive dissemination was performed and the impact was evaluated. The profile of users and registered centers and the use of the tool were analyzed, and its usability was evaluated using the System Usability Scale (SUS) questionnaire. Results: a free-access responsive website (http://nemecum.com) that allows searches based on pre-established search filters was obtained. This tool allows for a detailed analysis available formulas in Spain by observing a wide variety of formulas with similar characteristics. The dissemination campaign managed to increase its use exponentially, currently reaching 1,370 users and 79 registered centers. Usability was rated as excellent. Conclusion: the development of the NEmecum represents a valuable tool in the search and consultation of the characteristics of enteral nutrition formulas and infant preparations.

RESUMEN Commotio cordis o conmoción cardíaca es un síndrome arritmogénico mecano-eléctrico raro y mortal. Es la segunda causa de muerte súbita en atletas jóvenes. Se asocia con una lesión que se produce durante la práctica deportiva, en la que un proyectil impacta a alta velocidad en el precordio y provoca una arritmia que conduce a la muerte inmediata del individuo sin una reanimación cardíaca. En las autopsias, los corazones son estructuralmente sanos. Con el conocimiento de este síndrome y las capacitaciones de reanimación cardiorrespiratoria a la comunidad, las tasas de supervivencia han mejorado. El objetivo de este trabajo es describir un paciente que llegó a nuestro hospital con conmotio cordis y su evolución, enfatizando la importancia de medidas de prevención y capacitación de la población en técnicas de reanimación cardiopulmonar y uso del desfibrilador externo automático para la supervivencia de los pacientes que sufren esta entidad.

Resumen: El confinamiento instaurado durante la pandemia por SARS-CoV-2 y el efecto del virus en la población podrían suponer un factor precipitante para trastornos de salud mental en la población infantil. Objetivo: Comparar los motivos de consulta, diagnósticos al alta, tasa de ingreso y reconsulta de pacientes pediátricos que acuden al Servicio de Urgencias por trastornos de salud mental antes y después del confinamiento por SARS-CoV-2. Pacientes y Método: Estudio descriptivo, retrospectivo. Se incluyeron pacientes menores de 16 años con motivos de consulta relacionados con salud mental durante los periodos preconfinamiento (01/07/2018-01/07/2019) y postconfinamiento (01/07/202001/07/2021). Se comparó la frecuencia de diagnósticos de salud mental, necesidad de inicio de fármacos, de hospitalización y de reconsultas. Resultados: Se incluyeron 760 pacientes (399 preconfinamiento y 361 postconfinamiento). Tras el confinamiento se observó un aumento del 45,7% en la frecuencia de consultas relacionadas con salud mental respecto al total de consultas de urgencias. La alteración del comportamiento fue el motivo de consulta más frecuente en ambos grupos (34,3% vs. 36,6%, p = 0,54). En el periodo postconfinamiento aumentaron significativamente las consultas relacionadas con intentos autolíticos (16,3% vs. 24,4%, p < 0,01) y el diagnóstico de depresión (7,5% vs. 18,5%, p < 0,01). Se objetivó un aumento del 58,8% en los pacientes que ingresaron respecto al total de pacientes que acudieron a urgencias (0,17% vs. 0,27%, p = 0,003) y un aumento del número de reconsultas (12% vs. 17,8%, p = 0,026). No se observaron diferencias en los días de hospitalización (7 días [RIC 4-13] vs. 9 días [RIC9-14], p0,45). Conclusión: En el periodo postconfinamiento se incrementó la proporción de pacientes pediátricos que acudieron a urgencias con alteraciones de la salud mental.

