Resumen Introducción: El aprendizaje servicio virtual (APSv) se define como una modalidad innovadora que desarrolla aprendizajes significativos en los estudiantes y da respuesta a las necesidades de la comunidad sin restricciones geográficas. En la carrera de nutrición y dietética de una universidad pública del sur de Chile, se implementó el APSv, en la asignatura “Taller de nutrición clínica del adulto”. Objetivo: Determinar la percepción de los estudiantes y socios comunitarios sobre la experiencia de virtualización de la estrategia aprendizaje servicio implementada. Método: Diseño de modelo mixto, exploratorio, no experimental, descriptivo y de corte transversal. La muestra fue no probabilística intencional de 43 estudiantes y 22 socios comunitarios que cumplieron los criterios de inclusión. La estrategia de APSv se efectuó mediante 5 etapas y al finalizar se evaluó la percepción de los estudiantes mediante un grupo focal y autoevaluación. Los socios comunitarios respondieron la “Evaluación de la metodología aprendizaje servicio en virtualidad”. Los aspectos éticos fueron resguardados según los principios éticos de Helsinki. Resultados: Se observó un alto nivel de satisfacción por parte de los socios comunitarios (sobre 90% “muy de acuerdo”). El promedio de autoevaluación de los estudiantes fue de 6.52 (escala de notas 1.0 a 7.0). Destacando que sobre el 90% están de acuerdo o muy de acuerdo con su desempeño en relación a las competencias genéricas. Con relación a la percepción del tiempo destinado, motivación, estudio de los contenidos y satisfacción, los alumnos manifestaron un promedio 66% estar “muy de acuerdo”. La estrategia APSv fue asociada a los conceptos de; competencias profesionales, motivación, comunicación efectiva, fortalezas, sentimientos, emociones, reflexión, retroalimentación, trabajo en equipo, virtualidad y sugerencias. Conclusiones: El APSv favorece la integración de competencias que vinculan al estudiantado con la comunidad mediante herramientas digitales logrando un aprendizaje significativo, favoreciendo la responsabilidad social universitaria.

Abstract Introduction: Virtual service learning (APSv) is defined as an innovative modality that develops significant learning in students and responds to the needs of the community without geographical restrictions. In the nutrition and dietetics career of a public university in southern Chile, the APSv was implemented, in the subject “Adult clinical nutrition workshop”. Objective: To determine the perception of students and community partners about the virtualization experience of the implemented service-learning strategy. Method: Design of mixed, exploratory, non-experimental, descriptive and cross-sectional model. The sample was intentional non-probabilistic of 43 students and 22 community partners who met the inclusion criteria. The APSv strategy was carried out through 5 stages and at the end the perception of the students was evaluated through a focus group and self-evaluation. Community partners responded to the “Evaluation of the servicelearning methodology in virtuality”. The ethical aspects were safeguarded according to the ethical principles of Helsinki. Results: A high level of satisfaction was observed on the part of community partners (about 90% “strongly agree”). The average self-assessment of the students was 6.52 (scale of grades 1.0 to 7.0). Highlighting that over 90% agree or strongly agree with their performance in relation to generic competencies. Regarding the perception of the time spent, motivation, study of the contents and satisfaction, the students expressed an average of 66% to be “very much in agreement”. The APSv strategy was associated with the concepts of; Professional skills, motivation, effective communication, strengths, feelings, emotions, reflection, feedback, teamwork, virtuality and suggestions. Conclusions: The APSv favors the integration of competences that link students with the community through digital tools, achieving meaningful learning, favoring university social responsibility.

Abstract Introduction Loneliness and social isolation are known risk factors for cognitive decline; their effect in older adults (OA) after COVID-19 lockdown is emerging. Objective To establish an association between loneliness and social isolation, with daily cognitive function in Mexican OA during the first wave of the COVID-19 pandemic. Method Cross-sectional study, derived from the cohort “The impact of COVID 19 on well-being, cognition, and discrimination among older adults in the United States and Latin America”, which included 308 OA recruited between March-August 2020 whose daily cognitive function were determined with the Everyday Cognition Scale (E-Cog) as dichotomized score (cut point: 1.31 for normal cognition). Loneliness and social isolation were binomial variables. Results The mean age was 65.4 ± 7.9 years, 75.7% were women. The mean continuous E-Cog score was 57.4 (SD = ± 19.1), 49.1% had a score < 1.31 (normal cognition), while 50.9% had a higher score (cognitive impairment). Eighty four percent of participants reported loneliness, 79.9% reported social isolation. Multivariate regression model showed a negative and statistically significant association between social isolation and loneliness and E-Cog, adjusted by age, sex and education level (β = -.046, 95% CI = [-.8, -.013], p = .007; β = -.16, 95% CI = [-.08, -.018], p = .003), and a positive association with subjective memory complaint (β = .81, 95% CI = [-.16, -.11], p = < .001). Discussion and conclusion These data suggest the need for increased vigilance of those who have loneliness and social isolation due to its potential deleterious effect on cognitive function.

