Abstract In a globalized world, Legislative control over matters related to Mercosur and the European Union (EU) is important. However, its importance varies according to Regional Foreign Policy (RFP) decisions. This article investigates whether there are configurations, considering institutional design, political conditions, and economic factors, which explain the intensity of legislative participation in determining such matters. Specialists were consulted to select five decisions that represented significant changes for the regional dynamics of Mercosur and EU member countries. After defining the intentional sample of cases, necessary and sufficient conditions for the participation of the Legislature in RFP were identified through a Qualitative Comparative Analysis (QCA). The results indicate that institutional design and economic factors matter, but prior debates in Parliaments on the subject are also relevant to explaining legislative action. This was corroborated by a Coincidence Analysis (CNA) that demonstrated that this variable makes up the causal chain of participation. world (EU important However (RFP configurations countries cases QCA. QCA . (QCA) matter action CNA (CNA (QCA

Résumé Dans un monde globalisé, le contrôle du législatif sur les questions liées au Mercosur et à l’Union Européenne est important, mais il varie en fonction des décisions de Politique Étrangère Régionale (PER). Cet article examine s’il existe des configurations, en tenant compte de la conception institutionnelle, des conditions politiques et des facteurs économiques, qui expliquent l’intensité de la participation législative dans la détermination de telles questions. Une consultation d’experts a été réalisée pour sélectionner 5 décisions représentant des changements significatifs pour la dynamique régionale des pays du Mercosur et de l’Union européenne. Après avoir défini l’échantillon intentionnel de cas, grâce à une Analyse Qualitative Comparative (QCA), des conditions causales, nécessaires et suffisantes, ont été identifiées pour la participation du législatif à la PER. Les résultats indiquent que la conception institutionnelle et les facteurs économiques importent, mais les débats préalables dans les Parlements sur le sujet sont également pertinents pour expliquer l’action législative. Cela a été corroboré par une Analyse de Coïncidence qui a démontré que cette variable fait partie de la chaîne causale de la participation. globalisé lUnion l Union important PER . (PER) sil s configurations lintensité intensité dexperts d experts européenne léchantillon échantillon cas QCA, QCA , (QCA) causales suffisantes importent laction action (PER (QCA

Resumo Em um mundo globalizado, o controle do Legislativo sobre matérias ligadas ao Mercosul e à União Europeia importa, mas varia em relação às decisões de Política Externa Regional (PER). Este artigo investiga se existem configurações, considerando o desenho institucional, as condições políticas e os fatores econômicos, que expliquem a intensidade da participação legislativa na determinação de tais matérias. Foi realizada uma consulta com especialistas para selecionar 5 decisões que representaram mudanças significativas para a dinâmica regional dos países mercosulinos e europeus. Após definida a amostra intencional de casos, através de uma Análise Qualitativa Comparativa (QCA), foram identificadas condições causais, necessárias e suficientes, para a participação do Legislativo em PER. Os resultados indicam que desenho institucional e fatores econômicos importam, mas debates prévios nos Parlamentos sobre o tema também são relevantes para explicar a atuação legislativa. Isso foi corroborado por uma Análise de Coincidência que demonstrou que essa variável compõe a cadeia causal da participação. globalizado importa PER . (PER) configurações europeus casos QCA, QCA , (QCA) causais suficientes importam (PER (QCA

Resumen En un mundo globalizado, el control legislativo sobre los asuntos relacionados con el Mercosur y la Unión Europea es importante, pero varía en relación con las decisiones de Política Exterior Regional (PER). Este artículo investiga si existen configuraciones, teniendo en cuenta el diseño institucional, las condiciones políticas y los factores económicos, que expliquen la intensidad de la participación legislativa en la determinación de tales asuntos. Se consultó a expertos para seleccionar cinco decisiones que representaban cambios significativos en la dinámica regional del Mercosur y de los países europeos. Una vez definida la muestra intencional de casos, se utilizó un Análisis Cualitativo Comparativo (ACC) para identificar las condiciones causales necesarias y suficientes para la participación de la legislatura en PER. Los resultados indican que el diseño institucional y los factores económicos importan, pero los debates previos en los parlamentos sobre el tema también son relevantes para explicar la acción legislativa. Esto fue corroborado por un Análisis de Coincidencias que demostró que esta variable conforma la cadena causal de la participación. globalizado importante PER . (PER) configuraciones europeos casos ACC (ACC importan (PER

Resumen Marco contextual: El contexto de la enseñanza clínica y la experiencia de la pandemia de COVID-19 son factores potencialmente estresantes y/o ansiógenos para los estudiantes de enfermería. Objetivo: Evaluar la eficacia del programa “Aprender a Relajarse” para reducir el estrés y la ansiedad en estudiantes de enfermería. Metodología: Estudio longitudinal preexperimental con una muestra de siete estudiantes a los que se les hizo un seguimiento en la clínica de ansiedad. Diseño y aplicación del programa “Aprender a Relajarse”, basado en técnicas de respiración diafragmática y relajación muscular progresiva, con ocho sesiones a lo largo de cinco semanas. Evaluación inicial, final y de seguimiento mediante la Escala de Percepción del Estrés y el Cuestionario de Autoevaluación de la Ansiedad de Zung. Resultados: Reducción de los niveles de estrés entre la evaluación inicial y la final (p = 0,069) y disminución significativa entre la evaluación inicial y el follow-up (p = 0,033). Disminución significativa de la ansiedad entre la evaluación inicial y la final (p = 0,033) y entre la evaluación inicial y el follow-up (p = 0,006). Conclusión: Programa mostró un efecto positivo sobre la gestión del estrés, el autocontrol de la ansiedad y los síntomas asociados, lo que lo convierte en un recurso terapéutico útil para la intervención con estudiantes de enfermería.