Abstract: The lockdown during the SARS-CoV-2 pandemic and the effect of the virus on the population could be a precipitating factor for mental health disorders in the pediatric population. Objective: To compare the reasons for consultation, diagnoses at discharge, and admission and re-consultation rates of pediatric patients attending the Emergency Department due to mental health disorders before and after the SARS-CoV-2 pandemic lockdown. Patients and Method: Retrospective, descriptive study. Patients under 16 years of age consulting due to mental health-related disorders during the pre- (07/01/2018-07/01/2019) and post-lockdown (07/01/2020-07/01/2021) periods were included. The frequency of mental health diagnoses, need for drug administration, hospitalization, and reconsultations were compared. Results: 760 patients were included, 399 pre-lockdown and 361 postlockdown. After the lockdown, there was a 45.7% increase in the frequency of mental health-related consultations with respect to the total number of emergency consultations. Behavioral alterations were the most frequent reason for consultation in both groups (34.3% vs. 36.6%, p = 0.54). In the post-lockdown period, consultations related to self-harm attempts (16.3% vs. 24.4%, p < 0.01) and the diagnosis of depression (7.5% vs. 18.5%, p < 0.01) increased significantly. There was an increase of 58.8% in patients who were hospitalized with respect to the total number of ED patients (0.17% vs. 0.27%, p = 0.003) and in the number of re-consultations (12% vs. 17.8%, p = 0.026). No differences were observed in days of hospitalization (7 days [IQR 4-13] vs. 9 days [IQR 9-14], p0.45). Conclusion: In the post-lockdown period, the proportion of pediatric patients presenting to the ED with mental health disturbances increased.

Resumen La inmunonutrición es una ciencia que engloba aspectos relacionados con la nutrición, la inmunidad, la infección, la inflamación y el daño tisular. Las fórmulas inmunomoduladoras han demostrado beneficios en una amplia variedad de situaciones clínicas. El objetivo de este trabajo es revisar la evidencia disponible en inmunonutrición (IN). Para ello, se ha realizado una búsqueda bibliográfica con las palabras clave: inmunonutrición, arginina, glutamina, nucleótidos, ácidos grasos omega-3, ERAS, fast-track. Se han incluido ensayos clínicos, revisiones y guías de práctica clínica. La IN ha demostrado reducir las fístulas en el postoperatorio en pacientes con cáncer de cabeza y cuello. En pacientes con cáncer gástrico y cáncer de esófago, la IN se asocia a una disminución de las complicaciones infecciosas y la estancia hospitalaria. Otras situaciones clínicas que se benefician del uso de la IN son la cirugía del cáncer de páncreas, la cirugía del cáncer colorrectal y los grandes quemados. Son necesarios más estudios controlados, prospectivos y aleatorizados para confirmar los potenciales beneficios de la IN en otras situaciones clínicas como la cirugía torácica no esofágica, el cáncer vesical, la cirugía ginecológica, la fractura de cadera, la patología hepática y la COVID-19, entre otros.

Abstract Immunonutrition is a science that encompasses aspects related to nutrition, immunity, infection, inflammation and tissue damage. Immunomodulatory formulas have shown benefits in a wide variety of clinical situations. The objective of this work was to review the available evidence in immunonutrition (IN). For this, a bibliographic search has been carried out with the keywords: immunonutrition, arginine, glutamine, nucleotides, omega-3 fatty acids, ERAS, fast-track. Clinical trials, reviews and clinical practice guidelines have been included. IN has been shown to reduce postoperative fistulae in head and neck cancer patients and in gastric and esophageal cancer patients, infectious complications and hospital stay. Other clinical situations that benefit from the use of IN are pancreatic cancer surgery, colorectal cancer surgery and major burns. More controlled, prospective, and randomized studies are necessary to confirm the potential benefits of IN in other clinical situations such as non-esophageal thoracic surgery, bladder cancer, gynecological surgery, hip fracture, liver pathology and COVID-19, among others.

