Abstract A central issue for professional practice abroad is the recognition of higher education qualifications, a procedure with obstacles that affects people trained in different countries. Faced with this, we have created an extension action (2019-current) to provide guidance on this topic: the Center for Guidance on Revalidation and Recognition of High School and Higher Education Diplomas, a project developed in a Brazilian university. Based on this, we propose to approach the procedure for the recognition of higher education degrees in Argentina, Brazil and Paraguay, and to describe and to analyze the experiences of the Guidance Center. To achieve this objective, we worked with qualitative research techniques which allowed to observe that there is a great demand to recognize higher degrees in Brazil. As conclusions, we highlight the relevance of having a body of professionals trained in the procedure, as well as the need to establish policies that simplify the process.

Resumo Uma questão central para o exercício profissional no exterior é o reconhecimento de diplomas de ensino superior, procedimento cheio de empecilhos, que afeta pessoas formadas em diferentes países. Diante disso, criamos uma ação de extensão (2019-atual) para orientar sobre o tema: O Núcleo de orientação sobre revalidação e reconhecimento de diplomas de ensino médio e ensino superior, projeto desenvolvido em uma universidade brasileira. Com base nisso, pretende-se abordar o procedimento de reconhecimento de diplomas de ensino superior na Argentina, no Brasil e no Paraguai, e relatar e analisar as experiências do Núcleo. Para atingir esse objetivo, trabalhamos com técnicas de pesquisa qualitativa que permitiram observar que há uma grande demanda para o reconhecimento de diplomas no Brasil. Como conclusões, destacamos a relevância de contar com um corpo de profissionais capacitado sobre o procedimento, bem como a necessidade de estabelecer políticas que simplifiquem o processo.

Resumen Introducción: Todavía no se comprende si el desarrollo político, científico y médico en un país se asocia a mejores resultados clínicos de los pacientes con COVID-19 según el sexo. Objetivo: Determinar las tendencias de mortalidad hospitalaria asociada a COVID-19 en mujeres y hombres entre marzo de 2020 y febrero de 2022. Métodos: Se utilizaron los datos clínicos de todos los pacientes con COVID-19 atendidos en 21 hospitales españoles, tanto de quienes fueron dados de alta como de quienes fallecieron durante el ingreso. La asociación entre la fecha del ingreso y la mortalidad se analizó con modelos de regresión logística. Resultados: Fueron incluidos 7974 pacientes, de los cuales 3234 fueron mujeres y 928 fallecieron. Se encontró una tendencia significativa y decreciente en la mortalidad según avanzaba la fecha del ingreso. Cuando el análisis se realizó por sexos, no se halló una tendencia significativa en las mujeres (RM = 0.96 [0.90-1.03], p = 0.239), pero sí en los hombres (RM = 0.87 [0.82-0.92], p < 0.001). Conclusión: Las políticas de salud, junto con las intervenciones clínicas y preventivas, pueden dar cuenta de los resultados. Diferencias en la respuesta al tratamiento o en los comportamientos pueden explicar por qué la mortalidad no disminuye en las mujeres.

Abstract Introduction: Whether political, scientific and medical development in a country is associated with better clinical results according to gender in patients with COVID-19 has not yet been clearly elucidated. Objective: To determine the trends of COVID-19-related in-hospital mortality in women and men from March 2020 to February 2022. Methods: Clinical data of all patients with COVID-19 cared for at 21 Spanish hospitals were used, both of those who were discharged and of those who died during hospitalization. The association between hospital length of stay and mortality was analyzed with logistic regression models. Results: Out of 7,974 patients that were included, 3,234 were women; 928 patients died. A significant decreasing trend in mortality was identified. When the analysis was carried out by gender, no significant mortality trend was found in women (OR = 0.96 [0.90-1.03], p = 0.239), while in men there was a significant decreasing trend identified (OR = 0.87 [0.82-0.92], p < 0.001). Conclusion: Health policies, together with clinical and preventive interventions, may explain these results. Response to treatment and behavioral differences may explain why mortality does not decrease for women.

