With the increase in life expectancy and the significant incidence of lesions of the musculoskeletal system, both the public and private sectors seek improvements in their products and processes in order to contribute to the health of the population. Every year tons of chicken eggshell (CES) from domestic consumption are released in environment and the present work aims the production of a synthetic ceramic bone substitute using the eggshell as a source of calcium ions. According to the methodology, 5, 10, 15 and 20 mol% of iron ions were used and the characterization assays demonstrated the formation of a double calcium iron phosphate - Ca9Fe(PO4)7. MG63 cells were cultured on test specimens to cell viability assay and to each doped group analyzed, verifying cell compatibility with the studied compounds, as well as a good adhesion profile. Scanning electron microscopy (SEM) of the cells showed that material surface favored cell adhesion and the results demonstrated that the production of the compounds were viable to Ca9Fe(PO4)7 phase. So, in the future, it will be possible to have a final comprehensive biological compatibility of the prototype for further in vitro and in vivo assays. system population CES (CES methodology 5 10 1 2 mol Ca9FePO47. Ca9FePO47 CaFePO Ca9Fe PO4 7. 7 Ca Fe PO MG MG6 analyzed profile SEM (SEM Ca9Fe(PO4) phase So future FePO Ca9FePO4 CaFe Ca9Fe(PO4 Ca9FePO Ca9Fe(PO

RESUMO Objetivo: Comparar a presença de anticorpos neutralizantes contra o SARS-CoV-2 no leite materno e no sangue das lactantes vacinadas em relação àquelas não vacinadas. Fontes de dados: Foi efetuado registro no International Prospective Register of Systematic Reviews — PROSPERO (CRD42021287554) e foram seguidas as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Foram elegíveis estudos de coorte, caso-controle e transversais que avaliaram anticorpos contra o SARS-CoV-2 no leite e no sangue de lactantes vacinadas e tiveram como grupo controle lactantes não vacinadas. Utilizaram-se os Descritores em Ciências da Saúde (DeCs), Medical Subject Heading (MeSH) e Emtree para as bases Biblioteca Virtual em Saúde (BVS), Medical Literature Analysis and Retrieval System Online (Medline/PubMed) e Embase, respectivamente. Na Web of Science e Scopus foi feita adaptação da estratégia. Não foram estabelecid as restrições quanto ao período de publicação e idioma. Síntese dos dados: As buscas identificaram 233 registros. Foram excluídos 128 duplicados e 101 fora dos critérios de inclusão, e quatro estudos de coorte foram elegíveis. As lactantes vacinadas com Pfizer-BioNTech e Moderna apresentaram anticorpos contra SARS-CoV-2 no sangue e no leite materno. Conclusões: As mulheres lactantes vacinadas apresentaram níveis mais elevados de imunoglobulina G (IgG) e A (IgA) no soro e no leite materno em comparação com as mulheres não vacinadas. Objetivo SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- dados CRD42021287554 CRD (CRD42021287554 MetaAnalysis Meta PRISMA. PRISMA . (PRISMA) casocontrole caso Utilizaramse Utilizaram se DeCs, DeCs , (DeCs) MeSH (MeSH BVS, BVS (BVS) Medline/PubMed MedlinePubMed Medline PubMed (Medline/PubMed Embase respectivamente estratégia idioma 23 registros 12 10 inclusão PfizerBioNTech Pfizer BioNTech Conclusões IgG (IgG IgA (IgA SARS-CoV CRD4202128755 (CRD4202128755 (PRISMA (DeCs (BVS 1 CRD420212875 (CRD420212875 CRD42021287 (CRD42021287 CRD4202128 (CRD4202128 CRD420212 (CRD420212 CRD42021 (CRD42021 CRD4202 (CRD4202 CRD420 (CRD420 CRD42 (CRD42 CRD4 (CRD4 (CRD

ABSTRACT Objective: To compare the presence of neutralizing antibodies against SARS-CoV-2 found in the breast milk and blood of vaccinated lactating women with those not vaccinated. Data source: The study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under CRD42021287554 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cohort, case-control, and cross-sectional studies that evaluated antibodies against SARS-CoV-2 in the milk and blood of vaccinated mothers and had as control group unvaccinated mothers were eligible. Health Sciences Descriptors (DeCs), Medical Subject Headings (MeSH) and Emtree descriptors were used for the Virtual Health Library (VHL), Medical Literature Analysis and Retrieval System Online (Medline/Pubmed), and Embase databases, respectively. In the Web of Science and Scopus, the strategy was adapted. No restrictions on the publication period and language were set. Data synthesis: The search identified 233 records, of which 128 duplicates and 101 papers that did not meet the inclusion criteria were excluded. Hence, four cohort studies were eligible. Nursing mothers vaccinated with the Pfizer-BioNTech and Moderna vaccines showed antibodies against SARS-CoV-2 in their blood and breast milk. Conclusions: Vaccinated lactating women had higher levels of immunoglobulin G (IgG) and A (IgA) in serum and breast milk than unvaccinated women. Objective SARSCoV2 SARSCoV SARS CoV 2 SARS-CoV- source PROSPERO (PROSPERO CRD CRD4202128755 MetaAnalyses Meta Analyses PRISMA (PRISMA guidelines Cohort casecontrol, casecontrol case control, case-control crosssectional cross sectional eligible DeCs, DeCs , (DeCs) MeSH (MeSH VHL, VHL (VHL) Medline/Pubmed, MedlinePubmed Medline/Pubmed Medline Pubmed (Medline/Pubmed) databases respectively Scopus adapted set synthesis 23 records 12 10 excluded Hence PfizerBioNTech Pfizer BioNTech Conclusions IgG (IgG IgA (IgA SARS-CoV CRD420212875 (DeCs (VHL (Medline/Pubmed 1 CRD42021287 CRD4202128 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