Resumo Enquadramento: O contexto de ensino clínico e a vivência da pandemia COVID-19 são potencialmente stressores e/ou ansiogénicos em estudantes de enfermagem. Objetivo: Avaliar a eficácia do programa “Aprender a Relaxar” na redução do stresse e ansiedade em estudantes de enfermagem. Metodologia: Estudo pré-experimental, longitudinal, com amostra de sete estudantes seguidos na consulta de ansiedade. Concebido e implementado Programa “Aprender a Relaxar” baseado nas técnicas de respiração diafragmática e relaxamento muscular progressivo, com oito sessões, em cinco semanas. Avaliação inicial, final e follow-up utilizada Escala de Perceção de Stresse e Questionário de Autoavaliação de Ansiedade de Zung. Resultados: Redução dos níveis de stresse entre avaliação inicial e avaliação final (p = 0,069) e diminuição significativa entre avaliação inicial e follow-up (p = 0,033). Diminuição significativa da ansiedade entre avaliação inicial e avaliação final (p = 0,033) e entre avaliação inicial e follow-up (p = 0,006). Conclusão: Programa demonstrou efeito positivo na gestão do stresse, autocontrolo da ansiedade e sintomatologia associada, sendo um recurso terapêutico útil na intervenção com estudantes de enfermagem.

Abstract Background: Clinical placements and the COVID-19 pandemic are experiences that cause stress and anxiety in nursing students. Objective: To assess the effectiveness of the ‘‘Learning to Relax’’ (Aprender a relaxar) program in reducing stress and anxiety in nursing students. Methodology: A pre-experimental, longitudinal study was conducted with seven students who sought an anxiety consultation. The ‘‘Learning to Relax’’ program was designed based on diaphragmatic breathing and progressive muscle relaxation techniques and implemented in eight sessions during five weeks. The evaluation was conducted at baseline, endline, and follow-up using the Perceived Stress Scale and the Zung Self-Rating Anxiety Scale. Results: Stress levels were lower between baseline and endline (p = 0.069) and significantly lower between baseline and follow-up (p = 0.033). There was a significant decrease in anxiety between baseline and endline (p = 0.033) and between baseline and follow-up (p = 0.006). Conclusion: Program had a positive impact on managing stress, anxiety, and associated symptoms. It is therefore a therapeutic resource for interventions with nursing students.

ABSTRACT Introduction: Burnout results from chronic exposure to work-related stress and it is characterized by a reduction in professional efficacy, feelings of lack of energy/exhaustion, and negativity related to work activities. It has a higher incidence in professions with significant interpersonal contact and among caregivers, making doctors a vulnerable population. The Maslach Burnout Inventory questionnaire is considered the gold standard for measuring this disease. In 2014, quinquennial prevention was described, aiming to prevent harm to patients through strategies that reduce Burnout in doctors. Clinical Case: The case describes a 29-year-old woman, a physician in her final year of Residency in General and Family Medicine, who sought an urgent consultation due to feelings of physical and mental exhaustion, hopelessness, irritability, initial and middle insomnia, for the last three months, and hyperphagia, two months ago. She has requested a sick leave from work because “I can't stand working anymore. I need to sleep for a week”. She identified excessive workload at the Clinic, stemming from the demands of her medical residency, as the main cause. She feels unsupported by her colleagues and Training Supervisor and feels pressured to manage the medical agenda without adequate preparation. She reports occasional errors in prescriptions, leading her to feel the need to repeatedly review records and decisions she has made. She denies any appointment with her designated Work physician ever since she started her internship. Upon physical examination, she appeared slaughtered, with a depressed mood, tearful, restless, and with fleeting eye contact. Applying the Maslach Burnout Inventory: Section A- 34 points- high level; Section B- 28 points- high level; Section C- 25 points- high level. A work leave from work was issued, laboratory studies were requested, and fluoxetine 20 mg and trazodone 50 mg were initiated, along with psychotherapy. So far, the patient has been re-evaluated in three consultations, with organic causes ruled out, and in the last re-evaluation, her scores were: Section A- 20 points- moderate level; Section B- 5 points- low level; Section C- 39 points- moderate level. She reports a decrease in medical errors. She maintained the prescribed medication and psychotherapy. She declined to join a Balint group. A new re-evaluation was scheduled in six months. Discussion/Conclusion: This is a case of a General and Family Medicine Resident Physician, diagnosed with Burnout, who has managed to substantially improve her quality of life and job satisfaction, as well as her personal life, following the implementation of both pharmacological and non-pharmacological measures, along with workplace adjustments and the setting of boundaries. She has successfully reduced her perception of making medical errors, thereby improving the quality of healthcare provided to the patients. The long journey of recovery from Burnout makes the monitoring of this illness imperative not only by the patients Family Doctor and Psychologist, but also by the Occupational physician, targeting the improvement of the quality of life of the healthcare professionals in their occupational activity. This clinical case’s purpose is to address and raise awareness among professionals to the prevention of Burnout, particularly in Residents, promoting quinquennial prevention. It is important to note that only professionals who are fulfilled in their biopsychosocial sphere can provide quality care and significantly reduce medical errors.