Abstract One of the difficulties generated in the context of confinement due to the SARS-CoV-2 pandemic was the feedback process for written production at the graduate level. This has an essential role in learning, not only regarding the perception of feedback, i.e., giving feedback once the student's work is concluded; but also in the feedforward process that involves accompanying the development of writing by detecting and correcting mistakes (Canabal and Margalef, 2017; Navarro, 2020). As Ahshan (2021) points out, the pandemic forced active teaching and learning strategies to become remote, both synchronous and asynchronous, mediated by educational technologies and platforms for learning management. During the pandemic, the learning of the academic writing process was affected as well. This is a process that already involves different challenges to mediate its elaboration (Carlino, 2013), whether with undergraduate or graduate students (Sabaj et al., 2011). Regarding this obstacle, literature suggests the application of rhetorical moves (Swales, 1990) and genres pedagogy (Venegas et al., 2015; Venegas et al., 2016) as a contribution that facilitates the development of final thesis works. Based on the aforementioned, the question arises: How did the group of graduate students perceive remote feedback from teachers, regarding writing practices, during the elaboration process of the qualitative research project? Therefore, the aim of the study was to understand the perception of remote feedback on writing practices that graduate students received from teachers during the elaboration of the qualitative research project. In order to provide a methodological response, a qualitative, descriptive-phenomenological research was proposed through a case study. The participants were students from the 2018 and 2019 cohorts who took the qualitative analysis elective course of a doctoral education program from a Chilean public university. The classes included group and individual feedback of the writing practices of the qualitative research project, through synchronous educational technologies such as the Zoom platform and Google meet; and also, asynchronous ones such as Ucampus, Youtube and email. Two focus groups were conducted, whose corpus was analyzed under the inspiration of grounded theory (Strauss and Corbin, 2002) with the assistance of Atlas Ti software. Informed consents were applied as ethical criteria for the research. The findings indicate a positive valuation by the students of both the feedback provided through different virtual resources and the modeling of the writing process of the project from video capsules. Furthermore, the asynchronous interactions allowed the prompt communication of the rubrics, before and after the evaluation process. The thematic relevance stands out, having collected the needs of the participants themselves, and the in-depth application of a critical analysis contributed by the group work of a community of researchers in training, which contrasts with the traditional academic training of postgraduate students.

Resumen El objetivo de este artículo es describir la eficacia de las prácticas de retroalimentación digital en la producción del género informe de proyecto. La muestra está constituida por 353 participantes en un contexto de Aprendizaje Basado en Proyectos. La investigación contempla tres instancias evaluativas que son parte de una cadena genérica: 1) Avance de informe de proyecto 2) Pitch oral de presentación de proyecto y 3) Informe final de proyecto. A través de un análisis cuantitativo, los estadísticos descriptivos demuestran que los promedios de las evaluaciones son superiores a medida que se va desarrollando la cadena genérica. Por su parte, los datos cualitativos evidencian criterios de éxito y los hitos difíciles de producción de este género discursivo. Finalmente, se perfilan los dispositivos didácticos que posibilitaron una retroalimentación digital efectiva de la escritura colaborativa y del trabajo por proyecto. Es así que las implicancias para una pedagogía del género son discutidas.

Abstract: Metaphor is frequently used in science popularization as a strategy to make specialized knowledge accessible to a lay audience. However, there is no empirical evidence of its effectiveness in conveying this kind of knowledge. The aim of this study is to explore the impact of metaphor in the comprehension of popularization written texts on Biology. A written comprehension test was designed, containing 4 excerpts of popularization texts with and without metaphors, and 16 multiple choice questions. The test was applied to 30 second year secondary school Chilean students, and complemented with semi-structured interviews to three students of the sample. Results showed that, at the local level of comprehension, one-correspondence structural metaphors and image metaphors facilitated comprehension. However, at the global level, no evidence of better comprehension in text with metaphors was found. These findings help to assess the effectiveness of conceptual metaphor in specialized knowledge comprehension, and can inform the design of popularization texts with didactic purposes.