Resumen Introducción La soledad y el aislamiento social son factores de riesgo conocidos para el deterioro cognitivo; su efecto en las personas mayores (PM) después del confinamiento por COVID-19 está emergiendo. Objetivo Establecer una asociación entre la soledad y el aislamiento social, con la función cognitiva diaria en PM mexicanas durante la primera ola de la pandemia por COVID-19. Método Estudio transversal derivado de la cohorte “The impact of COVID 19 on well-being, cognition, and discrimination among older adults in the United States and Latin America”, incluyó 308 AM reclutados de marzo-agosto 2020, la función cognitiva diaria fue evaluada con Everyday Cognition Scale (E-Cog) con un punto de corte 1.31 (cognición normal); la soledad y el aislamiento social fueron variables binomiales. Resultados La media de edad fue 65.4 ± 7.9 años, 75.7% mujeres. E-Cog promedio fue 57.4 (DE = ± 19.1), 49.1 % tenía una puntuación < 1.31 (cognición normal), 50.9% > 1.31 (deterioro cognitivo). Ochenta y cuatro por ciento de los participantes reportaron soledad, 79.9% aislamiento social. El modelo de regresión multivariado mostró una asociación negativa y estadísticamente significativa entre aislamiento social y soledad con E-Cog (β = -.046, IC 95% = [-.8, -.013], p = .007; β = -.16, IC 95% = [-.08, -.018], p = .003), y una asociación positiva con queja de memoria subjetiva (β = .81, IC 95% = [-.16, -.11], p = < .001) ajustado a edad, sexo y escolaridad. Discusión y conclusión Estos datos sugieren la necesidad de una mayor vigilancia de quienes presentan soledad y aislamiento social debido a su potencial efecto deletéreo sobre la función cognitiva.

Abstract The Everyday Cognition (ECog) scale was created to evaluate the functional abilities of older adults across a wide range of abilities between normal aging and dementia. ECog screens cognitive alterations such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This early recognition is done by the measurement of the ability to perform the activities of daily living (ADLs). Objective: To establish the cross-cultural adaptation, validity, and reliability of the ECog Mexican version (M-ECog) in participants with: SCD, MCI, and dementia coming from a memory clinic. Methods: There were 200 patients and their respective informants in a memory clinic of a third level hospital in Mexico City. Four groups were studied: 50 cognitively healthy (CH), 50 SCD, 50 MCI, and 50 dementia. The clinical evaluation included: sociodemographic and health characteristics, cognitive status by the Mini-Mental State Evaluation (MMSE) and Montreal Cognitive Evaluation Spanish version (MoCA-E), and caregiver information (informants) about the difficulty in ADLs as well as the ECog Spanish version (M-ECog). Results: The M-ECog was significantly correlated with MMSE, MoCA-E, and ADLs. It showed the ability to discriminate the different cognitive declines (Cronbach’s alpha 0.881). The intra-class correlation coefficient was 0.877 (95% confidence interval — CI, 0.850–0.902; p<0.001). The patient’s group area under curve (AUC) of M-ECog for SCD was 0.70 (95%CI 0.58–0.82, p<0.005), for MCI it was 0.94 (95%CI 0.89–0.99, p<0.001) and for dementia 0.86 (95%CI 0.79–0.92, p<0.001). Conclusion: The M-ECog scale proves to be valid and reliable for measuring everyday abilities mediated by cognition. It is self-applicable without requiring extensive prior formation. It is useful to screen for SCD and MCI in older Mexican adults.

RESUMO A escala Cognição Cotidiana (ECog) foi criada para avaliar as habilidades funcionais de idosos em uma ampla gama de habilidades entre o envelhecimento normal e a demência. O ECog rastreia alterações cognitivas como declínio cognitivo subjetivo (DCS) e comprometimento cognitivo leve (CCL). Esse reconhecimento precoce é feito pela mensuração da capacidade de realizar as atividades de vida diária (AVD). Objetivo: Estabelecer a adaptação transcultural, validade e confiabilidade da versão mexicana do ECog (M-ECog) em participantes com: SCD, MCI e demência provenientes de uma clínica de memória. Métodos: Foram 200 pacientes e seus respectivos informantes em uma clínica de memória de um hospital de terceiro nível na Cidade do México. Quatro grupos foram estudados: 50 cognitivamente saudáveis (CH), 50 SCD, 50 MCI e 50 com demência. A avaliação clínica incluiu: características sociodemográficas e de saúde, estado cognitivo pelo Mini-Mental State Evaluation (MMSE) e Montreal Cognitive Evaluation versão em espanhol (MoCA-E), bem como informações do cuidador (informantes) sobre a dificuldade nas AVD e o ECog versão em espanhol (M-ECog). Resultados: O M-ECog foi significativamente correlacionado com MMSE, MoCA-E e AVD. Mostrou capacidade de discriminar os diferentes declínios cognitivos (alfa de Cronbach 0,881). O coeficiente de correlação intraclasse foi de 0,877 (intervalo de confiança de 95% — IC95%, 0,850–0,902; p<0,001). A AUC do grupo do paciente de M-ECog para SCD foi de 0,70 (IC95% 0,58–0,82, p<0,005), para MCI foi de 0,94 (IC95% 0,89–0,99, p<0,001) e para demência foi de 0,86 (IC95% 0,79–0,92, p<0,001). Conclusão: A escala M-ECog mostra-se válida e confiável para medir habilidades cotidianas mediadas pela cognição. É autoaplicável sem exigir extensa formação prévia. É útil para rastrear MSC e MCI em adultos mexicanos mais velhos.