RESUMO Introdução: O Burnout resulta da exposição crónica ao stress laboral e caracteriza-se por redução da eficácia a nível profissional, sentimentos de falta de energia/exaustão e negatividade relacionados com a atividade laboral. Tem maior incidência em profissões de elevado contacto com pessoas e em prestadores de cuidados, tornando os médicos uma população vulnerável. O questionário Maslach Burnout Inventory é considerado gold standard para a medição desta patologia. Em 2014 foi descrita a prevenção quinquenária, que pretende evitar o dano para o paciente, atuando no médico através de estratégias que visem a diminuição do Burnout. Caso Clínico: Descreve-se uma mulher de 29 anos, médica, no último ano da especialização em Medicina Geral e Familiar, que recorreu a consulta aberta por sensação de exaustão física e mental, sentimentos de desesperança, irritabilidade, insónia inicial e intermédia, com três meses de evolução e hiperfagia há dois meses. Solicitou certificado de incapacidade temporária para o trabalho, porque “já não aguento mais trabalhar. Preciso de dormir uma semana”. Aponta como principal etiologia o trabalho excessivo no Centro de Saúde, decorrente da exigência do internato médico. Sente-se pouco apoiada pelos colegas de equipa e orientador de formação e considera-se pressionada a gerir a agenda médica sem ter preparação para tal. Relata erros pontuais na prescrição médica, pelo que sente necessidade de rever várias vezes os registos efetuados e as atitudes tomadas. Nega ter sido convocada para qualquer consulta de Medicina do Trabalho desde que ingressou na especialidade. Ao exame objetivo, apresentava-se cabisbaixa, com humor deprimido, chorosa, inquieta e com contacto ocular fugaz. Aplicando o questionário atrás mencionado: Secção A - 34 pontos - nível elevado; Secção B - 28 pontos - nível elevado; Secção C - 25 pontos - nível elevado. Foi emitido o certificado de incapacidade temporária para o trabalho, solicitado estudo analítico e iniciada fluoxetina 20mg e trazodona 50mg, bem como psicoterapia. Até à data, a doente foi reavaliada em três consultas, foi excluída patologia orgânica e na última reavaliação apresentava os seguintes valores: Secção A- 20 pontos- nível moderado; Secção B- 5 pontos- nível baixo; Secção C- 39 pontos- nível moderado. Refere diminuição dos erros médicos. Manteve a medicação instituída, bem como a psicoterapia. Recusou o grupo Balint. Foi programada nova reavaliação em seis meses. Discussão/Conclusão: Trata-se de uma doente, Médica Interna em Medicina Geral e Familiar com o diagnóstico de Burnout, que conseguiu melhorar substancialmente a sua qualidade de vida e satisfação no trabalho e vida pessoal, após a implementação de medidas farmacológicas e não farmacológicas e também após alterações a nível laboral e imposição de limites. Conseguiu diminuir a perceção de erro médico, melhorando assim os cuidados de saúde prestados aos utentes. O longo percurso de recuperação desta doença torna fulcral o acompanhamento destes utentes pela equipa de Medicina do Trabalho, e não só pelo Médico de Família e Psicólogo, visando melhorar a qualidade de vida e saúde dos profissionais no âmbito da sua atividade laboral. Com este caso clínico pretende-se abordar e sensibilizar os profissionais para a prevenção do Burnout, em particular nos médicos internos, fomentando a prevenção quinquenária. De ressalvar que apenas profissionais realizados na sua esfera biopsicossocial conseguem proporcionar cuidados de qualidade e reduzir de forma importante o erro médico.

Resumo: Introdução: As estomias de eliminação são definidas como uma externalização de parte do sistema digestivo em razão de agravos inflamatórios, oncológicos ou congênitos, gerando um conjunto de implicações biopsicossociais Objetivo: Identificar algumas percepções e representações sociais construídas por pessoas com estomias de eliminação em torno da sua condição. Metodologia: Trata-se de um estudo descritivo e exploratório, de abordagem qualitativa, pautado na Teoria das Representações Sociais, realizado através de relatos de pacientes com estomias de eliminação em uma consulta ambulatorial de enfermagem em estomaterapia, processados por meio do software IRaMuTeQ. Resultados: infere-se uma série de interpretações que revelam os desafios e as consequências impostas por esses dispositivos, a exemplo as barreiras sociais, laborais e alimentares, que somam-se aos estigmas e sentimentos negativos associados à autoimagem e a autopercepção na consciência desses indivíduos, bem como as potencialidades observadas como a família, comunidade e a espiritualidade dos participantes, exigindo dos profissionais de saúde a compreensão. Considerações finais: O trabalho expressa representações construídas em torno de algumas percepções dos pacientes em torno do uso da estomia, podendo auxiliar na compreensão desse estado, embasando uma prática profissional mais empática e antenada aos aspectos psicológicos, sociais e espirituais

Resumen: Introducción: Las ostomías de eliminación se definen como una externalización de parte del sistema digestivo por efectos nocivos inflamatorios, oncológicos o congénitos, que generan un conjunto de implicaciones biopsicosociales. Objetivo: Identificar algunas percepciones y representaciones sociales construidas por personas con ostomías de eliminación en torno a su condición. Metodología: Se trata de un estudio descriptivo y exploratorio, con enfoque cualitativo, basado en la teoría de las representaciones sociales, realizado a través de relatos de pacientes con ostomía de eliminación en una consulta ambulatoria de enfermería en estomaterapia, procesados mediante el software IRaMuTeQ. Resultados: Se infieren una serie de interpretaciones que revelan los desafíos y consecuencias que imponen estos dispositivos, como barreras sociales, laborales y alimentarias, que se suman a los estigmas y sentimientos negativos asociados a la autoimagen y la autopercepción en la conciencia de estos individuos, así como las potencialidades observadas como familia, comunidad y espiritualidad de los participantes, que requieren comprensión por parte de los profesionales de la salud. Consideraciones finales: El trabajo expresa representaciones construidas en torno a las percepciones de algunos pacientes sobre el uso de la ostomía, que pueden ayudar a comprender ese estado, apoyando una práctica profesional más empática y sintonizada con los aspectos psicológicos, sociales y espirituales

Abstract: Introduction: Elimination ostomies are defined as an externalization of part of the digestive system due to harmful inflammatory, oncological or congenital effects, generating a set of biopsychosocial implications. Objective: To identify some perceptions and social representations constructed by people with elimination ostomies around their condition. Methodology: This is a descriptive and exploratory study, with a qualitative approach, based on the Theory of Social Representations, carried out through reports from patients with elimination stoma in an outpatient nursing consultation in stoma therapy, processed using the IRaMuTeQ software. Results: A series of interpretations are inferred that reveal the challenges and consequences imposed by these devices, such as social, work and food barriers, which add to the stigmas and negative feelings associated with self-image and self-perception in the consciousness of these individuals, as well as the potentialities observed such as the family, community and spirituality of the participants, requiring understanding from health professionals. Final Considerations: The work expresses representations built around some patients’ perceptions regarding the use of a stoma, which can help in understanding this state, supporting a more empathetic professional practice that is attuned to psychological, social and spiritual aspects