ABSTRACT Purpose: To develop a simple, subjective, and reliable grading scale for isotretinoin-induced meibography changes. Methods: After analyzing meibography images obtained from systemic isotretinoin users, a grading scale was proposed and named “meibography health score.” The score ranged from 1 to 3, with decreasing gland reflectivity and identifiable margins. A total of 11 medical professionals were asked to grade 10 meibography images obtained from isotretinoin users using the proposed scale and were divided into three groups: (A) ophthalmologists with experience with meibography, (B) ophthalmologists with no experience with meibography, and (C) radiologists. The kappa statistic was determined to test interrater reliability. Results: The overall kappa was approximately 0.64. The kappa scores for Groups A, B, and C were 0.78, 0.59, and 0.90, respectively. Grade 2 had the lowest kappa scores (0.62, 0.35, and 0.82 for A, B, and C, respectively) and grade 3 the highest (0.78, 0.90, and 1.0 for A, B and C, respectively). Furthermore, Group C had the highest kappa scores and Group B the lowest. Conclusion: The meibography health score exhibited good interrater reliability, particularly in severe cases. Purpose simple subjective isotretinoininduced induced changes Methods score. margins groups (A (B (C radiologists reliability Results 064 0 64 0.64 078 78 0.78 059 59 0.59 090 90 0.90 respectively 0.62, 062 62 (0.62 035 35 0.35 082 82 0.8 (0.78 1. . Furthermore Conclusion cases 06 6 0.6 07 7 0.7 05 5 0.5 09 9 0.9 0.62 (0.6 03 0.3 08 8 0. (0.7 (0. (0 (

ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0–19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1–14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services. Purpose Brazil Methods Câncer 200 2018 019 0 19 0–1 years selected demographic diagnostic therapeutic described <20, 20 (<20 2075, 2075 75, 75 20-75 >7 cases. . Results 2269 2 269 2,26 8 institutions 48 Southeast 54 male 66 4 < NA (NA 84 system 40 history 88 involvement 583 58 3 58.3 NA=2, NA2 NA=2 , (NA=2) 366 36 6 36.6 remission 108 10 10.8 127 12 7 12.7 NA=59%. NA59 NA=59% 59 (NA=59%) 90 >90 ( days IQR [IQR 1–14 114 1 14 343 (34 212539 212 539 212-539 highvolume volume (>7 medium lowvolume low Conclusions factors Additionally centers outcomes inequalities services 201 01 0– <20 (<2 207 20-7 > 226 26 2,2 5 58. NA= (NA=2 36. 10. 12. NA5 NA=59 (NA=59% 9 >9 1–1 11 34 (3 21253 21 53 212-53 (> <2 (< 20- 22 2, (NA= NA=5 (NA=59 1– 2125 212-5 (NA=5 212-

ABSTRACT Objective: To evaluate the predictive validity and cut-off point of heart rate and blood pressure on heart rate variability (HRV) changes in children with and without obesity. Methods: This study included 125 children, of whom 41 were normal weight and 84 were obese. Anthropometry, blood pressure, heart rate, and HRV were measured using an electronic scale and stadiometer, a sphygmomanometer, and HRV monitor. In addition, the receiver operating characteristic (ROC) curve was obtained by statistical analysis of the data. Results: Heart rate proved to be a good predictor for changes in the square root of the mean of the square of the differences between consecutive NN intervals (RMSSD) parameter in students of both sexes for the normal-weight group (ROC 0.89; 95%CI 0.77–1.00) and obesity (ROC 0.90; 95%CI 0.83–0.97). In addition, the heart rate cut-off point for alterations in the RMSSD parameter for normal-weight boys was 93 bpm (sensitivity 100.00% and specificity 87.50%) and for boys with obesity, the established cut-off point was 91 bpm (sensitivity 94.74% and specificity 63.64%). Heart rate also proved to be a good predictor considering low-frequency/high-frequency ratio (LF/HF) and standard deviation of long-term continuous NN intervals /standard deviation of the instantaneous variability of continuous NN intervals in the Poincaré graph ratio (SD2/SD1). Systolic and diastolic blood pressures were good predictors in more specific stratifications and, therefore, can be used in some cases. Conclusions: The predictive validity of heart rate was shown to be at a good level, with high sensitivity and acceptable specificity for the cut-off points according to the different analyses stratified by gender and nutritional status. In this sense, health professionals will be able to use heart rate to estimate cardiovascular risk in children of different sexes and nutritional status. Objective cutoff cut off (HRV Methods 12 4 8 obese Anthropometry stadiometer sphygmomanometer monitor addition ROC data Results (RMSSD normalweight 0.89 089 0 89 95CI CI 95 0.77–1.00 077100 77 1 00 0.90 090 90 0.83–0.97. 083097 0.83–0.97 . 83 97 0.83–0.97) 9 10000 100 100.00 87.50% 8750 87 50 9474 94 74 94.74 63.64%. 6364 63.64% 63 64 63.64%) lowfrequency/highfrequency lowfrequencyhighfrequency low frequency/high frequency LF/HF LFHF LF HF (LF/HF longterm long term SD2/SD1. SD2SD1 SDSD SD2/SD1 SD2 SD1 SD (SD2/SD1) therefore cases Conclusions level status sense 0.8 08 0.77–1.0 07710 7 0.9 09 08309 0.83–0.9 1000 10 100.0 87.50 875 5 947 94.7 636 63.64 6 lowfrequency highfrequency frequencyhigh SD2SD SD2/SD (SD2/SD1 0. 0.77–1. 0771 0830 0.83–0. 100. 87.5 94. 63.6 (SD2/SD 0.77–1 077 083 0.83–0 87. 63. 0.77– 07 0.83– 0.77 0.83 0.7