Abstract Introduction: Due to the COVID-19 pandemic, university teaching had to adapt traditional teaching to emergency remote education, looking for the best way to comply with the graduate profile. In the Nutrition and Dietetics career of a public university in southern Chile, the telesimulation tool was used in the subject of adult diet therapy II, taught in the seventh semester. Objective: To determine the quality and satisfaction of students in the Nutrition and Dietetics career when using clinical telesimulation as a teaching and learning method in the subject of adult diet therapy II, during the COVID-19 pandemic. Method: The research design is quantitative, exploratory, non-experimental, descriptive and cross-sectional. with a non-probabilistic sample of 42 students who met the inclusion criteria. The telesimulation applied was protocolized, then the clinical simulation quality and satisfaction survey and a self-assessment were applied to the students. The statistical data were processed and the descriptive statistical analysis was carried out, the answers to the open question were analyzed qualitatively. The ethical aspects of the research were safeguarded according to the ethical principles of the Declaration of Helsinki. Results: in relation to the quality and satisfaction survey in clinical simulation, they reported high satisfaction, with 75.87% of responses “strongly agree”. Telesimulation was associated with the concepts of learning, competence, strength and emotions. Conclusions: Telesimulation is an efficient strategy through which theoretical and practical knowledge can be integrated in a controlled learning environment, favoring the achievement of skills. It is proposed that this strategy be incorporated for the evaluation of the final learning outcome of the subjects.

Resumen Introducción: Debido a la pandemia COVID-19, la docencia universitaria tuvo que adaptar la enseñanza tradicional a la educación remota de emergencia, buscando la mejor manera de dar cumplimiento al perfil de egreso. En la carrera de Nutrición y Dietética de una universidad pública del sur de Chile, se utilizó la herramienta de telesimulación en la asignatura de Dietoterapia del Adulto II, dictada en el séptimo semestre. Objetivo: Determinar la calidad y satisfacción de los estudiantes de la carrera de Nutrición y Dietética al utilizar la telesimulación clínica como método de enseñanza y aprendizaje en la asignatura de Dietoterapia del Adulto II, durante la pandemia COVID-19. Método: El diseño de la investigación es cuantitativo, exploratorio, no experimental, descriptivo y de corte transversal, con una muestra no probabilística de 42 estudiantes que cumplieron con los criterios de inclusión. La telesimulación aplicada fue protocolizada, posteriormente se aplicó a los estudiantes la encuesta de calidad y satisfacción de simulación clínica y una autoevaluación. Los datos estadísticos fueron procesados y se trabajó el análisis estadístico descriptivo, las respuestas de la pregunta abierta fueron analizadas cualitativamente. Los aspectos éticos de la investigación fueron resguardados según los principios éticos de la declaración de Helsinki. Resultados: en relación a la encuesta calidad y satisfacción en simulación clínica, reportaron una alta satisfacción, con un 75.87% de respuestas “muy de acuerdo”. La telesimulación fue asociada a los conceptos de aprendizaje, competencia, fortaleza y emociones. Conclusiones: La telesimulación es una estrategia eficiente mediante la cual se pueden integrar los conocimientos teóricos y prácticos en un ambiente de aprendizaje controlado, favoreciendo el logro de competencias. Se propone que esta estrategia sea incorporada para la evaluación del resultado de aprendizaje final de las asignaturas.

Abstract Jackfruit (Artocarpus heterophyllus Lam.) is a fruit of tropical and subtropical zones of the world, is an important source of phytochemicals (phenolic acids, flavonoids and tannins). Several studies have associated phytochemicals with antioxidant and antimicrobial properties. The objective of this work was to analyze the polyphenolic content, the antioxidant and antifungal properties of jackfruit extracts on phytopathogenic fungi. Two phenolic extracts of jackfruit of different maturity level (J1-J2) were used. The total polyphenol content (TPC) was determined by Folin-Ciocalteu method and total flavonoids (TFC) by the aluminum chloride method, the free radical trapping potential was measured using FRAP and ORAC methods. The results showed a TPC of 844 and 1,178 mgEAG/100 g and TFC of 37 and 68 mgQE/100 g, of dry jackfruit, the antioxidant potential analysis by FRAP was 7,575 and 8,691, by ORAC was 13.369 and 14.728 µmol Trolox/100 g, of dry jackfruit for J1 and J2 respectively. Additionally, it was observed that the phenolic extracts of jackfruit reduced the mycelial growth of: Penicillium digitatum (20-14%), Geotrichum candidum (56-55%), Aspergillus niger (72-67%) and Botrytis cinerea (100%-100%) for J1 and J2 respectively. We conclude that regardless of the degree of maturity, jackfruit has antioxidant and antifungal properties on phytopathogens important in agriculture.