ABSTRACT The objective was to analyze the social determinants of health in Angola. This is a documentary, exploratory and quantitative research, carried out with data from the 2015-2016 Multiple Indicators and Health Survey in Angola. The analyzed variables were: access to drinking water sources; appropriate sanitary facilities; access to electricity; educational level; access to jobs; child mortality rate; prenatal consultations; and vaccination coverage. It was observed that 45.2% of households do not have access to adequate water sources for drinking; 52.9% use inappropriate sanitation facilities, mainly in rural areas; 31% of men aged 15 to 49 were unemployed; 42% of households had access to electricity; 22% of women and 8% of men aged 15 to 49 have never attended school; the estimated infant mortality rate was 44 deaths for every 1000 live births; 44.1% of pregnant women with lower socioeconomic status did not undergo any prenatal consultation; 18.3% of children aged 12 to 23 months and 21% aged 24 to 35 months did not receive any vaccine. It is concluded that there are large gaps in access to social determinants of health, highlighting the need for government efforts in partnership with international organizations to improve the population’s health conditions.

RESUMO Objetivou-se analisar os fatores determinantes sociais da saúde em Angola. Trata-se de uma pesquisa documental, exploratória e quantitativa, realizada com dados do Inquérito de Indicadores Múltiplos e de Saúde 2015-2016 de Angola. Foram analisadas as variáveis: acesso a fontes de água para beber; instalações sanitárias apropriadas; acesso à eletricidade; nível educacional; acesso a empregos; taxa de mortalidade infantil; consultas pré-natais; e cobertura vacinal. Observou-se que 45,2% dos agregados familiares não têm acesso a fontes de água apropriada para beber; 52,9% utiliza instalações sanitárias não apropriadas, principalmente nas áreas rurais; 31% dos homens de 15 a 49 anos estavam desempregados; 42% dos agregados familiares possuíam acesso à eletricidade; 22% das mulheres e 8% dos homens de 15 a 49 anos nunca frequentaram a escola; a estimativa da taxa de mortalidade infantil foi de 44 mortes para cada 1000 nascidos-vivos; 44,1% das gestantes com menor nível socioeconômico não realizaram nenhuma consulta pré-natal; 18,3% das crianças de 12 a 23 meses e 21% de 24 a 35 meses não receberam nenhuma vacina. Conclui-se que existem grandes lacunas no acesso a determinantes sociais da saúde, evidenciando a necessidade de esforços governamentais em parceria com organismos internacionais para melhorar as condições de saúde da população.

SUMMARY: The teaching of human anatomy plays a fundamental role for both students and health professionals; understanding the structure of the human body is essential for accurate diagnosis and effective treatment. In this context, this systematic review article focused on answering the following main question: What are the most effective methodological strategies for teaching human anatomy? To address this question, an exhaustive investigation was carried out involving the consultation of recognized databases such as Web of Science (Wos), PubMed and Scopus, covering the period from 2013 to 2023. It was concluded that effective teaching of human anatomy is achieved through various methodological strategies, including the use of information and communication technologies (ICTs), practice in dissection laboratories, active learning methods, teacher training factors, evaluation of student performance and promotion of collaborative learning.

RESUMEN: La enseñanza de la anatomía humana desempeña un papel fundamental tanto para estudiantes como para profesionales del ámbito de la salud; comprender la estructura del cuerpo humano resulta esencial para realizar diagnósticos precisos y llevar a cabo tratamientos efectivos. En este contexto, el presente artículo de revisión sistemática se enfocó en responder a la siguiente pregunta principal: ¿Cuáles son las estrategias metodológicas más efectivas para la enseñanza de la anatomía humana?. Para abordar esta cuestión, se llevó a cabo una exhaustiva investigación que incluyó la consulta de bases de datos reconocidas como Web of Science (Wos), PubMed y Scopus, abarcando el periodo comprendido entre 2013 y 2023. Se concluyó que la enseñanza efectiva de la anatomía humana se alcanza a través de diversas estrategias metodológicas, entre las que se incluyen el uso de tecnologías de la información y comunicación (TICs), la realización de prácticas en laboratorios de disección, métodos de aprendizaje activo, factores de formación docente, la evaluación del desempeño estudiantil y la promoción del aprendizaje colaborativo.

Abstract: The objective of this research is to determine how informed consent is used in dental practice in southern Peru in the year 2023. The methodological design adopts a descriptive level with a mixed approach that is divided into two stages: The first consisted of a qualitative theoretical-analytical-rational analysis, followed by a subsequent empirical analysis with a quantitative, descriptive and cross-sectional approach. The study was carried out in a population of dentists who practice the dental profession in southern Peru in the year 2023 with a non-probabilistic convenience sample of 131 dentists. The main results were that the use of informed consent (14.5%) states that they do not use it in their daily consultation and (59.5%) use it in an erroneous way, due to different factors that influence this procedure and that the non-use of informed consent in its highest percentage arguing “lack of time” on the part of dentists It was concluded that there is a high rate of dental professionals who do not use informed consent in their professional practice, even more so that there is a high percentage that does not use consent correctly reported as an ethical-legal document.

