RESUMEN El presente trabajo es fruto de un proyecto dirigido a la precisión de uno de los problemas profesionales de la carrera Licenciatura en Educación Primaria en la Universidad de Guantánamo relacionado con el diagnóstico del grupo, el entorno comunitario, familiar y los educandos cuyo propósito es elaborar una metodología para el desarrollo de esta habilidad en el futuro profesional del nivel educativo primario. Para ello se utilizaron varios métodos de investigación científica tales como el análisis y síntesis, inducción deducción el histórico-lógico entre otros que permitieron arribar a conclusiones acerca de la efectividad de la propuesta.

ABSTRACT The present work is the result of a project aimed at the precision of one of the professional problems of the Bachelor's Degree in Primary Education at the University of Guantánamo related to the diagnosis of the group, the community and family environment and the students, the purpose of it is to elaborate a methodology for the development of this skill in the future professional of the primary education level. For this purpose, several scientific research methods were used, such as analysis and synthesis, induction, deduction, historical-logical, among others, which allowed reaching conclusions about the effectiveness of the proposal.

ABSTRACT Background: Chagasic cardiomyopathy (CC) differs from other heart failure causes in multiple aspects, highlighting the risk of systemic embolisms. However, few studies have evaluated the risk of embolic events in anticoagulated patients with CC compared with other cardiomyopathies. Objective: We aimed to analyze the incidence of systemic embolisms in a cohort of anticoagulated patients diagnosed with atrial fibrillation (AF) with and without CC. Methods: A retrospective cohort study was carried out at a fourth level hospital in Colombia during the period 2014-2020. All patients diagnosed with cardiomyopathy of any etiology and AF, who were on an anticoagulation regimen were included. The primary outcome was the incidence of embolic events. A survival analysis was performed using adjusted Cox proportional hazard models. A p-value <0.05 was considered significant. All statistical tests were two-tailed. Results: A total of 149 anticoagulated patients with cardiomyopathy were evaluated (median age: 71 years; women: 30.20%). The cumulative incidence of embolic events was significantly higher in patients with CC (17.50%) compared with those presenting other cardiomyopathies (4.95%), despite that the latter had a significantly higher CHA2DS2-VASc score (p=0.013). After multivariate analysis, patients with CC had a significantly higher risk of embolic events regardless of the CHA2DS2-VASc score and the type of anticoagulant prescribed (HR 5.65; 95% CI 1.46-21.83; p=0.012). Conclusions: Chagasic cardiomyopathy was associated with a significantly higher risk of embolic events, despite anticoagulation therapy in both groups. More research is required to understand the origin of the risk observed in order to translate this knowledge into specific indications for anticoagulation in patients with CC.

RESUMEN Introducción: La miocardiopatía chagásica (MC) difiere de otras causas de insuficiencia cardíaca en múltiples aspectos, destacándose el riesgo de embolias sistémicas. Sin embargo, pocos estudios han evaluado el riesgo de eventos embólicos en pacientes anticoagulados con MC en comparación con otras miocardiopatías. Objetivo: Nuestro objetivo fue analizar la incidencia de embolias sistémicas en una cohorte de pacientes anticoagulados con diagnóstico de fibrilación auricular (FA) con y sin MC. Material y métodos: Se realizó un estudio de cohorte retrospectivo en hospital de cuarto nivel en Colombia durante el periodo 2014-2020. Se incluyeron todos los pacientes con diagnóstico de miocardiopatía de cualquier etiología y FA que estuvieran en régimen de anticoagulación. El resultado primario fue la incidencia de eventos embólicos. Se realizó un análisis de supervivencia mediante modelos de riesgos proporcionales de Cox ajustados. Un valor de p <0,05 se consideró significativo. Todas las pruebas estadísticas fueron de dos colas. Resultados: Se evaluaron 149 pacientes anticoagulados con miocardiopatía (mediana de edad: 71 años; mujeres: 30,20%). La incidencia acumulada de eventos embólicos fue significativamente mayor en los pacientes con MC (17,50%) en comparación con aquellos con otras miocardiopatías (4,95%), a pesar de que estos últimos tenían una puntuación CHA2DS2-VASc significativamente mayor (p=0,013). Tras el análisis multivariado, los pacientes con MC tuvieron un riesgo significativamente mayor de eventos embólicos independientemente de la puntuación CHA2DS2-VASc y del tipo de anticoagulante prescrito (HR 5,65; IC 95% 1,46-21,83; p=0,012). Conclusiones: La MC se asoció con un riesgo significativamente mayor de eventos embólicos, a pesar del tratamiento anticoagulante en ambos grupos. Se requiere más investigación para comprender el origen de este riesgo observado y traducir este conocimiento en indicaciones específicas de anticoagulación para pacientes con MC.