Abstract Biofilms arise as an alternative to replace synthetic polymers, which have generated environmental pollution. The aim of this work was to extract starch from Hass avocado seeds (Persea americana Mill) to produce biofilms. Starch was extracted using the wet method and characterized by infrared spectroscopy. Moisture, ash content, gelatinization temperature, and color were determined. Two types of biofilms were produced: T1 (starch) and T2 (starch and glycerol). The colour was measured, and the films were characterized by mechanical tests. A yield of 11.38% was obtained for the isolated starch. Glycerol addition significantly influenced the tensile strength being T1 higher than T2. In elongation percentage, T1 was lower than T2. The results indicate that it is possible to use Hass avocado seed waste for starch extraction and produce biofilms to give it added value. This biofilm can be used in low moisture food coatings.

Resumen El objetivo De este artículo es visibilizar y cuantificar la dificultad analítica que se presenta al momento de interpretar los índices de criminalidad, debido al rezago temporal del registro en el instante en que se comete el delito y la fecha de ingreso de la denuncia. Ese rezago temporal genera un sesgo benévolo en la medición del crimen y la interpretación criminal para la toma de decisiones, cuando se comparan periodos parciales (años anteriores y vigencia actual). La metodología Utilizada es exploratoria con un enfoque cuantitativo en el tratamiento de los datos registrados desde el año 2005 hasta el 2018, y consolidados en los sistemas Penal Oral Acusatorio (SPOA) de la Fiscalía General de la Nación y de Información Estadístico Delincuencial, Contravencional y Operativo (SIEDCO) de la Policía Nacional de Colombia. Para el análisis se compararon los datos de los delitos de homicidio, hurto, lesiones personales, violencia intrafamiliar y delitos sexuales durante los primeros cuatro y cinco meses de cada periodo anual con los siguientes meses del año. Como Resultado Se evidenció que el rezago temporal promedio en los homicidios fue del 2,85%; en el hurto del 11,8%; en las lesiones personales del 12,7%; en la violencia intrafamiliar del 18,9% y en los delitos sexuales del 30,5%.

Abstract The purpose Of this article is to visualize and quantify the analytic difficulty that arises in interpreting crime indicators due to the time lag between the time when the crime took place and the date on which the crime report was filed2. This time lag creates a lenient bias in crime measurement and interpretation for decision-making effects when time periods are compared (previous periods against the current period). The methodology Used is exploratory with a quantitative approach in the treatment of data recorded from 2005 to 2018, and consolidated in the Oral Criminal Prosecution System (SPOA, for the Spanish original) of the National Prosecutor's Office (Fiscalía) and in the Crime, Infraction and Operations Statistical System (SIEDCO, for the Spanish original) of the National Police of Colombia. Data on the crimes of homicide, theft, personal injuries, intra-family violence and sexual crimes during the first four and five months of each annual period were compared to the data from the subsequent months of the year. As a result It was found that the average time lag was 2.85% for homicides; 11.8% for theft; 12.7% for personal injuries; 18.9% for intra-family violence and 30.5% for sexual crimes.

Resumo O objetivo Deste artigo é tornar visível e quantificar a dificuldade analítica que surge na interpretação dos índices de criminalidade, devido à defasagem temporal do registro no momento em que o crime é cometido e na data de apresentação da denúncia3. Esse lapso temporal gera um viés benevolente na medição e interpretação do crime para a tomada de decisões, quando são comparados períodos parciais (anos anteriores e validade atual). A metodologia Utilizada é exploratória com abordagem quantitativa no tratamento dos dados registados de 2005 a 2018, e consolidados no sistema Penal Oral Acusatório (SPOA) da Procuradoria Geral da Nação e no sistema de Informação Estatístico Delinquencial, Contravencional e Operativo (SIEDCO) da Polícia Nacional da Colômbia. Para a análise foram comparados os dados dos crimes de homicídio, furto, lesões pessoais, violência doméstica e crimes sexuais durante os primeiros quatro e cinco meses de cada período anual com os meses seguintes do ano. Como resultado Constatou-se que a média do lapso temporal nos homicídios foi de 2,85%; no furto de 11,8%; nas lesões pessoais de 12,7%; na violência doméstica de 18,9% e nos crimes sexuais foi de 30,5%.