Resumen: El objetivo de la presente investigación es determinar cómo se utiliza el consentimiento informado en la práctica odontológica en el sur del Perú. El diseño metodológico adoptó un nivel descriptivo con enfoque mixto, que se dividió en dos etapas: la primera consistió en un análisis teórico analítico-racional cualitativo, seguido de un análisis empírico posterior con enfoque cuantitativo, descriptivo y transversal. El estudio fue realizado en una población de odontólogos que ejercía la profesión odontológica en el sur del Perú en 2023 con una muestra no probabilística por conveniencia de 131 odontólogos. Los principales resultados fueron que el 14,5% de los odontólogos manifiesta no utilizar el consentimiento informado en su consulta diaria y un (59,5%) lo utiliza de forma errónea, debido a distintos factores que influyen en este proceder, en su mayor porcentaje argumentando “falta de tiempo”. Se concluyó que existe un alto índice de profesionales odontológicos que no utiliza el consentimiento informado en su práctica profesional, más aun existiendo un alto porcentaje que no utiliza el consentimiento informado correctamente como un documento ético-legal.

Resumo: O objetivo da presente investigação é determinar como se utiliza o consentimento informado na prática odontológica no sul do Peru. O desenho metodológico adotou um nível descritivo com enfoque misto que se dividiu em duas etapas: a primeira consistiu em uma análise teórica analítico-racional qualitativa, seguida de uma análise empírica posterior com enfoque quantitativo, descritivo e transversal. O estudo foi realizado em uma população de odontólogos que exerciam a profissão odontológica no sul do Peru em 2023 com uma amostra não probabilística de conveniência de 131 odontólogos. Os principais resultados foram que 14,5% dos odontólogos declaram não utilizar o consentimento informado em seu trabalho diário e 59,5% o utiliza de forma errônea, devido a diferentes fatores que influenciam esse procedimento, em sua maioria argumentando “falta de tempo”. Concluiu-se que existe um alto índice de profissionais odontológicos que não utilizam o consentimento informado em sua prática profissional, e ainda uma alta porcentagem que não utiliza o consentimento informado corretamente como um documento ético-legal.

Resumen El trabajo se apoya en las pruebas individuales del monitoreo ambulatorio de la presión arterial realizado a 5,089 cubanos adultos de ambos sexos, atendidos en la consulta de hipertensión arterial del Hospital Provincial Universitario Cardiocentro Ernesto “Che” Guevara de Villa Clara, entre los años 2012 y 2016, con el fin de estimar experimentalmente sus vulnerabilidades individuales y el peligro asociado a las condiciones meteorológicas influyentes durante las pruebas, para estimar el riesgo meteoro-trópico individual aplicando la metodología para el cálculo del riesgo de desastres, utilizada en los estudios cubanos de peligro, vulnerabilidad y riesgo. Las vulnerabilidades individuales se evaluaron mediante la relación entre los factores de riesgo no modificables de cada paciente y la ocurrencia de anomalías durante el monitoreo ambulatorio. De igual forma, la ocurrencia de estas anomalías se comparó con el comportamiento del estado del tiempo existente durante las pruebas, para definir el llamado “factor de impacto biotrópico” como índice del peligro asociado a cada elemento meteorológico. El estimado del riesgo meteoro-trópico individual se obtuvo como resultado del producto de las vulnerabilidades por los peligros individuales, siendo el riesgo promedio en los hombres un 15 % mayor que en las mujeres de la muestra y con máximos individuales muy altos en algunos individuos de ambos sexos. Los resultados son relevantes para la aplicación práctica de los pronósticos biometeorológicos en el sistema de salud pública del país.

Abstract The work is based on individual tests of ambulatory blood pressure monitoring carried out on 5,089 Cuban adults of both sexes, treated in the arterial hypertension consultation of the Provincial University Hospital Cardiocenter Ernesto “Che” Guevara of Villa Clara, between 2012 and 2016, in order to experimentally estimate their individual vulnerabilities and the danger associated with the meteorological conditions present during the tests. The estimation of the individual meteor-tropic risk was done applying the methodology for calculating disaster risk, used in Cuban studies of danger, vulnerability and risk. Individual vulnerabilities were assessed by the relationship between each patient's non-modifiable risk factors and the occurrence of anomalies during the ambulatory monitoring. Likewise, the occurrence of these anomalies was compared with the behavior of the existing weather conditions during the tests, to define the so-called “biotropic impact factor” as an index of the danger associated with each meteorological element. The evaluation of the individual meteor-tropic risk was reached, as a result of the product of the vulnerabilities and the individual hazards, being the average risk in men 15% higher than in the women of the sample and with very high individual maximums in some individuals of both sexes. The results are relevant for the practical application of biometeorological forecasts in the country's public health system.

Abstract Introduction. The COVID-19 infection drastically affected health care worldwide, creating challenges for primary care. In order to mitigate and manage infection, telemedicine has become an emerging and effective modality in several medical specialties, including head and neck surgery. Methods. Retrospective cross-sectional analysis of patients seen in virtual consultation over 18 months. Absolute and relative frequencies were estimated, univariate analysis was done with chi-square, and bivariate analysis with binary logistic regression. Variables such as primary diagnosis, the resolution power of the consultation, the need for an in-person appointment, the platform, and its difficulties were included. Results. 2485 patients from 11 departments were included. Thyroid pathology was the most frequent (62.9%), followed by aerodigestive tract pathology (10.8%). The consultation was efficient in 99% of cases, with a resolution capacity of 96.4%. 1.4% had difficulties on the platform and 8.3% of patients required an in-person. When there was difficulty in reviewing exams or an inadequate functional inspection, it was 30 times more likely to not be able to efficiently be resolved. Conclusion. Telemedicine provides an efficient alternative for care in head and neck surgery, especially in thyroid pathology controls, avoiding unnecessary travel. In the aerodigestive tract, where the physical examination is essential, its usefulness is limited to the possibility of performing a subsequent endoscopic examination that allows adequate staging and facilitates in-person assessment.