Resumen: El confinamiento instaurado durante la pandemia por SARS-CoV-2 y el efecto del virus en la población podrían suponer un factor precipitante para trastornos de salud mental en la población infantil. Objetivo: Comparar los motivos de consulta, diagnósticos al alta, tasa de ingreso y reconsulta de pacientes pediátricos que acuden al Servicio de Urgencias por trastornos de salud mental antes y después del confinamiento por SARS-CoV-2. Pacientes y Método: Estudio descriptivo, retrospectivo. Se incluyeron pacientes menores de 16 años con motivos de consulta relacionados con salud mental durante los periodos preconfinamiento (01/07/2018-01/07/2019) y postconfinamiento (01/07/202001/07/2021). Se comparó la frecuencia de diagnósticos de salud mental, necesidad de inicio de fármacos, de hospitalización y de reconsultas. Resultados: Se incluyeron 760 pacientes (399 preconfinamiento y 361 postconfinamiento). Tras el confinamiento se observó un aumento del 45,7% en la frecuencia de consultas relacionadas con salud mental respecto al total de consultas de urgencias. La alteración del comportamiento fue el motivo de consulta más frecuente en ambos grupos (34,3% vs. 36,6%, p = 0,54). En el periodo postconfinamiento aumentaron significativamente las consultas relacionadas con intentos autolíticos (16,3% vs. 24,4%, p < 0,01) y el diagnóstico de depresión (7,5% vs. 18,5%, p < 0,01). Se objetivó un aumento del 58,8% en los pacientes que ingresaron respecto al total de pacientes que acudieron a urgencias (0,17% vs. 0,27%, p = 0,003) y un aumento del número de reconsultas (12% vs. 17,8%, p = 0,026). No se observaron diferencias en los días de hospitalización (7 días [RIC 4-13] vs. 9 días [RIC9-14], p0,45). Conclusión: En el periodo postconfinamiento se incrementó la proporción de pacientes pediátricos que acudieron a urgencias con alteraciones de la salud mental.

Abstract: The lockdown during the SARS-CoV-2 pandemic and the effect of the virus on the population could be a precipitating factor for mental health disorders in the pediatric population. Objective: To compare the reasons for consultation, diagnoses at discharge, and admission and re-consultation rates of pediatric patients attending the Emergency Department due to mental health disorders before and after the SARS-CoV-2 pandemic lockdown. Patients and Method: Retrospective, descriptive study. Patients under 16 years of age consulting due to mental health-related disorders during the pre- (07/01/2018-07/01/2019) and post-lockdown (07/01/2020-07/01/2021) periods were included. The frequency of mental health diagnoses, need for drug administration, hospitalization, and reconsultations were compared. Results: 760 patients were included, 399 pre-lockdown and 361 postlockdown. After the lockdown, there was a 45.7% increase in the frequency of mental health-related consultations with respect to the total number of emergency consultations. Behavioral alterations were the most frequent reason for consultation in both groups (34.3% vs. 36.6%, p = 0.54). In the post-lockdown period, consultations related to self-harm attempts (16.3% vs. 24.4%, p < 0.01) and the diagnosis of depression (7.5% vs. 18.5%, p < 0.01) increased significantly. There was an increase of 58.8% in patients who were hospitalized with respect to the total number of ED patients (0.17% vs. 0.27%, p = 0.003) and in the number of re-consultations (12% vs. 17.8%, p = 0.026). No differences were observed in days of hospitalization (7 days [IQR 4-13] vs. 9 days [IQR 9-14], p0.45). Conclusion: In the post-lockdown period, the proportion of pediatric patients presenting to the ED with mental health disturbances increased.

Abstract Fibre Reinforced Concrete (FRC) is internationally recognised as a structural material in the fib Model Code 2010 and at a national level in the recently published ABNT standard NBR 16935, which establishes the structural design procedure based on post-cracking parameters. This publication should foster an increase in the number of applications of FRC in Brazil in the next years. In this context, many researchers have investigated the use of the DEWS test for the FRC characterisation as an alternative to the three-point bending test (3PBT) usually recommended by standards. The DEWS test is conducted by applying a compressive load on specimens with triangular grooves that induce a pure mode‑I tensile fracture. Despite the advantages of the test, such as a smaller specimen and simpler testing procedure to obtain the anisotropic/orthotropic material properties, it still requires transducers to measure crack opening and generate the triangular grooves in the specimen, which is more complex, and labour demanding. This study addresses these issues by proposing a simplified test method and preparation consisting of removing the transducers (correlating the machine stroke and the crack opening) and generating the triangular groves during the casting instead of sawing afterwards. These modifications made the testing procedure much easier to perform. The experimental program assesses the modifications in the DEWS test setup and their influence on the post-cracking characterisation of FRC. Additionally, the effective fibre content and orientation were assessed by performing the inductive test. The results show that FRC characterisation can be successfully conducted using a simpler configuration of the DEWS test. This alternative test presents some advantages in comparison with the 3PBT test for FRC quality control, especially the lower volume of material and the test control by machine displacement.