Resumo Introdução: É importante identificar fatores de risco para progressão da doença renal policística autossômica dominante (DRPAD). Entretanto, são escassos os estudos que avaliam esse assunto utilizando amostra brasileira. Portanto, o objetivo deste estudo foi identificar fatores de risco para desfechos renais e óbito em coorte brasileira de pacientes com DRPAD. Métodos: Os pacientes tiveram o primeiro atendimento médico entre janeiro/2002 e dezembro/2014, sendo acompanhados até dezembro/2019. Associações entre variáveis clínicas e laboratoriais com desfecho primário (redução sustentada de pelo menos 57% na TFGe em relação ao valor basal, necessidade de diálise ou transplante renal) e desfecho secundário (óbito por qualquer causa) foram analisadas pelo modelo de regressão múltipla de Cox. Entre 80 pacientes com DRPAD, foram excluídos aqueles menores de 18 anos, com TFG <30 mL/min/1,73 m2 e/ou aqueles com dados ausentes. Foram acompanhados 70 pacientes. Resultados: Fatores independentemente associados aos desfechos renais foram: comprimento renal total – Razão de Risco (HR) ajustada com intervalo de confiança de 95% (IC 95%): 1,137 (1,057–1,224), taxa de filtração glomerular – HR (IC 95%): 0,970 (0,949–0,992) e nível sérico de ácido úrico - HR (IC 95%): 1,643 (1,118–2,415). Diabetes mellitus – HR (IC 95%): 8,115 (1,985–33,180) e TFG – HR (IC 95%): 0,957 (0,919–0,997) foram associados ao desfecho secundário. Conclusões: Esses achados corroboram a hipótese de que comprimento renal total, TFG e nível sérico de ácido úrico podem ser importantes preditores prognósticos de DRPAD em uma coorte brasileira, o que pode ajudar a selecionar pacientes que necessitam de acompanhamento mais próximo. Introdução . (DRPAD) Entretanto Portanto Métodos janeiro2002 janeiro 2002 janeiro/200 dezembro2014 dezembro 2014 dezembro/2014 dezembro2019 2019 dezembro/2019 redução 57 basal causa Cox 8 1 anos 30 <3 mLmin173 mLmin mL min 73 mL/min/1,7 m eou ausentes 7 Resultados (HR 95 IC 95%) 1137 137 1,13 1,057–1,224, 10571224 1,057–1,224 , 057 224 (1,057–1,224) 0970 0 970 0,97 0,949–0,992 09490992 949 992 (0,949–0,992 1643 643 1,64 1,118–2,415. 11182415 1,118–2,415 118 2 415 (1,118–2,415) 8115 115 8,11 1,985–33,180 198533180 985 33 180 (1,985–33,180 0957 957 0,95 0,919–0,997 09190997 919 997 (0,919–0,997 Conclusões próximo (DRPAD janeiro200 200 janeiro/20 dezembro201 201 dezembro/201 5 3 < mLmin17 mL/min/1, 9 113 13 1,1 1057122 1,057–1,22 05 22 (1,057–1,224 097 97 0,9 0,949–0,99 0949099 94 99 (0,949–0,99 164 64 1,6 1118241 1,118–2,41 11 41 (1,118–2,415 811 8,1 1,985–33,18 19853318 98 (1,985–33,18 095 0,919–0,99 0919099 91 (0,919–0,99 janeiro20 20 janeiro/2 dezembro20 dezembro/20 mLmin1 mL/min/1 1, 105712 1,057–1,2 (1,057–1,22 09 0, 0,949–0,9 094909 (0,949–0,9 16 6 111824 1,118–2,4 4 (1,118–2,41 81 8, 1,985–33,1 1985331 (1,985–33,1 0,919–0,9 091909 (0,919–0,9 janeiro2 janeiro/ dezembro2 dezembro/2 mL/min/ 10571 1,057–1, (1,057–1,2 0,949–0, 09490 (0,949–0, 11182 1,118–2, (1,118–2,4 1,985–33, 198533 (1,985–33, 0,919–0, 09190 (0,919–0, dezembro/ mL/min 1057 1,057–1 (1,057–1, 0,949–0 0949 (0,949–0 1118 1,118–2 (1,118–2, 1,985–33 19853 (1,985–33 0,919–0 0919 (0,919–0 105 1,057– (1,057–1 0,949– 094 (0,949– 111 1,118– (1,118–2 1,985–3 1985 (1,985–3 0,919– 091 (0,919– 10 1,057 (1,057– 0,949 (0,949 1,118 (1,118– 1,985– 198 (1,985– 0,919 (0,919 1,05 (1,057 0,94 (0,94 1,11 (1,118 1,985 19 (1,985 0,91 (0,91 1,0 (1,05 (0,9 (1,11 1,98 (1,98 (1,0 (0, (1,1 1,9 (1,9 (1, (0 (1 (