Resumen Introducción. La infección por COVID-19 afectó drásticamente la atención en salud a nivel mundial, generando retos para la atención primaria. En orden de mitigar y manejar el contagio, la telemedicina se convirtió en una modalidad emergente y efectiva en varias especialidades médicas, incluida la cirugía de cabeza y cuello. Métodos. Estudio de corte transversal con análisis retrospectivo de pacientes atendidos en la consulta virtual durante 18 meses. Se estimaron frecuencias absolutas y relativas, y bivariado con regresión logística binaria. Se incluyeron las variables de diagnóstico primario, poder resolutivo de la consulta, necesidad de cita presencial, plataforma y dificultades de la misma. Resultados. Se incluyeron 2485 pacientes provenientes de 11 departamentos. La patología tiroidea fue la más frecuente (62,9 %), seguida de la aerodigestiva (10,9 %). La consulta fue eficiente en el 99 % de los casos, con una capacidad resolutiva del 96,4 %. El 1,4 % tuvo dificultades en la plataforma y el 8,3 % de los pacientes requirió cita presencial. Cuando hubo dificultad para la revisión de exámenes o una inadecuada inspección funcional, fue 30 veces más probable no poder resolver eficientemente la consulta. Conclusión. La telemedicina provee una alternativa eficiente de atención en cirugía de cabeza y cuello, especialmente en los controles de patología tiroidea, evitando desplazamientos innecesarios. En el tracto aerodigestivo, donde el examen físico es primordial, su utilidad está limitada a la posibilidad de realizar un examen endoscópico posterior que permita una adecuada estadificación y facilite la valoración presencial.

Heelwat navorsing is al gedoen in 'n poging om 'n greep op aspekte van goeie en slegte plaaslike regering te kry. 'n Kernvraag wat steeds onbeantwoord bly is die volgende: Wat is "plaaslike regering", en hoe kan die werklikheid waarna die begrip verwys, verstaan en herken word? 'n Begripsraamwerk van "plaaslike regering" is onlangs ontwikkel bestaande uit die herkenbare eienskappe van die begrip om dit te identifiseer. Gepaardgaande daarmee is 'n sosiale ontologie van sorg vir "plaaslike regering" ontwikkel. Die veronderstelling is dat plaaslike regerings in Suid-Afrika en ander lande aan die hand van daardie eienskappe herken sal word. Binne die Suid-Afrikaanse konteks is daar egter 'n moontlike nietipiese voorbeeld van plaaslike regering, naamlik Orania, 'n bestaande dorp binne die geografiese gebied van die Thembelihle Plaaslike Munisipaliteit in die Noord-Kaapprovinsie. Orania is nie 'n muni-sipaliteit ingevolge die Suid-Afrikaanse grondwet en wetlike raamwerk nie. Die vraag is gevolglik of Orania wel as 'n "plaaslike regering" beskou kan word. In antwoord op die vraag gee hierdie artikel 'n ontiese¹ beskrywing van Orania aan die hand van die gekose begripsraamwerk en sosiale ontologie van sorg. Dit blyk uit die beskrywing en ontleding daarvan dat Orania wel aan die institusionele, funksionele en territoriale eienskappe van die begrip "plaaslike regering" voldoen en op 'n outentieke wyse as plaaslike regering funksioneer. Die gevallestudie wys dat 'n outentieke plaaslike regering een is wat 'n integrerende deel uitmaak van sy plaaslike gemeenskap en omsluitende wêrelde, wat voortdurende ongemak met die hede beleef en met sorg, besorgdheid en sorgsaamheid daarop reageer.

Much research has been conducted to grasp aspects of good and bad local governance. A central question that remains unanswered is: What constitutes "local government" and how can the reality to which this concept refers be understood and recognised? Recently, a conceptual framework was developed by identifying recognisable characteristics of this concept's reference. The assumption is that local governments in South Africa and other countries will be recognised based on these characteristics. Alongside this, a social ontology of care for "local government" was established. However, within the South African context, a potentially atypical example of local government is found, namely Orania, an existing town situated within the geographical area of the Thembelihle Local Municipality in the Northern Cape province. Orania is not a municipality in terms of the South African constitution and legal framework. The question thus arises whether Orania can indeed be considered a "local government". In response to this query, this article provides a description of Orania using the chosen conceptual framework and social ontology of care as part of a case study design. The analysis and ontological description ofOrania, by means of the conceptual framework, reveal that the phenomenon of Orania does indeed possess a territorial jurisdictional sphere (the Orania Overlay Zone), a democratically elected representative council (the OVR), and a Town Council and its administration that performs a range of local functions and responsibilities. While the territory of a municipality is generally determined by authorising measures or decisions by other jurisdictions (such as province, state, and national government), the territorial area known as the Orania Overlay Zone results from the purchase and cultivation of land by members of a homogeneous cultural community. Therefore, the territory is not only a demarcation of jurisdiction, but the place to which this community is connected. The institutional aspect of local government is likely a universal feature. The nature and scope of the institutional structure of local governments are often also the result of standardised external authorising measures or decisions by other jurisdictions. Consequently, the structures may not necessarily resonate with the needs and resources of the sometimes diverse society that constitutes the inhabitants of such an area. In the case of Orania, the institutional structure of local government (the OVR and the Town Council) is directly determined by the community, as represented by various land entities, based on the community's specific needs and available resources. The performance of a limited range of local functions can also be considered a universal feature of local government. In this particular case, the functions of the relevant local government are determined by its decision-making bodies, such as the Town Council, in consultation with the community as represented by the various land entities. Consequently, typical local government functions are performed according to the community's needs and available resources. Non-typical local government functions, such as residence rights, are performed within the general scope of the 1996 Constitution of the Republic of South Africa and other national legislation. The analysis confirmed that Orania meets the characteristics consistent with the concept of "local government" as outlined in the conceptual framework. Additionally, viewing Orania through the theoretical lens of social ontology of care highlights that it is a human construct, making objective observation and description challenging. Orania is a network of interconnected individuals and social institutions situated within overlapping human, spiritual, natural, territorial, and political worlds. The authenticity of this existence lies in its concern for the affairs of the world in which it is situated and the conscientiousness with which it carries out its functions in conjunction with others. The case study shows that an authentic local government is one that forms an integral part of its local community and surrounding worlds, continually experiencing discomfort (anxiety) with the present, and responding to that anxiety with care, concern, and nurturing for society and its things.