Resumo O Concreto Reforçado com Fibras (CRF) é reconhecido internacionalmente como material estrutural pelo fib Model Code 2010 e em nível nacional, na recém publicada norma ABNT NBR 16935, que estabelece o procedimento de projeto estrutural baseado nos parâmetros pós-fissuração do compósito. Esta publicação deve propiciar um aumento do número de aplicações de CRF no Brasil nos próximos anos. Nesse contexto, muitos pesquisadores têm investigado o uso do teste DEWS para a caracterização de CRF como alternativa ao ensaio de flexão em três pontos (3PBT) usualmente recomendado pelas normas. O ensaio DEWS é realizado aplicando-se uma carga compressiva em corpos de prova com duplo corte à 450 que induzem uma falha em modo-I de fratura. Apesar das vantagens, como uso de corpo de prova menor e procedimento de ensaio mais simples para obter as propriedades anisotrópicas/ortotrópicas do material, ele ainda requer transdutores para medir a abertura da fissura e gerar os cortes triangulares no corpo de prova, o que é mais complexo e trabalhoso. Este estudo aborda essas questões propondo um método de ensaio e preparação simplificado que consiste em remover os transdutores (correlacionando o deslocamento da máquina e a abertura da fissura) e gerar os cortes triangulares à 450 durante a moldagem em vez de cortar posteriormente. Essas modificações tornaram o procedimento de ensaio muito mais fácil de ser realizado. O programa experimental avalia as modificações na configuração do ensaio DEWS e sua influência na caracterização pós-fissuração do CRF. Além disso, o conteúdo efetivo de fibra e a orientação foram avaliados através da realização do ensaio indutivo. Os resultados mostram que a caracterização do FRC pode ser realizada com sucesso usando uma configuração mais simples. Esse ensaio alternativo apresenta vantagens em comparação ao ensaio 3PBT para o controle tecnológico do CRF, principalmente em relação as dimensões do corpo de prova e controle do ensaio pelo deslocamento do equipamento.

Resumen: Aunque diversos estudios señalan las consecuencias psicológicas negativas de la pandemia por COVID-19 en los profesionales de la salud, pocos se centran en la experiencia de los pediatras. Objetivo: evaluar el estado de ansiedad de los pediatras tras la primera oleada e identificar posibles factores relacionados. Material y Método: Estudio de encuestas transversales enviado a pediatras españoles a través del listado de la Asociación Española de Pediatras. Se recogieron datos demográficos, socio-fa miliares, laborales, autopercepción emocional, síntomas psicosomáticos, consumo de tabaco, alcohol y fármacos psicótropos. Se incluyó la escala Ansiedad Estado-Rasgo (STAI), y se estudió su asociación con variables cualitativas y cuantitativas de la muestra. Resultados: Se registraron 440 encuestas. Una media del 42,2% de los participantes expresó algún síntoma de ansiedad moderado-intenso según la escala Ansiedad-Estado y del 26,9% según la escala Ansiedad-Rasgo. El aislamiento en domicilio se relacionó con una mayor puntuación en ambas escalas. Además, el cambio en la situación laboral del conviviente supuso una puntuación mayor en la escala Ansiedad-Estado. El 41,1% de los encuestados clasificaron el impacto psicológico sufrido como leve, el 50% como moderado y el 8,9% como grave. El 71,8% de los participantes manifestaron algún síntoma psicosomático, con una asociación lineal entre la concurrencia de síntomas y mayores puntuaciones en las dos escalas. Conclusiones: Tras la primera ola por COVID-19 los pediatras han sufrido ansiedad, lo que les ha generado malestar físico y emocional. Las situaciones personales fueron la principal fuente de preocupación. Así mismo, la presencia de varios síntomas somáticos se asoció a mayores niveles de ansiedad.