Resumen: La metáfora conceptual es utilizada con frecuencia como estrategia divulgativa para acercar el conocimiento especializado a un público lego, pero su eficacia comunicativa para la transmisión de contenido especializado no se ha comprobado empíricamente. El objetivo de este trabajo es explorar la incidencia de las metáforas en la comprensión de textos escritos divulgativos del área de Biología. Se diseñó una prueba de comprensión lectora con 4 fragmentos de textos de divulgación con expresiones metafóricas y sin expresiones metafóricas, acompañados de 16 preguntas de selección múltiple. La prueba se aplicó a 30 estudiantes de segundo año medio de un colegio chileno, y se complementó con una entrevista semiestructurada a tres de los estudiantes. Los resultados obtenidos demostraron que, a nivel local, las metáforas estructurales de una correspondencia y las de imagen posibilitan una mejor comprensión. Sin embargo, a nivel global, no se evidenció un mejor desempeño en la lectura de textos con presencia de expresiones metafóricas. Estos hallazgos permiten caracterizar el nivel de eficacia de la metáfora conceptual en el proceso de comprensión de contenido especializado, así como informar sobre el diseño de textos divulgativos con propósitos didácticos.

ABSTRACT Introduction: The aim to graduate a general dentist with a high standard in knowledge to solve the most general and prevalent periodontal oral health issues is a social demand that is revealed in the current study program of dentistry major. Objective: To elaborate some theoretical references concerning dentistry student preparation in terms of education for periodontal oral health. Method: From January to July 2020, at the Facultad de Estomatología in the Universidad de Ciencias Médicas Guantanamo, a narrative review on the subject was carried out through a search in electronic databases (Virtual Health Library, LILACS, PubMed, SciELO, REDALYC, Scopus). It was systematized all the theoretical references that support the preparation of the dentistry students in terms of education for periodontal oral health. Conclusions: It is evident the necessity of this type of training due to its implication in the way to the best professional performance for an integral oral care. The foundations for achieving this goal emerge from the harmonious conjugation of philosophical, sociological, legal, psychological, pedagogical and didactic referents, in accordance to the practice of the profession.

RESUMEN Introducción: La aspiración de egresar un estomatólogo general suficientemente preparado para resolver los problemas de salud bucal periodontal más generales y prevalentes es una exigencia social que se revela en el actual plan de estudio de la carrera de Estomatología. Objetivo: Elaborar unos referentes teóricos de la preparación del estudiante de Estomatología en función de la educación para la salud bucal periodontal. Método: De enero a julio de 2020, en la Facultad de Estomatología de la Universidad de Ciencias Médicas Guantánamo se realizó una revisión narrativa sobre el tema a través de una búsqueda en bases de datos electrónicas (Biblioteca Virtual en Salud, LILACS, PubMed, SciELO, REDALYC, Scopus). Se sistematizaron referentes teóricos que sustentan la preparación del estudiante de Estomatología en función de la educación para la salud bucal periodontal. Conclusiones: Se evidencia la necesidad de esta preparación dada su implicación en el modo de actuación profesional para una Atención Bucal Periodontal Integral. Las bases para esta finalidad emergen de la conjugación armoniosa de referentes filosóficos, sociológicos, legales, psicológicos, pedagógicos y didácticos en función de la práctica de la profesión.

ABSTRACT Introduction: Periodontal diseases are caused by an inadequate oral health, and to prevent them, gum care is essential. Objective: To specify the perception of affected patients about this disease in order to support the systematization of the theoretical bases directed to the preparation in the subject of students of stomatology and comprehensive general stomatologists in training. Method: A descriptive, prospective and cross-sectional study was carried out in the Stomatological Teaching Clinic "Julio A. Mella", a branch of the University of Medical Sciences of Guantanamo. Twenty-five patients with diagnosis of periodontal disease were surveyed to as cert a in their perception of the disease. The results were summarized by means of absolute frequencies and expressed in tables. Results: it was common that patients revealed an un favor able opinion regarding the following topics: absolute lack of knowledge about this disease (n=22), insufficient posture of the patients about gum self-care (n=22) and dissatisfaction with educational actions in terms of prevention (n=14). Conclusions: Patients reveal an inadequate perception of periodontal disease which supports the systematization of the theoretical bases for the understanding of the need to develop in them a culture of gum care for a good periodontal health. Furthermore, the value of the stomatologist, the family, the school, the media and the community as social agents responsible for the education of the population in terms of the prevention of periodontal diseases is reiterated.