Abstract Background COVID-19 affects several systems in the body, including the central nervous system (CNS), expressed in the form of headaches, hyposmia, cerebrovascular disease, and neuropathy. Older Adults (OA) are vulnerable to this infection, and may also present delirium, which may be the result of the virus directly affecting the CNS or of systemic inflammation during infection. Objective To determine the clinical characteristics, risk factors, pathophysiology, treatment measures, and prevention of delirium associated with COVID-19 from a review of the literature in times of the SARS-CoV-2 pandemic. Method A search was conducted in PubMed, SciELO, UpToDate, and Medscape using keywords in English and Spanish. Results Seventy-two articles were reviewed. We analyzed inclusion and exclusion criteria and 43 articles with relevant information for the narrative description of the review were selected. Twenty to thirty per cent of the COVID-19 patients will present or develop delirium, or changes in mental status during their hospitalization, with rates of 60% to 70% in severe illness. The exact mechanisms are likely to be multifactorial. There is a worrying lack of attention to the implications of identifying and managing delirium in the response to this pandemic. Discussion and conclusion Delirium is a frequent neurological manifestation in OA with COVID-19 and requires early identification, as well as the implementation of non-pharmacological and pharmacological treatment strategies, which may reduce the associated morbidity and mortality in this age group.

Resumen Antecedentes La COVID-19 afecta múltiples sistemas del organismo. Uno de ellos es el sistema nervioso central (SNC), cuya afección se manifiesta con cefalea, hiposmia, enfermedad vascular cerebral y neuropatía. Además de que los adultos mayores (AM) son vulnerables a esta infección, pueden presentar delirium, el cual puede ser resultado de una afección directa del virus al SNC o resultado de la inflamación sistémica durante la infección. Objetivo Conocer las características clínicas, factores de riesgo, fisiopatología, medidas de tratamiento y prevención del delirium asociados a COVID-19 a partir de la revisión de la literatura en tiempos de la pandemia por SARS-CoV-2. Método Se realizó una búsqueda en PubMed, SciELO, UpToDate y Medscape utilizando palabras clave en inglés y español. Resultados Se revisaron 72 artículos, se analizaron criterios de inclusión y exclusión y se seleccionaron 43 artículos con información relevante para la descripción narrativa de la revisión. El 20-30% de los pacientes con COVID-19 presentarán o desarrollarán delirium, o cambios en su estado mental durante el curso de su hospitalización, con tasas del 60-70% en enfermedad grave. Es probable que los mecanismos exactos sean multifactoriales. Existe una preocupante falta de atención a las implicaciones de la identificación y el manejo del delirium en la respuesta a esta pandemia. Discusión y conclusión El delirium es una manifestación neurológica frecuente en los AM con COVID-19 y requiere su identificación temprana, así como la implementación de estrategias de tratamiento no farmacológico y farmacológico, lo que puede disminuir la morbimortalidad asociada en este grupo etario.

Abstract Introduction Growth and nutrition are basic topics in pediatrics; Although its content is part of undergraduate education, there is limited evidence of the acquisition of knowledge and skills achieved. Objective Evaluate competencies developed to promote adequate nutrition and growth in the first two years of life in pediatric interns rotating in two hospitals with different educational processes. Method A quasi-experimental study with intervention developed at the Medical School of Universidad Mayor de San Andrés, La Paz - Bolivia. It included 17 interns from hospital one, which did not have scheduled educational activities for feeding and growth, and 24 from hospital two, which had scheduled educational activities on these topics, with seven theoretical hours and 25 practical, individually and in groups, face-to-face and online. Competencies were evaluated with four objective structured clinical evaluation stations that assessed counseling, breastfeeding, complementary feeding, and growth. The data were analyzed in SPSS. To identify differences between the two comparison groups the Student’s t test was used. Normality and homogeneity of variances were verified, and Student’s t value adjusted if less than 0.05. Results The results showed that the group of hospital two had a better response in the objective structured clinical evaluation, obtained 23.86 more percentual points in knowledge (p 0.000 95% CI -33.07 to -14.63) and a difference of 15.02% in the rubric (p 0.000 95% CI - 20.68 to -9.35) in relation to the group of hospital one. Conclusions The differentiated teaching-learning process improves the knowledge and skills of the pediatric interns. The limiting factors for acquiring skills were: the interns' lack of time, the allocation of non-educational activities and the lack of opportunity to apply preventive and promotional care in hospitals; and the facilitating factor is the mandatory fulfillment of theoretical and practical activities.

Resumen Introducción Crecimiento y alimentación son temas básicos en pediatría; aunque su contenido es parte de pregrado, hay escasa evidencia sobre la adquisición de conocimientos y habilidades logradas. Objetivo Evaluar competencias desarrolladas para promover alimentación y crecimiento adecuados en los dos primeros años de vida en internos de pediatría que rotan por dos hospitales con procesos educativos diferenciados. Método Estudio cuasi experimental con intervención realizado en la Facultad de Medicina de la Universidad Mayor de San Andrés, La Paz - Bolivia. Incluyó 17 internos del hospital uno, que no contaba con actividades educativas programadas para alimentación y crecimiento, y 24 del hospital dos, con actividades educativas programadas con siete horas teóricas y 25 prácticas, en modalidad individual y grupal, presencial y en línea. Se midieron las competencias con cuatro estaciones de evaluación clínica objetiva estructurada sobre consejería, lactancia materna, alimentación complementaria y crecimiento. Los datos se analizaron en SPSS. Para identificar las diferencias entre los grupos de comparación se utilizó la prueba t de Student, se comprobó normalidad y homogeneidad de varianzas, ajustó el valor de la t de Student si era menor a 0,05. Resultados Los resultados mostraron que el grupo del hospital dos tuvo una mejor respuesta en la evaluación clínica objetiva estructurada. En conocimientos, los internos del hospital dos obtuvieron 23,86 puntos porcentuales de ventaja (p 0,000 IC 95% -33,07 a -14,63) y una diferencia de 15,02% en la rúbrica (p 0,000 IC 95% -20,68 a -9,35). Conclusiones El proceso de enseñanza-aprendizaje diferenciado mejora conocimientos y habilidades de los internos de pediatría. Los factores que limitan el desarrollo de competencias son: falta de tiempo de los internos, la asignación de actividades no educativas y falta de oportunidad para aplicar cuidados preventivos y de promoción en hospitales; y el factor facilitador es el cumplimiento obligatorio de actividades teóricas y prácticas.