Abstract: Previous studies have demonstrated that the COVID-19 pandemic has had negative psychological consequences on healthcare professionals, however, specific data on pediatricians are scarce. Objective: To evaluate anxiety among pediatricians after the first COVID-19 wave as well as to identify possible related risk factors. Material and Method: A cross-sectional multicentric survey study was designed and sent to Spanish pediatricians through the Asociación Española de Pediatría’s e-mail lists. Demographic, socio-familial, occupational, emotional self-perception, psychosomatic symptoms, smoking, alcohol, and psychotropic drugs use data were collected. The State-Trait Anxiety Scale (STAI) was included, and its association with qualitative and quantitative variables of the sample was studied. Results: 440 surveys were registered. 42.2% of the participants expressed moderate-intense anxiety symptomatology according to the Anxiety-State scale and 26.9% on the Anxiety-Trait scale. Isolation at home was associated with a higher score on both scales. A change in the work situation of the cohabitant resulted in a higher score on the Anxiety-State scale. 41.1% of the respondents classified the psychological impact suffered as mild, 50% as moderate, and 8.9% as severe. Up to 71.8% of the participants manifested some psychosomatic symptoms, with a linear association between the concurrence of symptoms and higher scores on the two scales. Conclusions: After the first pandemic wave, pediatricians have suffered anxiety, causing physical and emotional discomfort. Personal situations were the main source of concern. Likewise, the presence of several somatic symptoms was associated with higher levels of anxiety.

Abstract Introduction Intraoperative fluid therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy plays an important role in postoperative morbidity. Studies have found an association between overload fluid therapy and increased postoperative complications, advising restrictive intraoperative fluid therapy. Our objective in this study was to compare the morbidity associated with restrictive versus non-restrictive intraoperative fluid therapy. Methods Retrospective analysis of a database collected prospectively in the Anesthesiology Service of Virgen del Rocío Hospital, from December 2016 to April 2019. One hundred and six patients who underwent complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were divided into two cohorts according to Fluid Therapy received 1. Restrictive ≤ 9 mL.kg-1.h-1 (34 patients), 2. Non-restrictive ≥ 9 mL.kg-1.h-1 (72 patients). Percentage of major complications (Clavien-Dindo grade III-IV) and length hospital stay were the main outcomes variables. Results Of the 106 enrolled patients, 68.9% were women; 46.2% had ovarian cancer, 35.84% colorectal cancer, and 7.5% peritoneal cancer. The average fluid administration rate was 11 ± 3.58 mL.kg-1.h-1. The restrictive group suffered a significantly higher percentage of Clavien-Dindo grade III-IV complications (35.29%) compared with the non-restrictive group (15.27%) (p= 0.02). The relative risk associated with restrictive therapy was 1.968 (95% confidence interval: 1.158-3.346). We also found a significant difference for hospital length of stay, 20.91 days in the restrictive group vs 16.19 days in the non-restrictive group (p= 0.038). Conclusions Intraoperative fluid therapy restriction below 9 mL.kg-1.h-1 in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was associated with a higher percentage of major postoperative complications.