Abstract Introduction: Identifying risk factors for autosomal dominant polycystic kidney disease (ADPKD) progression is important. However, studies that have evaluated this subject using a Brazilian sample is sparce. Therefore, the aim of this study was to identify risk factors for renal outcomes and death in a Brazilian cohort of ADPKD patients. Methods: Patients had the first medical appointment between January 2002 and December 2014, and were followed up until December 2019. Associations between clinical and laboratory variables with the primary outcome (sustained decrease of at least 57% in the eGFR from baseline, need for dialysis or renal transplantation) and the secondary outcome (death from any cause) were analyzed using a multiple Cox regression model. Among 80 ADPKD patients, those under 18 years, with glomerular filtration rate <30 mL/min/1.73 m2, and/or those with missing data were excluded. There were 70 patients followed. Results: The factors independently associated with the renal outcomes were total kidney length – adjusted Hazard Ratio (HR) with a 95% confidence interval (95% CI): 1.137 (1.057–1.224), glomerular filtration rate – HR (95% CI): 0.970 (0.949–0.992), and serum uric acid level – HR (95% CI): 1.643 (1.118–2.415). Diabetes mellitus - HR (95% CI): 8.115 (1.985–33.180) and glomerular filtration rate - HR (95% CI): 0.957 (0.919–0.997) were associated with the secondary outcome. Conclusions: These findings corroborate the hypothesis that total kidney length, glomerular filtration rate and serum uric acid level may be important prognostic predictors of ADPKD in a Brazilian cohort, which could help to select patients who require closer follow up. Introduction (ADPKD However sparce Therefore Methods 200 2014 2019 sustained 57 baseline transplantation cause model 8 1 years 30 <3 mLmin173 mLmin mL min 73 mL/min/1.7 m2 m andor excluded 7 Results (HR 95 (95 CI CI) 1137 137 1.13 1.057–1.224, 10571224 1.057–1.224 , 057 224 (1.057–1.224) 0970 0 970 0.97 0.949–0.992, 09490992 0.949–0.992 949 992 (0.949–0.992) 1643 643 1.64 1.118–2.415. 11182415 1.118–2.415 . 118 2 415 (1.118–2.415) 8115 115 8.11 1.985–33.180 198533180 985 33 180 (1.985–33.180 0957 957 0.95 0.919–0.997 09190997 919 997 (0.919–0.997 Conclusions 20 201 5 3 < mLmin17 mL/min/1. 9 (9 113 13 1.1 1057122 1.057–1.22 05 22 (1.057–1.224 097 97 0.9 0949099 0.949–0.99 94 99 (0.949–0.992 164 64 1.6 1118241 1.118–2.41 11 41 (1.118–2.415 811 8.1 1.985–33.18 19853318 98 (1.985–33.18 095 0.919–0.99 0919099 91 (0.919–0.99 mLmin1 mL/min/1 ( 1. 105712 1.057–1.2 (1.057–1.22 09 0. 094909 0.949–0.9 (0.949–0.99 16 6 111824 1.118–2.4 4 (1.118–2.41 81 8. 1.985–33.1 1985331 (1.985–33.1 0.919–0.9 091909 (0.919–0.9 mL/min/ 10571 1.057–1. (1.057–1.2 09490 0.949–0. (0.949–0.9 11182 1.118–2. (1.118–2.4 1.985–33. 198533 (1.985–33. 0.919–0. 09190 (0.919–0. mL/min 1057 1.057–1 (1.057–1. 0949 0.949–0 (0.949–0. 1118 1.118–2 (1.118–2. 1.985–33 19853 (1.985–33 0.919–0 0919 (0.919–0 105 1.057– (1.057–1 094 0.949– (0.949–0 111 1.118– (1.118–2 1.985–3 1985 (1.985–3 0.919– 091 (0.919– 10 1.057 (1.057– 0.949 (0.949– 1.118 (1.118– 1.985– 198 (1.985– 0.919 (0.919 1.05 (1.057 0.94 (0.949 1.11 (1.118 1.985 19 (1.985 0.91 (0.91 1.0 (1.05 (0.94 (1.11 1.98 (1.98 (0.9 (1.0 (1.1 1.9 (1.9 (0. (1. (0 (1