ABSTRACT Introduction. Neonatal sepsis is a set of clinical signs and symptoms caused by a systemic infection, associated with maternal, neonatal or hospital risk factors. Objective. Provide informed recommendations for the best available evidence for the prevention, diagnosis and treatment of neonatal sepsis. Methods an Evidence-based Clinical Practice Guide (CPG) was developed through an adaptation process, in charge of a team of methodologists and neonatologists who are experts in the clinical management of neonatal sepsis. The search and preselection of CPGs that respond to the scope and objectives set were carried out, using the AGREE-II instrument, the methodological qualityof the guides was evaluated and their adaptation decided. To identify the evidence that answers the questions in the guideline, a systematic search was carried out in multiple databases: Medline / PubMed, Embase / Ovid, Cochrane Library and LILACS. These were selected and critically analyzed by clinical and methodological peers, the recommendations were elaborated using the GRADE approach. Results. 16 clinical questions and recommendations based on evidence were formulated, which were reached, through a deliberative dialogue of clinical experts from different reference hospitals for the management of neonatal sepsis in Peru. The recommendations address the identification of risk factors, the use of confirmatory methods and antibiotic treatment as prophylaxis and during disease management. Conclusions. The CPG allows standardizing the clinical management of neonatal sepsis, as well as the identification of research needs to be carried out in the Peruvian context.

RESUMEN Introducción. La sepsis neonatal es un conjunto de signos y síntomas clínicos causados por una infección sistémica, asociada a factores de riesgo de tipo materno, neonatal u hospitalario. Objetivo. Brindar recomendaciones informadas por la mejor evidencia disponible para la prevención, diagnóstico y tratamiento de la sepsis neonatal. Métodos. Se desarrolló una guía de práctica clínica (GPC) basada en evidencias, mediante un proceso de adaptación, a cargo de un equipo de metodólogos y médicos neonatólogos expertos en el manejo clínico de la sepsis neonatal. Se realizó la búsqueda y preselección de GPC que respondan al alcance y objetivos planteados, utilizando el instrumento AGREE-II se evalúo la calidad metodológica de las guías para decidir su adaptación. Se realizó una búsqueda sistemática en múltiples bases de datos: Medline/PubMed, Embase/Ovid, Cochrane Library y LILACS, para identificar la evidencia que responda a las preguntas de la guía. Estas fueron seleccionadas y analizadas críticamente por pares clínicos y metodológicos, las recomendaciones fueron elaboradas usando el enfoque GRADE. Resultados. Se formularon 16 preguntas clínicas y recomendaciones basadas en evidencia a las que se llegó, mediante un diálogo deliberativo de expertos clínicos de diferentes hospitales de referencia para el manejo de la sepsis neonatal en el Perú. Las recomendaciones abordan la identificación de factores de riesgo, el uso de métodos confirmatorios y el tratamiento antibiótico como profilaxis y durante manejo de la enfermedad. Conclusiones. La GPC permite estandarizar el manejo clínico de la sepsis neonatal, así como la identificación de necesidades de investigación a realizarse en el contexto peruano.

Abstract Chimbus culture was settled in the area where today is the city San José Chimbo, one of the cantons of the province of Bolívar in Ecuador. This culture was characterized by their widen knowledge on agriculture, weaving, pottery, and livestock. The remains found throughout my research show that the community used clay to make utensils with a little rustic texture; their rough vessels carry in their neck a kind of rings, made with a reed, with eyes in forms of coffee’s pepas. The Wuarankas had the same Chimbos´ characteristics; it is said that these peoples shared the same language- a mixture of bar- bacoa, cañari, and panzaleo. Consequently, the Kichwa language appeared during the commercial relationships among these and Peruvian peoples (Itier, 2015).

Resumen En el Ecuador, la cultura “Chimbo”, se ubicó en el mismo sitio donde hoy se asienta la ciudad de San José Chimbo, se caracterizó por un amplio conocimiento de las técnicas de la agricultura, hilandería, alfarería y el pastoreo. Los rastros encontrados a lo largo de la investigación, muestran una cerámica de textura rústica y áspera, las vasijas llevan en el cuello una especie de anillos, producidos con un tubo de carrizo, con ojos en formas de pepa de café. Los “Guarangas”, por su parte, tienen las mismas características que los Chimbos, además, sus lenguas, que eran una mezcla entre la barbacoa, cañarí y panzaleo (Guamán, 2018). Es decir, que la lengua kichwa, aparece posteriormente con las conquistas de los Incas y relaciones comerciales entre estos pueblos (Itier, 2015).