RESUMEN Introducción: Las enfermedades periodontales son un problema de salud bucal, y para prevenirlas es esencial el cuidado de las encías. Objetivo: Precisar la percepción de pacientes afectados sobre esta enfermedad para sustentar la sistematización de las bases teóricas dirigidas a la preparación de estudiantes de Estomatología y estomatólogos generales integrales en formación respecto al tema. Método: Se realizó un estudio descriptivo, prospectivo y transversal en la Clínica Estomatológica Docente “Julio Antonio Mella” adscrita la Universidad de Ciencias Médicas Guantánamo. Se encuestaron 25 pacientes con diagnóstico de enfermedad periodontal para indagar su percepción sobre la enfermedad. Los resultados se resumieron mediante frecuencias absolutas y se expresaron mediante tablas. Resultados: Lo más común es que los pacientes revelaran una opinión desfavorable en relación con los temas: expresión de una empobrecida educación sobre esta enfermedad (n=22), actitud insuficiente para el autocuidado de las encías (n=22) e Insatisfacciones con las acciones educativas en función de su prevención (n=14). Conclusiones: Los pacientes revelan una inadecuada percepción de la enfermedad periodontal lo que sustenta la sistematización de las bases teóricas para la comprensión de la necesidad de desarrollar en ellos una cultura del cuidado de las encías por una salud periodontal. Además, se reitera el valor del estomatólogo, la familia, la escuela, los medios y la comunidad como agentes sociales responsable de la educación de la población en función de la prevención de las enfermedades periodontales.

Resumen Introducción. El quiloperitoneo consiste en la presencia de fluido linfático en la cavidad intraabdominal, complicación poco descrita en el embarazo y cuyas repercusiones no están bien establecidas. Reporte de caso. Se presenta el caso de una mujer gestante con embarazo de 36,5 semanas, sin comorbilidades, hospitalizada por presentar cifras tensionales elevadas asociadas a síntomas de encefalopatía hipertensiva y bradicardia fetal sostenida; se le practicó una cesárea urgente en la cual se evidenció corioperitoneo incidental. La tomografía computarizada abdominal de control no demostró alteraciones. Discusión. Se descartaron las principales causas del quiloperitoneo, las cuales son neoplasia maligna y trauma. Se consideró que se trataba de un quiloperitoneo espontáneo posiblemente relacionado con la congestión pélvica propia del embarazo, por vasodilatación secundaria al influjo hormonal, aumento de la presión intraabdominal y contribución del volumen ascítico por la preeclampsia, que genera ruptura traumática de los vasos linfáticos. Conclusión. La ascitis quilosa es una entidad poco frecuente que puede verse asociada con el embarazo. Es fundamental el criterio acertado del ginecoobstetra para determinar tempranamente la etiología.

Abstract Introduction: Chyloperitoneum consists of the presence of a lymphatic fluid in the intra-abdominal cavity, a complication little described during pregnancy, and whose repercussions are not well established. Case report: A pregnant woman with a pregnancy of 36.5 weeks, without comorbidities, is hospitalized in the context of high blood pressure levels associated with symptoms of hypertensive encephalopathy and sustained fetal bradycardia, leading to an emergent cesarean section where incidental chorioperitoneum was evidenced. Posterior abdominal CT control showed no alterations. Discussion: The main associated etiologies (malignancy and trauma) were ruled out. It is considered a presentation of spontaneous chyloperitoneum that could be related to the pelvic congestion of pregnancy due to: vasodilatation secondary to hormonal influence, increased intra-abdominal pressure and contribution of ascites due to preeclampsia, generating traumatic rupture of lymphatic vessels. Conclusion: Chylous ascites is a rare entity that can be associated with pregnancy. It is essential that gynecologist and obstetrician correctly approach these patients to determine the etiology early.