RESUMO Objetivo: Avaliar a validade preditiva e o ponto de corte da frequência cardíaca e da pressão arterial nas alterações da variabilidade da frequência cardíaca (VFC) em crianças com e sem obesidade. Métodos: Foram incluídas 125 crianças neste estudo, sendo 41 com peso normal e 84 com obesidade. Antropometria, pressão arterial, frequência cardíaca e VFC foram medidas por meio de balança eletrônica e estadiômetro, esfigmomanômetro e monitor de VFC. Além disso, a curva característica de operação do receptor (ROC) foi obtida pela análise estatística dos dados. Resultados: A frequência cardíaca mostrou-se um bom preditor de alterações no parâmetro de raiz quadrada da média do quadrado das diferenças entre os intervalos NN consecutivos (RMSSD) em escolares de ambos os sexos para o grupo de peso normal (ROC 0,89; IC95% 0,77–1,00) e obesidade (ROC 0,90; IC95% 0,83–0,97). Além disso, o ponto de corte da frequência cardíaca para alterações no parâmetro RMSSD para meninos com peso normal foi de 93 bpm (sensibilidade 100,00% e especificidade 87,50%), e para meninos com obesidade, o ponto de corte estabelecido foi de 91 bpm (sensibilidade 94,74% e especificidade 63,64%). A frequência cardíaca também se mostrou um bom preditor considerando os índices da relação baixa frequência/alta frequência (LF/HF) e razão desvio padrão de intervalos NN contínuos de longo prazo/desvio padrão da variabilidade instantânea de intervalos NN contínuos na relação gráfica de Poincaré (SD2/SD1). As pressões arteriais sistólicas e diastólicas foram bons preditores em estratificações mais específicas e, portanto, podem ser utilizadas em alguns casos. Conclusões: A validade preditiva da frequência cardíaca mostrou-se em bom nível, com alta sensibilidade e especificidade aceitável para os pontos de corte, conforme as diferentes análises estratificadas por sexo e estado nutricional. Desta forma, os profissionais de saúde poderão utilizar a frequência cardíaca para estimar o risco cardiovascular em crianças de diferentes sexos e estado nutricional. Objetivo (VFC Métodos 12 estudo 4 8 Antropometria estadiômetro disso ROC dados Resultados mostrouse (RMSSD 0,89 089 0 89 IC95 IC 0,77–1,00 077100 77 1 00 0,90 090 90 0,83–0,97. 083097 0,83–0,97 . 83 97 0,83–0,97) 9 10000 100 100,00 87,50%, 8750 87,50% , 87 50 87,50%) 9474 94 74 94,74 63,64%. 6364 63,64% 63 64 63,64%) frequênciaalta LF/HF LFHF LF HF (LF/HF prazodesvio prazo SD2/SD1. SD2SD1 SDSD SD2/SD1 SD2 SD1 SD (SD2/SD1) portanto casos Conclusões nível nutricional forma 0,8 08 IC9 0,77–1,0 07710 7 0,9 09 08309 0,83–0,9 1000 10 100,0 875 87,50 5 947 94,7 636 63,64 6 SD2SD SD2/SD (SD2/SD1 0, 0,77–1, 0771 0830 0,83–0, 100, 87,5 94, 63,6 (SD2/SD 0,77–1 077 083 0,83–0 87, 63, 0,77– 07 0,83– 0,77 0,83 0,7

This article discusses guidance published on official websites regarding the response of the Brazilian National Health System (SUS) psychosocial care networks (RAPS) to the public health emergency caused by Covid-19. The discussion draws on the analysis of online materials published between 06/02/20 and 31/08/21 at state and federal level across all the country’s state capitals. We compare the results of the document analysis with guidance published by international organizations to reflect on the challenges, successes, mistakes and omissions in the guidance given to the RAPS at the beginning of the pandemic. It is concluded that, despite being formal, the guidance was poorly coordinated and integrated into the networks and with other sectors and pre-existing challenges, as recommended by the international community.

