Resumen En este artículo, se analiza cómo la salud sexual y reproductiva ha sido problematizada en el sistema público de salud costarricense, en el escenario de implementación de la Iniciativa Mesoamérica en la zona de Golfito. En las siguientes páginas, se desarrolla la tesis de que la persona adolescente es juzgada desde la patología y la anormalidad, resaltando fallos personales (afectivos o identitarios) o fallos en la socialización (reproducción de hábitos aprendidos de familiares y grupos de pares). Como consecuencia, el reconocimiento de derechos parte de una concepción negativa sobre la adolescencia y la salud. Este estudio es de corte cualitativo, y fue fundamentado tanto por medio de análisis documentales, como de entrevistas y grupos focalizados realizados a personal en salud pública.

Abstract This article analyses how sexual and reproductive health has been constructed as a policy problem in Costa Rica´s Public Healthcare System, in the context of implementation of the Mesoamerica Initiative in Golfito region. It will be argued that adolescents are seen from the pathology and anormality -focusing on personal fails (their affectivity and identity) as well as socialization fails (relative to family and peer groups). As a result, their rights recognition is based on a negative stand. The study is qualitative -document analysis, as well as interviews and focus groups conducted to public healthcare officials.

Background: The severity of community acquired pneumonia (CAP) can be evaluated by the PSI and CURB-65 scales. However, it is unknown whether their predictive capacity varies according to the etiology of the disease. Aim: To compare the performance of these scales in adults with viral, bacterial, mixed, and no agent detected CAP. Material and Methods: We studied 725 patients hospitalized for CAP aged 18 to 95 years (47% females) Urinary S. pneumoniae and Legionella antigens were detected by immuno-chromatography (Binax®). Respiratory viruses and bacteria were detected by PCR in nasopharyngeal smears. The proportions of deaths, admission to the intensive care unit (ICU), and oxygen therapy were compared between mild and non-severe patients defined by PSI (I/II and I-III) and CURB-65 (1 and 1-2), according to the causative agent. Results: Ten percent of patients died. A causative agent was detected in 65%. The proportion of mild and non-severe patients according to PSI and CURB-65, and of deceased patients, admitted to the ICU and with oxygen therapy was similar in the four categories per agent. There were no deaths among non-severe patients with bacterial CAP. However, 6% of patients with CAP caused by virus or without causative agents, died. No deaths occurred among mild patients with bacterial CAP. In viral CAP, no deaths occurred among patients classified as mild only by PSI. The yields of PSI were greater than those of CURB-65 in non-severe patients who died and were admitted to the ICU with bacterial and viral CAP (5 and 14%; 7 and 12% respectively, p = 0.04). Conclusions: The prognostic performance of PSI in CAP varies according to the causative agent in adults. It is higher in non-severe bacterial cases, and superior to CURB-65.

The functional assessment of patients with dyspnea usually uses static or submaximal exercise tests, which provide limited information because they do not expose patients to the real situation that causes exercise intolerance. The cardiopulmonary exercise test (CPET) is an increasingly used tool that can be used in these circumstances. It determines peak oxygen consumption, anaerobic threshold and cardiac and respiratory reserves, measuring oxygen uptake and carbon dioxide production during standardized exercise conditions. It is useful for risk assessment in cardiothoracic surgery and can provide valuable information such as the timing for transplant in patients with severe chronic disease. The test is non-invasive, has a short duration, and exhibits an adequate safety profile in specialized centers. It is mainly indicated for the dynamic evaluation of athletes or patients with heart, respiratory, and neuromuscular diseases, it is essential part of the study of dyspnea of unknown origin, and in the prognostic assessment of patients who face highly complex interventions. This review provides a comprehensive review of CPET with emphasis on its main indications in healthy people, athletes and, in particular, in functional evaluation of patients with exercise limitations in the context of their chronic diseases.

Resumen El acceso vascular en hemodiálisis constituye uno de los pilares de éxito del programa. Por tanto, los esfuerzos se deben encaminar a lograr en primera instancia el mayor número de accesos vasculares tipo fístulas Arteriovenosas, y en segundo lugar a disminuir las complicaciones relacionadas con la canulación del acceso para preservar funcionalmente el mismo. Se han descrito varias estrategias para mejorar este último aspecto; en el presente artículo se describe el uso del ultrasonido para mejorar la probabilidad de canulación exitosa en casos considerados como difíciles por parte del equipo de enfermería.

Abstract Vascular access in hemodialysis constitutes one of the pillars of the success of a program. Efforts should therefore be aimed at achieving, in the first instance, the greatest number of arteriovenous fistula vascular accesses, and secondly at decreasing the complications related to the cannulation of access to preserve the functionally thereof in the long term. Several strategies have been described to improve this last aspect; we describe case reports of the use of ultrasound to improve the probability of successful cannulation in situations considered difficult by the nursing team.