Background: Contact investigation is cardinal in the control of tuberculosis (TB) since it helps to stop its transmission. In Chile, the National TB Program strategy does not include latent TB infection testing, regular chemoprophylaxis or follow-up in adults. Active TB was found in only 1.2% of contacts at country-level during 2018. Aim: To evaluate the performance of a systematic screening of adult household contacts with targeted chemoprophylaxis and prolonged active follow-up. Material and Methods: Prospective cohort of household contacts in Santiago. Two face-to-face visits (at 0 and 12 weeks) that included QuantiFERON TB-Gold plus tests (QFT), chest radiography (CXR) at 0 and 24 weeks and, periodic text messaging or phone call follow-up for up to 48 weeks were implemented. Contacts with positive QFT were referred for TB chemoprophylaxis. Results: A total of 200 contacts were enrolled, 69% were migrants. At baseline evaluation, 45% had a positive QFT result and 1.6% had co-prevalent active TB. At follow-up, 13% contacts further converted to QFT (+), and 5.1% more were diagnosed with active TB (mean follow-up time 32 weeks). Of these 10 further active TB cases, 6 (60%) had a negative QFT and all (100%) had normal CXR at baseline; while three cases occurred in QFT converters. Conclusions: In this cohort of household contacts, 6.7 % were diagnosed with active TB (more than 2/3 at follow-up) and 13% had a late QFT (+) conversion. Active and prolonged contacts' follow-up are essential to detect new infections and tackle the TB epidemic in Chile.

RESUMO Introdução: Cuba atenção à saúde bucal é priorizada, que é determinada por vários fatores, incluindo a incidência de doença periodontal que prevalece é agora reconhecida como um problema de saúde, ele danifica o bem-estar biopsicossocial do indivíduo. Objetivo: fornecer aos estomatologistas as bases teóricas que lhes permitirão enriquecer seu preparo em relação à questão da doença periodontal e, assim, melhorar sua contribuição para sua prevenção, desde o nível de atenção primária até a saúde bucal. Método: os referentes à doença periodontal foram sistematizados na Faculdade de Ciências Médicas de Guantánamo, no período de janeiro a julho de 2017. Resultados: o primeiro estágio da doença periodontal é conhecido como gengivite. A doença periodontal afeta até 20% da população mundial. O cuidado das gengivas para a prevenção da doença periodontal exige que o indivíduo se aproprie dos conhecimentos essenciais que possibilitam esse propósito, para que eles sejam capazes de perceber o risco dele e contribuir com as ações voltadas à proteção ou Restauração da saúde periodontal. Conclusões: bases teóricas são oferecidas para a compreensão da necessidade de desenvolver em pacientes uma cultura de cuidado gengival para a saúde periodontal. O valor do estomatologista, da família, da escola, da mídia e da comunidade são reiterados como agentes sociais responsáveis pela educação da população em termos de promoção da saúde periodontal e prevenção de doenças periodontais.

ABSTRACT Introduction: in Cuba attention to oral health is prioritized, which is determined by various factors, including incidence of periodontal disease that now a day is recognized as a health problem, it damages the individual as well as biopsicosocial well-being. Objective: stomatologists provide the theoretical bases that allow them to enrich their preparation on the subject periodontal disease thus improve their contribution to prevent primary care level to oral health. Method: the references related to periodontal disease in the Faculty of Medical Sciences of Guantanamo are systematized, from January to July 2017. Results: first stage of periodontal disease is known as gingivitis. Periodontal disease affects 20% of the world population. The gingiva care to prevent periodontal disease requires the individual to appropriate the essential knowledges that will enable this purpose, so that they are able to perceive the risk of it and contribute to actions with the aim of protecting periodontal health. Conclusions: theoretical basis for understanding the need to develop in patients offer culture of gingival care by a periodontal health. The value of stomatology, family, school, community media and reiterated responsible for education as social agents of the population depending on periodontal health promotion and prevention of periodontal diseases.

RESUMEN Introducción: en Cuba se prioriza la atención a la salud bucal, la que está determinada por diferentes factores, entre los que prevalece la incidencia de la enfermedad periodontal que hoy se reconoce como problema de salud, pues daña el bienestar biopsicosocial del individuo. Objetiv: o brindar a los estomatólogos las bases teóricas que le permitan enriquecer su preparación respecto al tema enfermedad periodontal y de esta manera mejorar su contribución a su prevención desde el nivel de atención primaria a la salud bucal. Método: se sistematizaron los referentes relacionados con la enfermedad periodontal en la Facultad de Ciencias Médicas de Guantánamo, en el período de enero a julio de 2017. Resultados: el primer estadío de la enfermedad periodontal se conoce como gingivitis. La enfermedad periodontal incide hasta en un 20 % de la población mundial. El cuidado de las encías para la prevención de la enfermedad periodontal requiere que el individuo se apropie de los saberes esenciales que le posibiliten esta finalidad, a fin de que sean capaces de percibir el riesgo de ella y contribuir con las acciones dirigidas a la protección o restauración de la salud periodontal. Conclusiones: se ofrecen bases teóricas para la comprensión de la necesidad de desarrollar en los pacientes una cultura del cuidado de las encías por una salud periodontal. Se reitera el valor de estomatólogo, la familia, la escuela, los medios y la comunidad como agentes sociales responsables de la educación de la población en función de la promoción de salud periodontal y la prevención de las enfermedades periodontales.