Resumen Los cuidados paliativos proporcionan una atención integral que tiene en cuenta los aspectos físicos, emocionales, sociales y espirituales del paciente con enfermedad terminal y su entorno familiar. El tratamiento nutricional debe formar parte activa de los equipos de cuidados paliativos. La necesidad de iniciar o no un tratamiento nutricional sigue siendo, desde hace décadas, uno de los principales problemas éticos a los que se enfrentan los profesionales dedicados a la nutrición clínica. El origen de tal controversia radica, fundamentalmente, en cómo se consideran la nutrición y la hidratación: cuidado/soporte o tratamiento médico. Los objetivos fundamentales del tratamiento nutricional en los pacientes en cuidados paliativos deben ser otros: la mejoría de la calidad de vida, de la supervivencia o de ambas. La decisión de indicar o no el tratamiento nutricional en cuidados paliativos debe tomarse tras considerar el pronóstico, la calidad de vida y la relación “riesgo/beneficio”. En relación a la alimentación por vía oral (con o sin suplementos orales), prevalece la idea de la “alimentación de confort”, que se basa en intentos de alimentación oral hasta que se produzcan la incomodidad y/o el rechazo del paciente. No existen evidencias que justifiquen el uso de nutrientes específicos, aunque desde hace años se señala la posibilidad de lograr beneficios cuando se utilizan ácidos grasos omega-3 en los pacientes con cáncer. En cuanto al tratamiento nutricional (enteral o parenteral), en ausencia de evidencia, las decisiones sobre si iniciar una nutrición artificial en un paciente paliativo deben tomarse teniendo en cuenta los deseos y creencias del paciente y sus familiares, y basarse en el consenso del equipo interdisciplinar sobre los objetivos que se persiguen al iniciarla.

Abstract Palliative care provides a holistic approach and care for patients with a terminal illness and their families. In palliative care physical complaints as well as emotional, social and spiritual aspects are considered. Nutritional care should be also considered within palliative support. For those working in the nutritional support field, to withhold or withdraw nutritional support may be an ethical dilemma in this scenario. The controversy starts when considering nutrition and hydration as basic care or a treatment. The goals of nutrition support in palliative care patients differ from common ones, aiming to improve quality of life, survival or both. The decision should be based on a consideration of prognosis (length of survival), quality of life, and risks-benefits ratio. Regarding oral nutrition (with or without oral supplements) the idea prevails of “comfort feeding”, based on providing oral feeding till discomfort or avoidance develop. There is no evidence on the benefit of specific nutrients, despite the fact that omega-3 FAs may have some positive effects in patients with cancer. Regarding nutritional support (enteral or parenteral), no scientific evidence is present, so the decision needs to be agreed according to the desires and beliefs of the patient and their family, and based on a consensus with the interdisciplinary team on the aims of this support.

Abstract Objective To determine the association between perceived social support and family functioning in older people during the COVID-19 pandemic. Method A cross-sectional study was carried out of 72 participants aged ≥60 years enrolled at an Open University of the Third Age (U3A) in the interior of Sao Paulo state, Brazil. The variables analyzed were socioeconomic and demographic conditions, social support (Medical Outcomes Study Scale), and family functioning (Family APGAR). The Chi-Square, Mann-Whitney, and Multivariate Poisson Regression tests were used for data analysis, with a significance level of 5%. Results The type of support with the highest mean scores was affectionate (95.1 points) while the lowest was emotional (87.4 points). Family dysfunction rate was 22.2%. For every additional point of affectionate support score, there was a decrease in the probability of presenting family dysfunction (OR=0.96; p=0.001). Conclusion Affectionate support was associated with family functioning. These findings highlight the importance of identifying family structure, dynamics, and relationships in planning comprehensive health care for the older population.

Resumo Objetivo Verificar a associação entre apoio social percebido e funcionalidade familiar em pessoas idosas durante a pandemia de covid-19. Método Trata-se de um estudo transversal, realizado com 72 participantes idosos que estavam matriculados em uma Universidade Aberta para Pessoas Idosas, no interior do estado de São Paulo, Brasil. As variáveis analisadas foram: condições socioeconômicas, demográficas, apoio social (Escala do Medical Outcomes Study) e funcionalidade familiar (Apgar de família). Utilizaram-se os testes: Qui-Quadrado, Mann Whitney e Regressão de Poisson Múltipla para as análises dos dados, com nível de significância de 5%. Resultados O tipo de apoio com maiores escores médios foi o afetivo (95,1 pontos) e o menor, o emocional (87,4 pontos). A disfunção familiar foi de 22,2%. A cada ponto do escore de apoio afetivo havia o decréscimo na probabilidade de apresentar disfunção familiar. (RP=0,96; p=0,001). Conclusão O apoio afetivo associou-se à funcionalidade familiar. Tais achados demonstram a importância de identificar a estrutura, dinâmica e relações familiares para planejar o cuidado integral à saúde da população idosa.