ABSTRACT Introduction: The History of Cuba II syllabus lacks suggestions about bibliography that allow the teaching staff to deal with the curricular strategies in the Curriculum “D” in dental studies. Objective: To suggest the use of bibliographies for the treatment of curricular strategies in the subject History of Cuba II in Dentistry. Material and methods: A descriptive pedagogical research was conducted. Methods of document analysis, methodological workshop, and bibliographic review were used. Results: A total of 33 bibliographies were found, and proposals were made for linking curricular strategies in each of the topics of History of Cuba II syllabus for dental studies. Conclusions: The suggested bibliographies can contribute to the treatment of curricular strategies in the subject History of Cuba II, and favor the comprehensive training of the first- year dental students.

RESUMEN Introducción: El programa de la asignatura Historia de Cuba II carece de sugerencias de bibliografías que permitan a los docentes darle tratamiento a las estrategias curriculares plasmadas en el Plan “D” para la Carrera de Estomatología. Objetivo: Proponer el uso de bibliografías para el tratamiento de las estrategias curriculares en la asignatura Historia de Cuba II de la Carrera de Estomatología. Material y método: Investigación pedagógica de tipo descriptivo. Se utilizaron los métodos de análisis de documentos, búsqueda bibliográfica y taller metodológico. Resultados: Se localizaron 33 bibliografías y se elaboraron las propuestas de vinculación a las distintas estrategias curriculares en cada uno de los temas del programa de Historia de Cuba II de la Carrera de Estomatología. Conclusiones: Las bibliografías propuestas pueden contribuir a darles tratamiento a las estrategias curriculares en la asignatura Historia de Cuba II y favorecer la formación integral del estudiante de primer año de la Carrera de Estomatología.

Resumen:El artículo resume notas de campo y entrevistas a profundidad realizadas a jóvenes de la comunidad turística de Puerto Viejo, en el Caribe Sur costarricense, sobre el tema de salud sexual y riesgo. Se argumenta que sus visiones acerca del cuerpo, de la intimidad y de la persona extranjera, además de ser fundamentales al distinguir las previsiones que deben tener en sus relaciones sexuales, se encuentran enraizadas en distinciones de clase, de género y de raza. A partir de sus valoraciones en cuanto al uso del condón masculino, se ejemplifica cómo el empleo de técnicas de investigación cualitativas puede ofrecer insumos al debate tradicional sobre factores de riesgo desarrollado en el campo de la salud pública.

Abstract:The article summarizes data from field notes and in-depth interviews on the subject of sexual health and risk with young people in the tourist community of Puerto Viejo -located in Costa Rica's South Caribbean. It is argued that their views about the body, intimacy, and foreigners, are not only key to distinguishing the care they should have regarding their sexual relations, but also constitute reasons differentiated by class, gender and race. Besides, taking as example their assessment about the use of male condos, it is shown how the use of qualitative-based analysis can provide input to the traditional debate developed in the field of public health about risk factors.

ABSTRACT Objective: To evaluate the efficacy and safety of percutaneous tracheostomy by means of single-step dilation with fiber optic bronchoscopy assistance in critical care patients under mechanical ventilation. Methods: Between the years 2004 and 2014, 512 patients with indication of tracheostomy according to clinical criteria, were prospectively and consecutively included in our study. One-third of them were high-risk patients. Demographic variables, APACHE II score, and days on mechanical ventilation prior to percutaneous tracheostomy were recorded. The efficacy of the procedure was evaluated according to an execution success rate and based on the necessity of switching to an open surgical technique. Safety was evaluated according to post-operative and operative complication rates. Results: The mean age of the group was 64 ± 18 years (203 women and 309 males). The mean APACHE II score was 21 ± 3. Patients remained an average of 11 ± 3 days on mechanical ventilation before percutaneous tracheostomy was performed. All procedures were successfully completed without the need to switch to an open surgical technique. Eighteen patients (3.5%) presented procedure complications. Five patients experienced transient desaturation, 4 presented low blood pressure related to sedation, and 9 presented minor bleeding, but none required a transfusion. No serious complications or deaths associated with the procedure were recorded. Eleven patients (2.1%) presented post-operative complications. Seven presented minor and transitory bleeding of the percutaneous tracheostomy stoma, 2 suffered displacement of the tracheostomy cannula, and 2 developed a superficial infection of the stoma. Conclusion: Percutaneous tracheostomy using the single-step dilation technique with fiber optic bronchoscopy assistance seems to be effective and safe in critically ill patients under mechanical ventilation when performed by experienced intensive care specialists using a standardized procedure.