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.

RESUMEN Introducción: La deglución es una actividad compleja y de carácter evolutivo, que requiere de una atención estomatológica adecuada para mantener el equilibrio del sistema estomatognático. Objetivo: Identificar las insuficiencias en la atención estomatológica integral del nivel primario ante trastornos de la deglución en niños. Métodos: Se realizó un estudio descriptivo y transversal, con enfoque mixto, de 24 estomatólogos generales integrales de la Clínica Estomatológica Victoria de Santa Clara, provincia de Villa Clara, que se encontraban laborando durante enero-marzo del 2023 y tenían más de 3 años de experiencia profesional, para lo cual se utilizaron métodos teóricos y empíricos. Se efectuó el análisis cualitativo y cuantitativo de los datos mediante el empleo de frecuencias absolutas y relativas. Resultados: En los documentos normativos-metodológicos revisados no están reflejadas de forma explícita todas las actividades de promoción y prevención, así como los aspectos necesarios para el diagnóstico y tratamiento adecuados de pacientes con alteraciones de la deglución. La mayoría de los encuestados (83,3 %) identificó la deglución como un hábito; en tanto, entre los factores medioambientales condicionantes, hubo poco reconocimiento de la posición del niño al comer (20,8 %), del uso de la cuchara y el vaso (29,1 %) y de la respiración nasal (33,3 %). Igualmente, 50,0 % de la muestra presentó un nivel medio de conocimientos. Conclusiones: Existen insuficiencias en la atención estomatológica integral en el nivel primario ante trastornos de la deglución en niños.

ABSTRACT Introduction: Deglutition is a complex activity of evolutionary character that requires of an appropriate stomatologic care to maintain the balance of the stomatognathic system. Objective: To identify inadequacies in the comprehensive stomatologic care to children with deglutition disorders in primary health care. Methods: A descriptive and cross-sectional study was carried out, with mixed approach, of 24 comprehensive general stomatologists from Victoria Stomatologic Clinic in Santa Clara, Villa Clara province that were working during January-March, 2023 and had more than 3 years of professional experience, for which theoretical and empiric methods were used. The qualitative and quantitative analysis of the data was carried out by means of the absolute and relative frequencies. Results: In the revised normative-methodological documents are not explicitly reflected all the promotion and prevention activities, as well as the necessary aspects for the diagnosis and treatment of patients with deglutition disorders. Most of those interviewed (83.3%) identified deglutition as a habit; as long as, among the determining environmental factors there was little recognition of the kid position when eating (20.8 %), the use of tablespoon and glass (29.1 %) and nasal respiration (33.3 %). Equally, 50.0 % of the sample presented a medium level of knowledge. Conclusions: There are inadequacies in the comprehensive stomatologic care to children with deglutition disorders in primary health care.

Abstract This paper presents an analysis of the curriculum documents that, in 2022, regulate the teaching of philosophy in the various jurisdictions of Argentina for the training of teachers at the early childhood and primary levels. It reviews the conception of didactics as a field of knowledge and its relationship with specific didactics, both at the higher education level and within philosophy itself. Regarding the latter, it is assumed to entail a philosophical problem in itself, requiring an initial position regarding what philosophy is. Based on this, the paper reviews the different philosophical units included in the forty-eight curriculum designs that constitute the object of study, categorizing them based on their content and designations. Finally, excerpts from didactic guidelines, educational goals, and summaries of the subjects included in these educational proposals under the name "Philosophy" are presented and analyzed. These documents are evaluated to assess the presence and scope of the field of philosophy didactics and its conceptualizations in these regulations.