INTRODUCTION: The COVID-19 pandemic significantly impacted dental education and resulted in unprecedented curricular changes. While virtual teaching enabled theoretical content delivery, practical training was temporarily postponed. Upon resumption, innovative approaches were required to safeguard students, staff and patients. AIMS AND OBJECTIVES: This study aimed to provide a comprehensive overview of COVID-19's impact on dental education at a South African institution. The objectives were to explore the resultant changes, staff and students' experiences in adapting to the implemented changes, the opportunities for innovation and growth that emerged in response to the pandemic, and the potential long-term implications of these changes for dental education. METHODS: A qualitative study was conducted. The 2021 and 2022 final year Dental Therapy students were invited to participate in separate, virtual focus group discussions. In 2022, all 12 academic staff members were invited to participate in individual interviews. Among others, participants responded to structured questions regarding pandemic-related changes and how they adapted. Data were audio-recorded with consent, transcribed verbatim and thematically analysed. RESULTS: Study participants included eight staff members and two groups of six students. Four pandemic-related themes were identified, namely the sudden shift to online learning and virtual communication, safety protocols, students' wellbeing and long-term implications. Among other findings, home-based learning posed opportunities and challenges for students. Furthermore, the 2021 cohort reported concerns regarding limited clinical training. CONCLUSION: The knowledge acquired by institutions during the pandemic must serve as a foundation for future curricular disruptions. This may be achieved through consultation between institutions and dissemination of information.

Foi realizada uma análise métrica da revista Gaceta Médica de México (GMM) com base nos indicadores bibliométricos oferecidos pelos sistemas de indexação que cobrem a publicação histórica da revista. A principal fonte de consulta é o índice Scopus, por conter a mais ampla cobertura retrospetiva, a partir de 1945. Essa fonte foi complementada por indicadores obtidos no Scimago (que se baseia em informações bibliográficas da Scopus), Journal Citation Reports (JCR) da Web of Science, Periódica-Biblat, SciELO e Google Scholar Metrics. Os aspectos avaliados são a produção documental da revista, cuja consistência pode ser aferida através da linha do tempo, bem como a representação autoral e institucional dos seus conteúdos, através da qual se pode quantificar o alcance nacional e internacional da publicação enquanto canal de comunicação científica. Por outro lado, a análise de citações e os indicadores baseados em citações avaliam o impacto da publicação como fonte de referência para outros estudos. A conclusão mais geral é que a GMM passou por diferentes fases de crescimento e contração ao longo da sua longa história como a revista mais antiga do nosso país. Os anos mais recentes contrastam com o século e meio que os precedeu, manifestando uma tendência que a coloca num novo patamar de valores e que pode prenunciar uma nova era para a publicação.

A metric analysis of the journal Gaceta Médica de México (GMM) was carried out based on the bibliometric indicators offered by the indexing systems that cover the journal's historical publication. The main source of consultation is the Scopus index, as it contains the broadest retrospective coverage, starting in 1945. This source was complemented by indicators obtained from Scimago (which is based on bibliographic information from Scopus), Journal Citation Reports (JCR) of Web of Science, Periódica-Biblat, SciELO and Google Scholar Metrics. The aspects evaluated are the journal's documentary production, whose consistency can be assessed through the timeline, as well as the authorial and institutional representation of its contents, through which the national and international scope of the publication as a channel of scientific communication can be quantified. On the other hand, citation analysis and citation-based indicators assess the impact of the publication as a source of reference for other studies. The most general conclusion is that GMM went through different fluctuating phases of growth and contraction throughout its long history as the oldest journal in our country. The most recent years contrast with the century and a half that preceded it by manifesting a trend that places it in a new range of values and may foreshadow a new era for the publication.

Se realizó un análisis métrico de la revista Gaceta Médica de México (GMM) basado en los indicadores bibliométricos ofrecidos por los sistemas de indización que cubren la publicación histórica de la revista. La fuente principal de consulta es el índice Scopus, por contener la cobertura retrospectiva más amplia, a partir de 1945. Esta fuente fue complementada por indicadores obtenidos por Scimago (el cual se basa en la información bibliográfica de Scopus), Journal Citation Reports (JCR) de Web of Science, Periódica-Biblat, SciELO y Google Scholar Metrics. Los aspectos evaluados son la producción documental de revista, de la cual puede valorarse su consistencia a través de la línea de tiempo, así como la representación autoral e institucional de sus contenidos, a través de la cual se cuantifica el alcance nacional e internacional de la publicación como canal de comunicación científico. Por otra parte, el análisis de citas y los indicadores basados en la citación, evalúan el impacto de la publicación como fuente de consulta para otros estudios. La conclusión más general es que GMM atravesó por diferentes fases fluctuantes de crecimiento y contracción, a través de su largo historial como la revista más antigua de nuestro país. Los años más recientes contrastan con el siglo y medio que la antecede al manifestar una tendencia que la coloca en nuevo rango de valores y que puede prefigurar una nueva época para la publicación.

Abstract This article critically analyses the indigenous consultation process in Chile implemented after the ratification of ILO Convention 169 in 2008. Through the analysis of two cases and using an autoethnographic and documentary approach, it discusses how these processes, designed to guarantee the active participation of indigenous communities in decision-making that affects them, operate more as mechanisms for legitimising state policies and business projects, especially in extractive and environmental contexts. This research exposes the challenges and limitations of these processes in Chile, arguing that they fail to adequately comply with international standards of free, prior and informed consent, nor do they respect indigenous ontologies and cultural practices. The article concludes with the urgent need for legislative reforms to strengthen the representation and rights of indigenous communities within the Chilean governmental framework.