RESUMEN Objetivo: Evaluar eficacia y seguridad de la traqueostomía percutánea, mediante dilatación única con asistencia fibrobroncoscópica, en pacientes críticos sometidos a ventilación mecánica. Métodos: Entre los años 2004 y 2014, se incluyeron prospectivamente 512 enfermos consecutivos con indicación de traqueostomía según los criterios clínicos de nuestro centro. Un tercio de los pacientes fueron de alto riesgo. Se registraron variables demográficas, puntaje APACHE II, y días de ventilación mecánica previo a traqueostomía percutánea. La eficacia del procedimiento fue evaluada mediante tasa de éxito en su ejecución y necesidad de conversión a técnica abierta. La seguridad fue evaluada por tasa de complicaciones operatorias y postoperatorias. Resultados: La edad media del grupo fue 64 ± 18 años (203 mujeres y 309 varones). El puntaje APACHE II fue 21 ± 3. Los pacientes permanecieron en promedio 11 ± 3 días en ventilación mecánica antes de la realización de la traqueostomía percutánea. Todos los procedimientos se completaron exitosamente, sin necesidad de convertir a técnica abierta. Dieciocho pacientes (3,5%) presentaron complicaciones operatorias. Cinco pacientes experimentaron desaturación transitoria, cuatro presentaron hipotensión relacionada a la sedación, y nueve presentaron sangrado menor, pero ninguno requirió transfusión. No se registraron complicaciones graves, ni muertes asociadas al procedimiento. Once pacientes (2,1%) presentaron complicaciones postoperatorias. Siete presentaron sangrado menor y transitorio del estoma de la traqueostomía percutánea, 2 sufrieron desplazamiento de la cánula de traqueostomía y 2 desarrollaron infección superficial del estoma. Conclusión: La traqueostomía percutánea mediante la técnica de dilatación única con asistencia fibrobroncoscópica, parece ser efectiva y segura en enfermos críticos sometidos a ventilación mecánica, cuando es realizada por intensivistas experimentados mediante un abordaje estandarizado.

Oxidant/antioxidant imbalance has been reported in some infectious diseases, including community-acquired pneumonia (CAP). The aim was to assess the antioxidant status in adults with CAP and its relationship with clinical severity at admission. Fifty-nine patients with CAP were enrolled and categorized at admission by the FINE score, from July 2010 to October 2012. In the same period 61 controls were enrolled. Plasma samples were obtained at admission for determination of the ferric reducing ability of plasma (FRAP) and lipid peroxidation (8-isoprostane). Erythrocyte reduced (GSH)/oxidized (GSSG) glutathione, malondialdehyde (MDA) and antioxidant enzyme activity were assessed. Antioxidant status in adults with CAP represented by FRAP and the GSH/GSSG ratio were 16.8% (p=0.03) and 39.7% (p=0.04) lower than control values, respectively. In addition, FRAP values showed a positive correlation with GSH/GSSG ratio (r=0.852; p<0.02; n=59). The CAP group showed greater lipid peroxidation in both plasma and erythrocytes. The FINE score correlated negatively with FRAP (r= -0.718; p<0.05; n=59) and positively with MDA and F2 isoprostane levels (r=0.673; p<0.05; n=59; r=0.892; p<0.01; n=59, respectively). Antioxidant status alterations correlated with clinical severity. The FRAP assay and lipid peroxidation biomarkers may provide a useful parameter for estimating the severity and the clinical outcome of patients with CAP.

En el transcurso de la historia económica moderna, los salarios reales han sido un buen indicador del nivel de vida material de la clase trabajadora. Este documento presenta series de salarios reales para diferentes sectores y épocas en Colombia. Apoyándonos en datos compilados por varios autores, nuestra principal conclusión es que a lo largo de los últimos 170 años los salarios reales en Colombia aumentaron menos que el crecimiento del PIB per cápita en la mayoría de los períodos estudiados, a excepción de los últimos 50 años. Esta caída significativa en la participación de los asalariados puede ser interpretada como un deterioro en la distribución de los ingresos y, por tanto, puede ser una causa parcial de la mala distribución de los ingresos hoy en día en Colombia.

In the course of modern economic history, real wages have been a good indicator of the material living standards of the working class. This document presents real wage series for different sectors and periods of time in Colombia. Relying on data compiled by several authors, our main conclusion is that in the last 170 years Colombian real wages have increased less than the GDP per capita in most of the studied periods, except for the last 50 years. This significant drop in the participation of employees can be interpreted as deterioration in income distribution and, therefore, may be a partial cause of unequal distribution of income in Colombia today.

No decorrer da história econômica moderna, os salários reais têm sido um bom indicativo do nível de vida material da classe trabalhadora. Este documento apresenta séries de salários reais para diversos setores e épocas na Colômbia. Nossa principal conclusão, apoiada em dados compilados por vários autores, é que ao longo dos últimos 170 anos, os salários reais na Colômbia aumentaram menos que o crescimento do PIB per capita na maior parte dos períodos estudados, com exceção dos últimos 50 anos. Esta queda significativa na participação dos assalariados pode ser interpretada como uma deterioração na distribuição de renda e, portanto, pode ser uma causa parcial da má distribuição de renda atual na Colômbia.