A presente análise documental tem como objetivo debater as orientações publicadas on-line em sites oficiais para guiar as respostas das Redes de Atenção Psicossocial (Raps) do Sistema Único de Saúde (SUS) do Brasil diante da emergência de Saúde Pública causada pela Covid-19. Baseia-se na análise de materiais publicados on-line entre 6/2/20 e 31/8/21 nos níveis federal e estadual e em todas as capitais do país. Combina essa análise documental com orientações e publicações de entidades internacionais a fim de refletir sobre os desafios, acertos, erros e omissões das orientações dadas para as Raps no país durante o início do período pandêmico. Conclui que as orientações, apesar de existentes formalmente, foram pouco articuladas e integradas dentro das próprias redes, com outros setores e com desafios preexistentes, conforme preconizado pela comunidade internacional.

El presente análisis documental tiene el objetivo de debatir las orientaciones publicadas online en páginas web oficiales para guiar las respuestas de las Redes de Atención Psicosociales (RAPS) del Sistema Brasileño de Salud (SUS) ante la emergencia de salud pública causada por la Covid-19. Se basa en el análisis de materiales publicados online entre el 06/02/20 y el 31/08/21 en las esferas de la federación y de los estados en todas las capitales del país. Combina este análisis documental con orientaciones y publicaciones de entidades internacionales para reflexionar sobre los desafíos, aciertos, errores y omisiones de las orientaciones dadas para las RAPS en el país durante el inicio del período pandémico. Concluye que las orientaciones, a pesar de existentes formalmente, fueron poco articuladas e integradas dentro de las propias redes con otros sectores y con desafíos preexistentes, conforme lo determina la comunidad internacional.

ABSTRACT Introduction/framework/objectives Multiple Sclerosis has a reasonable prevalence and the diagnosis is generally made at working age, at a stage that is still demanding on a professional level, a time when there are also generally personal/family particularities that require some dedication. Furthermore, given the incidence, diversity and severity of the symptoms presented, limitations often arise that can seriously affect the ability to work or even lead to unemployment. It is then desirable that the members working in Occupational Health and Safety teams have some knowledge on the subject, in order to better guide their performance, safeguarding the interests of everyone involved. Methodology This is a Bibliographic Review, initiated through a search carried out in April 2023, in the databases “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina and RCAAP”. Content It is a demyelinating and autoimmune disease of the Central Nervous System; it is characterized by recurrent and intermittent episodes of inflammation, with generally progressive destruction of axonal myelin. In most cases there is a cycle of relapses and remissions and symptoms of varying intensity; the evolution is unpredictable. Causes autonomic, visual, motor and sensory symptoms; which makes independent daily living and the ability to work difficult; sometimes becoming debilitating. It is incurable and neurodegenerative. The severity varies depending on the neurological areas most affected. The function of myelin is to facilitate conduction at the level of axons; with changes in this, the electrical impulses that coordinate mental and physical functions become less effective. As myelin deteriorates, it is replaced by scars of abnormal tissue, with different consistency (stiffness, plaques), which further disrupts conduction. Injuries to the frontal and parietal lobes often result in cognitive and emotional changes; in the spinal cord, problems arise more easily in the lower limbs. Changes in the optic nerve and occipital lobe can cause visual problems. This is the neurological desease that causes most limitations in the young adult active population. Given the reasonably young age at which symptoms begin, there will be a decrease in quality of life, more significant than in other chronic diseases. Discussion and Conclusions Although the bibliography is not scarce, the emphasis in the vast majority of articles is not on Occupational Health or Safety. It would be relevant for some teams working in large companies with some prevalence, to evaluate the cases in detail, describing the main problems detected, proposed measures and their subsequent evaluation, in order to publish not only the path, but also the conclusions obtained, for greater dissemination of the subject.