Resumen Introducción: El fenómeno El Niño del 2015-2016 fue considerado como uno de los más severos a nivel mundial, causando el tercer evento global de blanqueamiento coralino. Eventos previos de alta intensidad (1982-83 y 1997-98), causaron altas mortalidades coralinas y el deterioro de estructuras arrecifales a lo largo de Pacífico Tropical Oriental, afectando tanto al ecosistema como las actividades económicas asociadas. Objetivo: El objetivo de este estudio, fue determinar el impacto del evento El Niño 2015-2016 en la salud de los arrecifes coralinos de la Isla del Coco y la costa Pacífico Sur de Costa Rica. Métodos: La evaluación de los arrecifes de coral se realizó antes (2013-2014) y después (2016) de la perturbación, utilizando censos visuales subacuáticos en transectos de banda, con el fin de cuantificar la cobertura del fondo a distintas profundidades. Resultados: En general, la cobertura coralina viva promedio disminuyó 50% después del evento El Niño 2015-2016, siendo Golfo Dulce la zona más afectada con una reducción del 75%. Sin embargo, en ciertas localidades como las islas Coco y Caño, los efectos de El Niño fueron aparentemente mínimos, ya que no se detectó una pérdida sustancial de la cobertura coralina viva. Las diferencias en el nivel de deterioro encontradas entre los arrecifes podrían estar relacionadas con varios factores, incluyendo el tiempo transcurrido desde que se estableció el área protegida, la distancia a los centros de la población humana y la efectividad en la aplicación de estrategias de manejo. Conclusiones: El impacto sinérgico del evento El Niño 2015-2016 y otros factores de estrés (por ejemplo, la pesca ilegal y el desarrollo costero no regulado) incrementó los niveles de perturbación en los arrecifes coralinos, amenazando su estructura y funcionamiento. Es necesario fortalecer las estrategias de conservación para mejorar la resiliencia de los arrecifes coralinos ante el impacto de perturbaciones naturales y antropogénicas. Acciones concretas como la jardinería de corales, la educación ambiental marina y el ordenamiento espacial marino, deben convertirse en herramientas importantes para mantener la buena salud de los arrecifes coralinos y asegurar la sostenibilidad de los bienes y servicios proporcionados por estos ecosistemas.

Abstract Introduction: El Niño 2015-2016 was considered one of the most severe worldwide, causing the third global event of coral bleaching. Previous high-intensity El Niño events (1982-83 and 1997-98) caused high coral mortalities and deterioration of coral reef structures along the Eastern Tropical Pacific, affecting both ecosystem and associated economical activities. Objective: The aim of this study was to determine the impact of the most recent El Niño event on coral reefs from Cocos Island and the Pacific coast of southern Costa Rica. Methods: Coral reefs were surveyed before (2013-2014) and after (2016) the disturbance, using underwater visual censuses within belt transects, to quantify the bottom coverage at different depths. Results: In general, average live coral cover decreased 50% after the 2015-2016 El Niño event, with Golfo Dulce being the most affected area with 75% of live coral cover decline. However, in certain localities such as Isla del Coco and Isla del Caño, the effects of El Niño were apparently minimal, since no substantial loss of live coral cover was detected. Differences in the level of deterioration found between coral reefs could be related to several factors, including the age of the protected area, the distance to centers of human population, and the effectiveness in the application of management strategies. Conclusions: The synergistic impact of the 2015-16 El Niño event and other stressors (e.g. illegal fishing and unregulated coastal human development) increased the levels of disturbance on coral reefs, threatening their structure and functioning. It is necessary to strengthen conservation strategies in order to improve the resilience of coral reefs to the impact of natural and anthropogenic disturbances. Concrete actions such as coral reef restoration, marine environmental education, and marine spatial planning must become important tools to maintain the good health of coral reefs and ensure the sustainability of the goods and services provided by these ecosystems.

ABSTRACT Objective: To validate the Shared Decision Making Questionnaire - physician version (SDM-Q- Doc) in Spanish. Design: Cross-sectional, multicenter, clinimetric validation study. Setting: Primary Care Units. Participants: In the cross-cultural adaptation phase there were 31 family doctors, and in the validation phase there were 219, all active medical professionals at the institutional and / or private level Main measures: Cross-cultural adaptation (direct translation, synthesis and reconciliation of the version by an expert committee, reverse translation, reconciliation of the reverse translation with authors of the original questionnaire, comprehension analysis in a sample of patients) and psychometric aspects (reliability and validity). Results: Cross-cultural adaptation was performed, guide question 2 was homologated to SDM-Q-9. No negative values were observed in the corrected item-total correlation- with the total correlation; all are higher than 0.80. Cronbach's Alpha was 0.963. Item 1 explained a variance of 77.2%. The Kaiser-Meyer-Olkin (KMO) test was 0.924 with a statistically significant Barlett Sphericity. Pearson's correlation matrix shows a positive correlation; in general the inter-item relationship is greater than 0.606. Conclusions: A useful, short and accessible questionnaire to be applied in Primary Care has been validated to measure shared decision-making from the physician's perspective.