Resumen El presente artículo analiza críticamente el proceso de consulta indígena en Chile implementado tras la ratificación del Convenio 169 de la OIT en el año 2008. A través del análisis de dos casos y con un enfoque autoetnográfico y documental, se discute cómo estos procesos, diseñados para garantizar la participación activa de las comunidades indígenas en la toma de decisiones que les afectan, operan más como mecanismos de legitimación de políticas estatales y proyectos empresariales, especialmente en contextos extractivos y ambientales. Esta investigación, expone los desafíos y limitaciones de estos procesos en Chile, argumentando que no logran cumplir adecuadamente con los estándares internacionales de consentimiento libre, previo e informado, ni respetan las ontologías y prácticas culturales indígenas. El artículo concluye con la necesidad urgente de reformas legislativas que fortalezcan la representación y derechos de las comunidades indígenas dentro del marco gubernamental chileno.

Abstract The article analyses the use of anthropological assessments in environmental licensing processes. On one hand, it supports the existence of a right to anthropological assessment. On the other hand, it argues that anthropological assessments in environmental matters contribute to judicial decision-making, since they are instruments which could reveal the constitutive elements of the indigenous peoples’ cultural identities. In particular, these assessments have a role in determining whether indigenous communities are affected or susceptible to be culturally affected, as a prerequisite to proceed to the indigenous consultation. With this purpose, the paper examines: the theoretical and disciplinary antecedents of anthropological assessments; their normative sources, in particular the human right to a cultural identity and to a healthy environment; and the relevant national environmental regulation. It also presents a set of Chilean judicial decisions on environmental matters which considered anthropological findings, systematizing their diverse approaches. Methodologically, we used bibliographic review, dogmatic and hermeneutic legal methods, and the deductive method for the review of jurisprudence.

Resumen: Se analiza el peritaje antropológico en los procesos de evaluación ambiental. Se postula, por una parte, la existencia de un derecho al peritaje antropológico, justificado en el derecho humano a la identidad cultural y el derecho humano al medio ambiente sano. Y, por otra, que la pericia antropológica en materia ambiental contribuye al razonamiento judicial, como un instrumento capaz de develar los elementos constitutivos de la identidad cultural de los pueblos indígenas y sus comunidades, bienes jurídicos protegidos en los procesos administrativos y judiciales de alcance ambiental. En especial, que esta pericia permite determinar su afectación o susceptibilidad de afectación como presupuesto de procedencia de la consulta indígena. Se estudian los antecedentes teóricos y disciplinares del peritaje antropológico; se examinan sus fuentes normativas, en particular los derechos humanos a la identidad cultural y al medio ambiente sano, más la legislación ambiental pertinente; y se revisa un conjunto de decisiones judiciales chilenas de competencia ambiental que consideraron peritajes antropológicos, sistematizando sus diversos abordajes. Metodológicamente, se recurre a revisión bibliográfica, a los métodos jurídicos dogmático y hermenéutico y al método deductivo para la revisión de jurisprudencia.

RESUMEN Introducción: el riesgo de aparición del infarto agudo de miocardio está relacionada con varias comorbilidades, muchas de las cuales son prevenibles y tratables. El infarto agudo de miocardio tiene un impacto relevante en términos de mortalidad y número de hospitalizaciones. Objetivos: determinar las características clínica-epidemiológicas del infarto agudo de miocardio con elevación del segmento ST en pacientes atendidos en el Centro Médico Nacional-Hospital Nacional, durante el periodo 2021-2023. Metodología: el diseño del estudio fue observacional, descriptivo de corte transversal, sobre las características clínica-epidemiológicas del infarto agudo de miocardio con elevación del segmento ST en pacientes mayores de edad atendidos en el Centro Médico Nacional-Hospital Nacional, durante el periodo 2021-2023. Resultados: se analizaron 102 expedientes de pacientes con diagnóstico de infarto agudo de miocardio con elevación del segmento ST con una media de 64 ± 12 años; el 68 % (n = 69) correspondió al sexo masculino, con una edad promedio de 62 años, y en relación a las mujeres el promedio fue de 64 años. El motivo de consulta principal fue el dolor precordial y la cara miocárdica más afectada de acuerdo con el electrocardiograma inicial fue la cara anteroseptal. La mortalidad intrahospitalaria fue del 16 %, el 68 % correspondió a varones. La comorbilidad más frecuente fue la hipertensión arterial. Conclusión: La hipertensión arterial es la patología más prevalente. Asimismo, son habituales la obesidad, el tabaquismo y la diabetes mellitus. Las comorbilidades están en relación directa con la edad y prevalecen en mayores de 60 años. El infarto agudo de miocardio con elevación del segmento ST es más frecuente en el sexo masculino.

ABSTRACT Introduction: the risk of acute myocardial infarction is related to several comorbidities, many of which are preventable and treatable. Acute myocardial infarction has a relevant impact in terms of mortality and number of hospitalizations. Objectives: the design of the study was observational, descriptive, cross-sectional, on the clinical characteristics of ST-segment elevation myocardial infarction, in adult patients treated at the Centro Médico Nacional-Hospital Nacional, during the period 2021-2023. Methodology: the design of the study was observational, descriptive, cross-sectional, on the clinical-epidemiological characteristics of acute myocardial infarction with ST segment elevation in adult patients treated at the National Medical Center-National Hospital, during the period 2021-2023. Results: 102 records of patients with a diagnosis of ST-segment elevation myocardial infarction with a mean age of 64 ± 12 years were analyzed; 68 % (n = 69) were male, with an average age of 62 years, and in relation to women the average was 64 years. The main reason for consultation was precordial pain and the most affected myocardial aspect according to the initial electrocardiogram was the anteroseptal aspect. In-hospital mortality was 16 %, 68 % of which were men. The most frequent comorbidity was arterial hypertension. Conclusion: high blood pressure is the most prevalent pathology. Likewise, obesity, smoking and diabetes mellitus are common. Comorbidities are directly related to age and prevail in those over 60 years of age. ST-segment elevation myocardial infarction is more common in males.