ABSTRACT Introduction: Humanity has been surprised by the impact of the COVID-19 pandemic; its contagiousness and lethality are great causes for concern around the world. In this context, it is very difficult for the health personnel to communicate bad news. Objective: To express the need to develop skills among the health care personnel to communicate bad news in the context of the COVID-19 pandemic. Material and Methods: A bibliographic review about the impact of the COVID-19 pandemic on mental health and the need to prepare the health personnel to communicate bad news was carried out. Results: Reactions of depression, anxiety, sleep disorders and post-traumatic stress caused by this pandemic have been described. Several protocols that can be followed when performing this practice are described; they include: The Buckman, Spikes and ABCDE protocols. Conclusions: The COVID-19 pandemic has caused great effects on the mental health of the general population around the world. Therefore, it is necessary for the health personnel to be well trained in communicating bad news, as well as to create suitable spaces for this practice. On the other hand, the institutions should design and implement their action protocols to carry out this task.

RESUMEN Introducción: La humanidad ha quedado sorprendida por el impacto de la pandemia de la COVID-19, su contagiosidad y letalidad constituyen grandes causas de preocupación en todo el mundo; en este contexto resulta muy difícil para el personal de la salud comunicar malas noticias. Objetivo: Expresar la necesidad de desarrollar habilidades para comunicar malas noticias por el personal de la salud ante esta pandemia de la COVID-19. Material y Métodos: Se realizó una revisión bibliográfica acerca del impacto sobre la salud mental de la pandemia de la COVID-19 y la necesidad de preparación del personal sanitario para ofrecer malas noticias. Resultados: Se han descrito reacciones de depresión, ansiedad, trastornos del sueño y estrés postraumático, causadas por esta pandemia. Se describen varios protocolos que se pueden seguir al realizar esta práctica: el Protocolo de Buckman, Spikes y ABCDE. Conclusiones: La pandemia de la COVID-19 ha producido grandes afectaciones de la salud mental en la población general en todo el mundo, por lo que se necesita que el personal de la salud esté bien entrenado para comunicar malas noticias, se creen espacios idóneos para esta práctica y las instituciones diseñen e implementen sus protocolos de actuación para llevar a cabo esta tarea.

RESUMEN Se analizan diferentes modelos educativos, propuestos en educación superior: La finalidad de este análisis es identificar las ventajas y desventajas en cuanto a formación integral, mediación por las Tecnologías de la Información y las Comunicaciones (TIC) y aporte al desarrollo sostenible. Lo anterior porque en situaciones se incorporan tecnologías en los procesos de enseñanza-aprendizaje, pero se siguen empleando modelos educativos tradicionales que poco aportan al descubrimiento de soluciones humanísticas y dignificantes para resolver los problemas de una región. En este estudio se emplea un protocolo de revisión sistemática; además, se integran la investigación, la innovación, la proyección social y promoción de los Objetivos de Desarrollo Sostenible (ODS). Se consideran como categorías del análisis comparativo: el enfoque pedagógico, reconociendo las bondades de aquellos modelos constructivistas; la presencia de lo dialógico, como forma de relación entre el estudiante y el docente; la formación para el desarrollo sostenible; el desarrollo del pensamiento crítico y social, entre otras. El resultado de este análisis permite identificar aspectos a considerar en la construcción de un modelo educativo para la educación superior mediado por las TIC.