Background: In 2013 the Chilean regulatory sanitary agency issued a warning concerning dose adjustment and use restriction to avoid severe adverse effects of metoclopramide such tardive dyskinesia. Aim: To study dyskinesia type adverse effects in a population using metoclopramide. Material and Methods: A cross sectional observational study was conducted among patients pertaining to palliative care and diabetes mellitus programs and consuming 10 mg/day or more of metoclopramide. Patients were interrogated looking for extrapiramidal signs and symptoms using a questionnaire validated by two neurologists. Results: In 40% of diabetic patients with gastroparesia and 35% of palliative care patients, extrapyramidal adverse reactions to metoclopramide were suspected. Palliative Care patients suffered the largest number of adverse events. The period of use and individual doses of the drug were largely above Chilean regulatory agency recommendations in all cases. Conclusions: A significant number of patients using metoclopramide could experience extrapyramidal adverse reactions.

Abstract: This article presents a study about the terminology used to refer to the Chilean military coup and dictatorship in high school History textbooks. Terms represent specialised concepts in a specific subject field and reflect the conceptualisation of reality of a given disciplinary community in a socio-temporal context. Term choice influences how readers access specialised knowledge. This study aimed at analysing the point of view about the military coup and dictatorship conveyed by term choice in Chilean history textbooks; and determine whether this point of view changed across time. For that purpose, the term variants referring to the main concepts of the historical period were analysed in a corpus of history textbooks distributed by the Chilean Ministry of Education between 2002 and 2014 to students in second and third year of secondary education. A semantic analysis was carried out, which took into account the conceptual information, the abstraction level of the categories and the point of view (positive, negative or neutral) reflected by term variants. Results showed that terminology remains quite stable throughout the years and convey mainly a neutral perspective about the historical events. These results are not coherent with the pluralist perspective recommended by the Ministry of Education in the curriculum guidelines.

Resumen: Este artículo presenta un estudio sobre la terminología empleada para referirse al período histórico del Golpe y Dictadura Militar en los textos escolares de enseñanza media de historia de Chile. Los términos representan los conceptos especializados de una disciplina y reflejan la conceptualización particular de la realidad por parte de una determinada comunidad disciplinar en un contexto socio-temporal. Por ello, influyen en la manera en que el receptor accede al conocimiento. Este estudio tuvo por objetivo describir el punto de vista sobre el Golpe y la Dictadura Militar transmitido a través de la terminología en los manuales de historia chilenos, y determinar si esta ha evolucionado con el paso de los años. Para ello, se analizaron las variantes terminológicas de los conceptos principales que configuran el periodo histórico en la unidad didáctica sobre el tema en textos escolares de 2º y 3º Medio, licitados por el Mineduc entre el 2002 y 2014. Luego, a partir del análisis de la información conceptual reflejada en cada variante y el nivel de abstracción de la categoría seleccionada, se interpretó si las variantes reflejaban un punto de vista negativo, neutro o positivo del concepto. Los resultados demostraron que las denominaciones son relativamente estables a lo largo de los años y transmiten puntos de vista mayormente neutros. Estos resultados contrastan con la perspectiva pluralista de los hechos que promulga el Mineduc en sus bases curriculares.

ABSTRACT We systematized theoretical references that support the diagnosis of periodontal diseases, supported by the use of the clinical method, which enhances the work of the professor of the subject Periodontics in the career of Stomatology aimed at preparing the student for this purpose, during the period January to July 2017, in the Faculty of Stomatology of Guantánamo.