RESUMO Introdução/enquadramento/objetivos A Esclerose Múltipla tem uma prevalência razoável e o diagnóstico faz-se geralmente em idade ativa, numa fase ainda exigente a nível profissional, altura essa onde geralmente também existem particularidades pessoais/familiares que necessitam de alguma dedicação. Para além disso, dada a incidência, diversidade e gravidade dos sintomas apresentados, com frequência surgem limitações que podem condicionar seriamente a capacidade de trabalho ou até levar ao desemprego. Será então desejável que os elementos a exercer em equipas de Saúde e Segurança Ocupacionais tenham alguns conhecimentos sobre o tema, de forma a melhor orientar o seu desempenho, salvaguardando os interesses de todos os envolvidos. Metodologia Trata-se de uma Revisão Bibliográfica, iniciada através de uma pesquisa realizada em abril de 2023, nas bases de dados “CINALH plus with full text, Medline with full text, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Nursing and Allied Health Collection: comprehensive, MedicLatina e RCAAP”. Conteúdo É uma doença desmielinizante e auto-imune do Sistema Nervoso Central; carateriza-se por episódios recorrentes e intermitentes de inflamação, com destruição de mielina axonal, geralmente progressiva. Na maioria dos casos existe um ciclo de relapsos e remissões e sintomas de intensidade oscilante; a evolução é imprevisível. Causa sintomas autonómicos, visuais, motores e sensoriais; o que dificulta a vida quotidiana independente e o trabalho, tornando-se por vezes debilitante. É incurável e neurodegenerativa. A gravidade varia com as áreas neurológicas mais atingidas. À medida que a mielina se detiora, ela é substituída por cicatrizes de tecido anormal, com diferente consistência (rigidez, placas), o que perturba ainda mais a condução. Lesões nos lóbulos frontal e parietal geralmente resultam em alterações cognitivas e emocionais; na espinal medula, mais facilmente surgem problemas nos membros inferiores. Alterações no nervo ótico e lobo occipital podem originar alterações visuais. Trata-se da doença neurológica que mais limitações causa na população ativa jovem adulta. Dada a idade razoavelmente jovem do início de sintomas, irá ocorrer diminuição da qualidade de vida, mais significativa que noutras doenças crónicas. Discussão e Conclusões Ainda que a bibliografia não seja escassa, a enfase da grande maioria dos artigos não é dada à Saúde ou Segurança Ocupacionais. Seria relevante que algumas equipas a exercer em empresas grandes e com alguma incidência, avaliassem com detalhe os casos, descrevendo os principais problemas detetados, medidas propostas e avaliação posterior das mesmas, de forma a publicar não só o caminho, mas também as conclusões obtidas, para maior divulgação do assunto.

ABSTRACT Introduction: this study focuses on the need to validate and reliably measure management indicators in the field of public health in Paraguay using psychometric techniques. Objective: the main objective of this study was to develop a valid and reliable instrument to measure public health management indicators in Paraguay considering its psychometric properties. Methodology: this study followed a quantitative approach using a descriptive and propositional observational design. A pilot test was conducted using Likert scales to capture different aspects of public health management indicators. Exploratory and confirmatory factor analyses were performed to validate the construct, and the JASP was used for statistical analysis. The sample included adults in Paraguay who were connected to the public health system in the previous year. Results: the results showed that Aiken's V for all items was higher than 0.7, indicating content validity. The fit indices of the confirmatory factor analysis, such as RMSEA=0.064 and CFI=0.971, demonstrated good construct validity. In addition, the alpha and omega values were higher than 0.9, which guarantees the high reliability of the instrument. Conclusion: these results indicate that the developed instrument is valid and reliable for measuring public health management indicators in Paraguay.

RESUMEN Introducción: la investigación se centra en la necesidad de validar y medir de manera confiable indicadores de gestión en el campo de la salud pública en Paraguay mediante técnicas psicométricas. Objetivo: el objetivo principal de este estudio fue desarrollar un instrumento válido y confiable para medir indicadores de gestión de salud pública en Paraguay considerando sus propiedades psicométricas. Metodología: esta investigación siguió un enfoque cuantitativo con un diseño observacional descriptivo y proposicional. Se realizó una prueba piloto utilizando escalas Likert para capturar diferentes aspectos de los indicadores de gestión de salud pública. Se realizaron análisis factoriales exploratorias y confirmatorias para validar el constructo y para el análisis estadístico se utilizó el programa JASP. La muestra incluyó a adultos de Paraguay que estuvieron relacionados con el sistema público de salud en el año anterior. Resultados: los resultados mostraron que la V de Aiken para todos los ítems fue superior a 0,7, lo que indica validez de contenido. Los índices de ajuste del análisis factorial confirmatorio como RMSEA=0,064 y CFI=0,971 demostraron una buena validez de constructo. Además, los valores alfa y omega fueron superiores a 0,9, lo que garantiza la alta confiabilidad del instrumento. Conclusión: estos resultados permitieron concluir que el instrumento desarrollado es válido y confiable para medir indicadores de gestión de salud pública en Paraguay.

ABSTRACT Paracoccidioidomycosis (PCM) is a systemic disease endemic to Latin American countries, with a high impact in terms of morbidity, mortality and costs for the health system if patients progress to advanced stages. This work aimed to collect data published in publications on autochthonous cases of PCM, from the first cases diagnosed in Paraguay, with a description of the historical context and identifying the pioneers in the diagnosis in Paraguay, following a chronological order, to the most recently reported cases. Methodology: search in national libraries and online databases of PCM cases in Paraguay, published in national historical scientific journals and other sources available in print format, and more recent scientific articles available in electronic format, respectively. Results: 479 cases of PCM were identified in publications between the years 1935 and 2023, corresponding to autochthonous cases and whose diagnoses were made in Paraguayan territory. Dr. Juan Boggino and collaborators were responsible for the first diagnoses in the country. The predominant clinical form was chronic. The average age was 45.78 years. The vast majority of patients diagnosed were from the Eastern Region of the country, predominantly male farmers. Conclusion: PCM is an endemic disease in Paraguay. Since the first cases were diagnosed and until today, patients with a severe and disabling course of the disease have been detected, which demonstrates the need to disseminate its knowledge and expand the early diagnostic capacity at the national level. Due to its clinical pleomorphism and its ability to simulate other diseases, it is important to include PCM as a differential diagnosis for patients who present risk factors for the development of the disease.