RESUMEN Objetivo: Validar Shared Decision Making Questionnaire - physician version (SDM-Q-Doc) en español. Diseño: Estudio transversal, multicéntrico y de validación clinimétrica. Emplazamiento: Unidades de Atención Primaria. Participantes: En la fase de adaptación transcultural fueron 31 médicos de familia y en la de validación 219, todos activos en la práctica médica a nivel institucional y/o privado. Mediciones Principales: Adaptación transcultural (traducción directa, síntesis y conciliación de la versión por un comité de expertos, traducción inversa, conciliación de la traducción inversa con autores del cuestionario original, análisis de comprensión en una muestra de pacientes) y aspectos psicométricos (fiabilidad y validez). Resultados: Se realizó la adaptación transcultural, la pregunta guía 2 se homologó al SDM-Q-9. No se observaron valores negativos en la correlación de item corregido - con la correlación total; todos son mayores que 0,80. El Alfa de Cronbach fue de 0,963. El item 1 explicó una varianza del 77,2 %. La prueba de Kaiser-Meyer-Olkin (KMO) fue de 0,924 con una esfericidad de Barlett estadísticamente significativa. La matriz de correlación de Pearson demuestra una correlación positiva; en general la relación inter-item es mayor a 0,606. Conclusiones: Se ha validado un cuestionario útil, corto y accesible para aplicarse en Atención Primaria, para medir la toma de decisiones compartidas desde la perspectiva del médico.

Abstract INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.

Abstract Introduction “Episodic” memory problems are common in people with cognitive impairment due to Alzheimer’s disease and related disorders. Dubois et al. developed the Five-Word Test (5WT) to evaluate episodic memory, which has proved to be an easy and valid test for identifying cognitive disorders. However, its validation and cultural adaptation from French to Spanish has not been undertaken and its usefulness in Mexican population is unknown. Objective Validation and cultural adaptation of the 5WT for screening minor and major neurocognitive disorder (ND) in Mexican older adults with probable Alzheimer’s disease. Method Two hundred and fifteen participants (70 cognitively healthy subjects, 73 with minor ND and 72 with major ND were included). The cognitive status (gold standard) was determined using current clinical criteria and neuropsychological evaluation. The Spearman coefficient, ROC curve, and multinomial logistic regression models were used to determine the concurrent validity of the 5WT. Results The correlation between the 5WT and the Mini-Mental State Exam (MMSE) was .58, whereas for the clock face test it was -.37 (p < .001). The area under the 5WT curve was .97 (95% CI [.94, .99]), with a cut-off point of ≤ 16/20 for the diagnosis of major ND (89% sensitivity, 98% specificity) and .77 (95% CI [.70, .85]) for minor ND with a cut-off point of ≤ 18/20 (66% sensitivity, 77% specificity). Discussion and conclusion Since the 5WT is a simple, valid instrument for the identification of neurocognitive disorders like Alzheimer’s disease, it could be a practical screening test.

Resumen Introducción Los problemas de la memoria “episódica” son comunes en las personas con deterioro cognitivo tipo Alzheimer. Dubois et al. desarrollaron la Prueba de Cinco Palabras (P5P) para evaluar la memoria episódica, la cual ha demostrado ser sencilla y válida para identificar trastornos cognitivos. Sin embargo, su validación y adaptación cultural del francés al español no se ha realizado y se desconoce su utilidad en población mexicana. Objetivo Validación y adaptación cultural de la P5P para el tamizaje del trastorno neurocognitivo (TNC) menor y mayor en adultos mayores mexicanos con probable enfermedad de Alzheimer. Método Participaron 215 participantes (70 cognitivamente sanos, 73 con TNC menor y 72 con TNC mayor. El estado cognitivo (estándar de oro) se determinó mediante los criterios clínicos vigentes y de evaluación neuropsicológica. El coeficiente de Spearman, la curva ROC y modelos de regresión logística multinomial se utilizaron para determinar la validez concurrente de la P5P. Resultados La correlación entre la P5P y el MMSE fue de .58, mientras que para la prueba de reloj fue de -.37 (p < .001). El área bajo la curva de la P5P fue .97 (IC 95% [.94, .99]), con un punto de corte ≤ 16/20 para el diagnóstico del TNC mayor (sensibilidad: 89%, especificidad: 98%) y de .77 (IC 95% [.70, .85]) para el TNC menor con un punto de corte ≤ 18/20 (sensibilidad: 66%, especificidad: 77%). Discusión y conclusión La P5P es un instrumento válido y simple para identificar de trastornos neurocognitivos de tipo Alzheimer por lo que podría ser una prueba práctica para uso en el tamizaje.