RESUMEN Se sistematizaron referentes teóricos que sustentan el diagnóstico de las enfermedades periodontales, apoyado en el uso del método clínico, lo que potencia la labor del profesor de la asignatura Periodoncia en la carrera de Estomatología dirigida a la preparación del estudiante para esta finalidad, durante el período enero a julio de 2017, en la Facultad de Estomatología de Guantánamo.

An investigation in health systems and services was carried out to evaluate the process quality in the implementation of the Preconceptional Risk Program by means of the professional competence of 45 doctors and nurses of "Ramón López Peña" Polyclinic in Santiago de Cuba, from April to November, 2016. An experts committee prestablished evaluation approaches, indicators and standards. There were difficulties in the knowledge about control, emission and failure of the program approaches, in the follow up of couples, as well as in everything concerning the medical records and the consultation with the obstetrician or other specialists related to the risk factor. The quality in the implementation of the program was not the best; the difficulties detected could impact in the negative results of the Maternal and Child Care Program in the health area. It is necessary to evaluate other dimensions of the quality and qualify the professionals in the aspects with difficulties

Se realizó una investigación en sistemas y servicios de salud para evaluar la calidad del proceso de ejecución del Programa de Riesgo Preconcepcional a través de la competencia profesional de 45 médicos y enfermeras del Policlínico "Ramón López Peña" de Santiago de Cuba, desde abril hasta noviembre del 2016. Un comité de expertos preestableció criterios, indicadores y estándares de evaluación. Hubo dificultades en el conocimiento sobre criterios de control, salida y fallo del programa, en el seguimiento de las parejas, así como en lo concerniente a las historias clínicas y la interconsulta con obstetra u otros especialistas afines al factor de riesgo. La calidad en la ejecución del programa no fue la mejor; las dificultades detectadas pudieran incidir en los resultados negativos del Programa de Atención Materno-Infantil en el área de salud. Resulta necesario evaluar otras dimensiones de la calidad y capacitar a los profesionales en los aspectos con dificultades

Objectives: To report the results of 13 years worth of epidemiologic surveillance of ventilator-associated pneumonia (VAP) following heart surgery and the main interventions applied in order to reduce VAP incidence. Methods: This is a retrospective and descriptive study of active epidemiologic surveillance of VAP. National diagnostic criteria were used. Interventions associated with a decrease in VAlP incidence in adults who underwent heart surgery are described. Results: A significant and sustained reduction was observed in the rate of VAP; being 56.7 per 1,000 ventilator-days in 1998 vs 4.7 per 1,000 ventilator-days in 2010 (p < 0.001). The strongest reduction was observed following 2003 (34.4 to 14.8 per 1,000 ventilator-days in 2004, p < 0.001). The interventions with greatest impact were the implementation of an early-weaning protocol, the introduction of trained nurses to perform the mechanical ventilator equipment management and the routine use of alcohol-based hand rubs. Conclusion: Epidemiologic surveillance associated with the establishment of a multifactorial intervention program applied in collaboration with the attending team, have demonstrated a significant reduction of VAP incidence after heart surgery.

Objetivos: Comunicar los resultados de 13 años de vigilancia epidemiológica de neumonía asociada a ventilación mecánica (NAVM) post cirugía cardíaca y las principales intervenciones implementadas para reducir su incidencia. Metodología: Estudio retrospectivo, descriptivo, de vigilancia epidemiológica activa de NAVM utilizando los criterios del ]Ministerio de Salud (MINSAL) y de las intervenciones asociadas con una disminución de la tasa de NAVM en adultos operados de cirugía cardíaca. Resultados: Se observó una reducción significativa y sostenida de la tasa de NAVM, siendo 56,7 por 1.000 días de ventilación mecánica (VM) en 1998 vs 4,7 por 1.000 días de VM en 2010 (p < 0,001). La mayor reducción fue observada a partir de 2003 (desde 34,4 a 14,8 por 1.000 días de VM en 2004, p < 0,001). Las intervenciones con mayor impacto fueron la implementación de un protocolo de extubación precoz, la incorporación de enfermeras capacitadas en el manejo de los equipos de VM y el uso rutinario de alcohol gel. Conclusión: La vigilancia epidemiológica asociada a un programa de intervención multifactorial aplicado en conjunto con el equipo tratante permitió reducir significativamente la incidencia de NAVM post cirugía cardíaca.