RESUMEN La Paracoccidioidomicosis (PCM), es una enfermedad sistémica endémica de países de América Latina, con alto impacto en términos de morbilidad, mortalidad y costos para el sistema de salud si los enfermos progresan a sus estadios avanzados. Este trabajo tuvo como objetivo recopilar datos divulgados en publicaciones sobre casos autóctonos de PCM, desde los primeros casos diagnosticados en Paraguay, con una descripción del contexto histórico e identificando a los pioneros en el diagnóstico en Paraguay, siguiendo un orden cronológico, hasta los casos más recientemente informados. Metodología: búsqueda en bibliotecas nacionales y bases de datos online de casos de PCM en Paraguay, publicados en revistas científicas históricas nacionales y otras fuentes disponibles en formato impreso, y artículos científicos más recientes disponibles en formato electrónico, respectivamente. Resultados: Se identificaron 479 casos de PCM en publicaciones entre los años 1935 y 2023, correspondientes a casos autóctonos y cuyos diagnósticos fueron realizados en territorio paraguayo. El Dr. Juan Boggino y colaboradores fueron los responsables de los primeros diagnósticos en el país. La forma clínica predominante fue la crónica. La media de edad de 45,78 años. La gran mayoría de los pacientes diagnosticados fueron oriundos de la Región Oriental del país, predominantemente hombres agricultores. Conclusión: La PCM es una enfermedad endémica del Paraguay, desde los primeros casos diagnosticados y hasta hoy en día, son detectados pacientes con una evolución grave y discapacitante de la enfermedad, lo que demuestra la necesidad de la difusión de su conocimiento y ampliación de la capacidad diagnóstica precoz a nivel nacional. Debido a su pleomorfismo clínico y su capacidad de simular otras enfermedades, es importante incluir a la PCM como diagnóstico diferencial de pacientes que presenten factores de riesgo para el desarrollo de la enfermedad.

Resumen Los trabajadores agrícolas se exponen frecuentemente a los pesticidas, los cuales pueden afectar el sistema cardiovascular. El objetivo de la investigación fue revisar la asociación entre la exposición ocupacional a pesticidas, el desarrollo de enfermedades cardiovasculares y los biomarcadores utilizados en la vigilancia de la salud de los trabajadores. Para ello se realizó una revisión no sistemática de la literatura en tres bases de datos: Pubmed, Embase y Scopus, con ecuaciones de búsqueda elaboradas con los términos “agrochemicals”, “myocardial infarction”, “occupational exposure” y “farmers", y se incluyeron artículos publicados entre 2007 y 2022. Se encontró que los pesticidas causan elevación de las cifras de presión arterial en trabajadores expuestos y en mujeres embarazadas se relaciona con hipertensión gestacional y preeclampsia. Respecto al infarto agudo de miocardio (IAM), el contacto con los pesticidas clorpirifós, coumafós, carbofurano, pendimetalina, trifluralina y acilalanina aumentan el riesgo de IAM en mujeres, y entre los trabajadores masculinos la exposición a dibromuro de etileno, maneb/mancozeb y dimetil-ditiocarbamato de zinc se asoció con mayor mortalidad. La vigilancia epidemiológica se realiza principalmente con la medición de la actividad de la acetilcolinesterasa eritrocitaria (AChE). Se puede concluir que la exposición a pesticidas puede desencadenar enfermedades cardiovasculares agudas y crónicas, como elevación de las cifras de presión arterial, IAM fatal y no fatal. Los pesticidas dimetil ditiocarbamato de zinc, clorpirifós, coumafós, carbofurano, paratión y malatión son las sustancias que tienen mayor relación con el desarrollo de enfermedad cardiovascular.

Abstract Farmworkers are frequently exposed to pesticides, which can affect the cardiovascular system. The objective of the research was to review the association between occupational exposure to pesticides and the development of cardiovascular diseases, and the biomarkers used in monitoring the health of workers. For this, a non-systematic review of the literature was carried out in three databases: Pubmed, Embase and Scopus, with search equations prepared with the terms "agrochemicals", "myocardial infarction", "occupational exposure" and "farmers". Articles published between 2007 and 2022 were included. Pesticides were found to cause elevated blood pressure levels in exposed workers, and in pregnant women it is related to gestational hypertension and preeclampsia. Regarding acute myocardial infarction (AMI), contact the pesticides chlorpyrifos, coumaphos, carbofuran, pendimethalin, trifluralin, and acylalanine increased the risk of AMI in women, and among male workers exposure to ethylene dibromide, maneb/mancozeb, and zinc dimethyldithiocarbamate was associated with increased mortality. Epidemiological surveillance is mainly carried out by measuring erythrocyte acetylcholinesterase (AChE) activity. It can be concluded that exposure to pesticides can trigger acute and chronic cardiovascular diseases, such as elevated blood pressure, fatal and non-fatal AMI. Zinc dimethyl dithiocarbamate, chlorpyrifos, coumafos, carbofuran, parathion and malathion pesticides are the substances most closely related to the development of cardiovascular disease.