ABSTRACT Some educational models proposed in higher education are analyzed. The objective of this analysis is to identify the advantages and disadvantages in terms of comprehensive training, mediation by Information and Communication Technologies (ICT) and contribution to sustainable development. This, because in situations, technologies are incorporated into the teaching-learning processes, but traditional educational models continue to be used, contributing little to the discovery of humanistic and dignifying solutions for solving the problems of a region. In this study, a systematic review protocol is used and includes research, innovation, social projection to promote the achievement of Sustainable Development Goals (SDG).The following are considered as categories of comparative analysis: the pedagogical approach, recognizing the benefits of those constructivist models; the presence of the dialogical, as a form of relationship between the student and the teacher training for sustainable development, the development of critical and social thinking, among others. The result of this analysis allows us to identify aspects to consider in the construction of an educational model for higher education mediated by ICT

RESUMO Os diferentes modelos educacionais propostos no ensino superior são analisados. O objectivo desta análise é identificar as vantagens e desvantagens em termos de formação abrangente, mediação por Tecnologias de Informação e Comunicação (TIC) e contribuição para o desenvolvimento sustentável. O acima exposto, porque nas situações em que as tecnologias são incorporadas nos processos de ensino-aprendizagem, mas ainda são utilizados modelos educativos tradicionais que contribuem pouco para a descoberta de soluções humanistas e dignas para resolver os problemas de uma região. Neste estudo, é utilizado um protocolo de revisão sistemática; além disso, a investigação, inovação, projecção social e promoção dos Objectivos de Desenvolvimento Sustentável (ODS) são integrados. São consideradas como categorias da análise comparativa: a abordagem pedagógica, reconhecendo os benefícios dos modelos construtivistas; a presença do dialógico, como forma de relação entre o aluno e o professor; a formação para o desenvolvimento sustentável; o desenvolvimento do pensamento crítico e social, entre outros. O resultado desta análise permite identificar aspectos a considerar na construção de um modelo educacional para o ensino superior, mediado pelas TIC.

RESUMEN En los últimos años, las estrategias de operación y control en los sistemas de distribución han cambiado debido al aumento en la conexión de las fuentes de generación distribuidas (DGs). Las pequeñas redes locales con usuarios de electricidad y DGs se conocen como microrredes. Estas microrredes pueden funcionar de forma independiente (aislada) o en colaboración (interconectadas) con la red principal u otras microrredes. Algunas ventajas de las microrredes interconectadas incluyen la reducción de pérdidas, aumento en la confiabilidad y la operación descentralizada bajo condiciones de falla. No obstante, cuando una microrred opera en modo aislado, sus características eléctricas cambian y, en consecuencia, la gravedad de las perturbaciones de calidad de potencia podrían aumentar, así como su impacto negativo en dispositivos electrónicos (cargas y dispositivos DG). Este artículo presenta una revisión literaria exhaustiva de los estudios existentes sobre perturbaciones de calidad de potencia en microrredes aisladas e identifica las necesidades más relevantes de investigación futura sobre este tema. Se analiza información detallada para comparar las diferencias entre los niveles de perturbaciones en microrredes interconectadas y aisladas. En el caso de perturbaciones causadas por armónicos, se analiza también el impacto de las diferentes configuraciones de microrredes.

ABSTRACT In recent years, operation and control strategies in distribution systems have changed due to the increase in the connection of distributed generation sources (DGs). Small local networks with electricity users and DGs are known as microgrids. These microgrids can operate independently (islanded) or in collaboration (interconnected) with the main network or other microgrids. Some advantages of interconnected microgrids include the reduction of losses, an increase in reliability, and decentralized operation under fault conditions. Nevertheless, when a microgrid operates in islanded mode, its electrical characteristics change and, consequently, the severity of power quality disturbances can increase, as well as their negative impact on electronic devices (loads and DG devices). This paper presents a comprehensive literature review of existing studies on power quality disturbances in islanded microgrids and identifies the most relevant needs for future research on this topic. Detailed information is analyzed to compare the differences between disturbance levels in both interconnected and islanded microgrids. In the case of harmonic disturbances, the impact of the different microgrid configurations is also analyzed.