Summary: Soil organic carbon (SOC) is a key indicator of soil health. Arbuscular mycorrhizal fungi (AMF) have been shown to increase SOC and respond to SOC content, which in turn, is directly related to land use. We investigated the relationships between land use and Glomeromycotina AMF spore abundance of two AMF functional guilds, rhizophilic (having high root internal AMF hyphal length) and edaphophilic (with high external soil hyphal length) to SOC content in agroforestry systems (AS) and seasonal forest (SF) of Tzucacab, Yucatan, Mexico. Our results indicate greater SOC values in SF than AS of the same age with a trend of increasing SOC with system age. Rhizophilic spore abundance correlated with SOC content, showing differences among land uses and system ages but not between seasons. No relationship was observed between edaphophilic spore abundance to SOC. Thus, we suggest that Glomeromicotyna spore abundance (measured at any time of the year) of rhizophilic fungi could be a good indicator of SOC and, a tool to monitor soil health due to land use changes.

Resumen: El carbono orgánico del suelo (COS) es un indicador clave de la salud del suelo. Se ha demostrado que los hongos micorrícicos arbusculares (HMA) pueden aumentar el COS, y también responder al contenido de COS; el cual, a su vez, está directamente relacionado con el uso del suelo. Investigamos las relaciones entre el uso del suelo y la abundancia de esporas de HMA de dos grupos funcionales de HMA, los rizófilos (con alta longitud hifal interna de HMA en las raíces) y los edafófilos (con alta longitud hifal externa del suelo) con el contenido de COS en sistemas agroforestales (SAF) y un bosque estacional (BE) en Tzucacab, Yucatán, México. Nuestros resultados indican valores de COS más altos en BE que en SAF de la misma edad, con una tendencia a aumentar el COS con la edad del sistema. La abundancia de esporas rizofílicas se correlaciona con el contenido de COS, mostrando diferencias entre los usos del suelo y las edades del sistema, pero no entre las estaciones. No se observó relación entre la abundancia de esporas edafófilas y el COS. Por lo tanto, sugerimos que la abundancia de esporas (medida en cualquier momento del año) de hongos rizófilos podría ser un buen indicador del COS y una herramienta para monitorear la salud del suelo debido a cambios en el uso del suelo.

Resumen: La pandemia por COVID-19 influyó en el proceso de educación superior generando una transición entre la modalidad presencial a la modalidad en línea-emergente en la que se identificaron varias dificultades para el acceso debido a la inequidad, problemas tecnológicos, crisis de salud y económica a nivel mundial, y en Ecuador a nivel de docentes y estudiantes. El descubrimiento de conocimiento en bases de datos de KDD - Educacional, el análisis de técnicas de minería de datos de clasificación y agrupación, y el complemento de análisis de datos con la inteligencia de negocios determinaron los factores desde la perspectiva de la institución, del docente y de los estudiantes que inciden en el proceso de educación en línea, donde se demuestra además, la importancia del modelo de educación, la metodología del proceso de enseñanza aprendizaje, el entorno de aprendizaje y el bienestar de los docentes y estudiantes que garantizan una educación superior en línea de calidad con igualdad de oportunidades en el acceso.

Abstract: The COVID-19 pandemic significantly impacted higher education, forcing a rapid transition from face-to-face modality to the emerging online learning modality. This transition exposed several challenges, including, inequitable access to technology, global health and economic crisis, and specific difficulties faced by both teachers and students in Ecuador. Knowledge discovery in KDD - Educational databases, the analysis of classification and clustering data mining techniques and the complement of data analysis with business intelligence determined the factors from the perspective of the institution, teachers and students that influence the online education process. In addition, the importance of the education model, the teaching-learning process methodology, the learning environment, and the well-being of teachers and students that guarantee quality online higher education with equal access opportunities is demonstrated.

ABSTRACT The research aimed to systematically identify the main drivers to enhance healthcare organizations' competitiveness, specifically for contributory regime (EPS) health insurers in the Colombian context. The study was interpretative, qualitative, and descriptive-exploratory studying documents that showed the possible drivers of competitiveness, and adapting them to the health 'industry', with a specific analysis. Those that, jointly and within a competitive-organizational behavior could be its differential and competitive factors in three dimensions or categories (organizational, strategy and results) and crossed by three levels of analysis (macro, meso, and micro) were identified. This can be useful in contributing to developing the competitive capacity of national Health Maintenance Organizations (HMOs), serving as a discussion platform for public policy and a possible reform regarding the health system, and studying the competitiveness of the health sector and its organizations in the future.

RESUMEN La investigación se propuso establecer sistémicamente los principales impulsores (drivers) que pueden desarrollar la competitividad de las organizaciones de salud, concretamente para las aseguradoras en salud del régimen contributivo (EPS´s) en el contexto colombiano. El estudio fue interpretativo, cualitativo y descriptivo-exploratorio, estudiando documentos que mostraran los posibles impulsores de la competitividad, adaptándolos a la ‘industria’ de la salud, con un análisis específico. Se identificaron aquellos que, conjuntamente y dentro un comportamiento competitivo-organizacional, podrían ser sus factores diferenciales y competitivos en tres dimensiones o categorías (organizacional, estrategia y resultados) y atravesados por tres niveles de análisis (macro, meso y micro). Esto puede ser útil para aportar al desarrollo de la capacidad competitiva de las EPS nacionales, como plataforma de discusión para la política pública y una posible reforma respecto al sistema de salud y para estudiar la competitividad de este sector y sus organizaciones hacia el futuro.

RESUMO A pesquisa se propôs a estabelecer de forma sistêmica os principais fatores que podem desenvolver a competitividade das organizações de saúde, especificamente para as seguradoras de saúde do sistema contributivo (EPS's) no contexto colombiano. O estudo foi interpretativo, qualitativo e descritivo-exploratório, estudando documentos que mostram os possíveis fatores de competitividade, adaptando-os ao "setor" de saúde, com uma análise específica. Foram identificados aqueles que, em conjunto e dentro de um comportamento competitivo-organizacional, poderiam ser seus fatores diferenciadores e competitivos em três dimensões ou categorias (organizacional, estratégia e resultados) e percorridos por três níveis de análise (macro, meso e micro). Isso pode ser útil para contribuir para o desenvolvimento da capacidade competitiva das EPSs nacionais, como uma plataforma de discussão para políticas públicas e uma possível reforma relativas ao sistema de saúde e para estudar a competitividade do setor de saúde e de suas organizações em direção ao futuro.

ABSTRACT This document analyzes social cartography in the fishing sector of Oaxaca, Mexico. The main objective is to represent the fishing system through the identification of the key actors, their relationships and the territory The methodology included three phases: 1) documentary to establish the theoretical framework; 2) field, with the application of 110 surveys to fishermen using the snowball technique; and 3) results, with the analysis and presentation of the data. The main results show that the agri-food sector; to which the fishing sector belongs, faces challenges such as enhancing production, supply, transformation, marketing and distribution capacities. The main government, business and higher education actors involved were identified. Regarding the fishing system in Oaxaca, the political-legislative, geographical, sustainability and health, financial and commercial, human capital, productive and infrastructural contexts were mapped, as well as the regional context of the Coast and Isthmus areas. The importance of recognizing the historical relationships that have marked fishing in Mexico is highlighted, especially in Oaxaca, one of the states with the highest rates of poverty and backwardness. JEL CLASSIFICATION: P42, J01, J54, Y90

RESUMEN Este documento analiza la cartografa social en el sector pesquero de Oaxaca, México. El objetivo principal es representar el sistema pesquero a través de la identificación de los actores clave, sus relaciones y el territorio. La metodología incluyó tres fases: 1) documental, para establecer el marco teórico; 2) de campo, con la aplicación de 110 encuestas a pescadores utilizando la técnica de bola de nieve; y 3) de resultados, con el análisis y presentación de los datos. Los principales resultados muestran que el sector agroalimentario, al cual pertenece el sector pesquero, enfrenta retos como potencializar las capacidades de producción, abastecimiento, transformación, comercialización y distribución. Se identificaron los principales actores gubernamentales, empresariales y de educación superior involucrados. En cuanto al sistema pesquero en Oaxaca, se mapearon los contextos político-legislativo, geográfico, de sustentabilidad y sanidad, financiero y comercial, de capital humano, productivo e infraestructural, así como el contexto regional de las zonas Costa e Istmo. Se destaca la importancia de reconocer las relaciones históricas que han marcado la pesca en México, especialmente en Oaxaca, uno de los estados con mayores índices de pobreza y rezago. CLASIFICACIÓN JEL: P42, J01, J54, Y90

RESUMO Este artigo analisa o mapeamento social no setor de pesca em Oaxaca, México. O principal objetivo é representar o sistema de pesca por meio da identificação dos principais atores, suas relações e o território. A metodologia incluiu três fases: l) documental, para estabelecer a estrutura teórica; 2) campo, com a aplicação de 110 pesquisas a pescadores usando a técnica de bola de neve; e 3) resultados, com a análise e apresentação dos dados. Os principais resultados mostram que o setor agroalimentar, ao qual pertence o setor pesqueiro, enfrenta desafios como o fortalecimento das capacidades de produção, fornecimento, processamento, comercialização e distribuição. Foram identificados os principais atores governamentais, empresariais e de ensino superior envolvidos. Com relação ao sistema de pesca em Oaxaca, foram mapeados os contextos político-legislativo, geográfico, de sustentabilidade e saúde, financeiro e comercial, de capital humano, produtivo e de infraestrutura, bem como o contexto regional das zonas da Costa e do Istmo. O estudo destaca a importância de reconhecer as relações históricas que marcaram a pesca no México, especialmente em Oaxaca, um dos estados com os mais altos índices de pobreza e atraso. CLASSIFICAÇÃO JEL: P42, J01, J54, Y90

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