Resumen Este trabajo presenta un análisis de los documentos curriculares que, en 2022, regularan la enseñanza de la filosofía en las distintas jurisdicciones de Argentina para la formación de docentes de los niveles inicial y primario. Para ello se repasa la concepción de la didáctica como campo del saber, así como su relación con las didácticas específicas, tanto del nivel superior como de la filosofía. Sobre la última se asume que implica en sí misma un problema filosófico al requerir un posicionamiento inicial respecto a qué es la filosofía. A partir de esto se revisan las distintas unidades de índole filosófica incluidas en los cuarenta y ocho diseños curriculares que componen el objeto de estudio y se las clasifica en categorías referidas a sus contenidos y denominaciones. Finalmente, se presentan y analizan fragmentos de las orientaciones didácticas, finalidades formativas y síntesis de las asignaturas que se incorporan en estas propuestas formativas con el nombre Filosofía. Desde estos documentos se evalúa la presencia y alcance del campo de la didáctica de la filosofía y sus conceptualizaciones en estas normativas.

ABSTRACT Foundation: Diabetes mellitus has been considered by the World Health Organization a serious health problem to be solved throughout the world. Its prevention and educating about it is essential. Objective: To describe an educational intervention on type 2 diabetes mellitus results in patients with risk factors. Methods: Intervention study, with a before and after design, which included 120 patients over 18 years of age with diabetes mellitus risk factors, belonging to Medical Office No. 6, in Nuevitas, Camagüey province. A survey was applied to measure the level of knowledge, before and after the educational intervention. The variables: age, educational level, knowledge about diabetes mellitus, risk factors and prevention were analyzed. Results: Women, university education level and those over 60 years of age predominated. At the beginning of the study, around 75% of the participants showed fair or low knowledge about diabetes mellitus, risk factors and prevention. All of these parameters increased above 85% after the intervention. Conclusions: A notable increase in knowledge about diabetes mellitus, its risk factors and how to prevent it was achieved. These types of strategies, applicable from the primary level of care, imply a benefit in the prevention of this and other non-communicable diseases.

RESUMEN Fundamento: La diabetes mellitus ha sido considerada por la Organización Mundial de la Salud un grave problema de salud por resolver en todo el orbe. Su prevención resulta imprescindible, y educar al respecto es fundamental. Objetivo: Describir resultados de una intervención educativa sobre diabetes mellitus tipo 2 en pacientes con factores de riesgo. Métodos: Estudio de intervención, con diseño de antes y después, que incluyó a 120 pacientes mayores de 18 años con factores de riesgo de diabetes mellitus, pertenecientes al Consultorio Médico No. 6, en Nuevitas, provincia de Camagüey. Se aplicó una encuesta para medir el nivel de conocimientos, antes y después de la intervención educativa. Se analizaron las variables edad, nivel de escolaridad, conocimiento sobre diabetes mellitus, factores de riesgo y prevención. Resultados: Predominaron las mujeres, el nivel de escolaridad universitario y los mayores de 60 años. Al inicio del estudio, alrededor del 75 % de los participantes mostró regular o bajo conocimiento sobre diabetes mellitus, factores de riesgo y prevención. Todos estos parámetros aumentaron por encima del 85 % después de la intervención. Conclusiones: Se logró un incremento notable de los conocimientos acerca de la diabetes mellitus, sus factores de riesgo y cómo prevenirla. Este tipo de estrategias, aplicables desde el nivel primario de atención, implican un beneficio en la prevención de esta y otras enfermedades no transmisibles.

ABSTRACT Non-communicable chronic diseases (NCDs) are considered one of the leading causes of death worldwide. During the COVID-19 pandemic, these diseases have been neglected due to the Brazilian Unified National Health System (BHUS) overload. In this context, this study aimed to analyze the bond between patients with NCDs and primary care during the COVID-19 pandemic while also seeking to identify the population's level of knowledge about health parameters and their relationship with the healthcare system. A cross-sectional and observational study was conducted, in which an online questionnaire was administered to collect socioeconomic information from patients and their bond with BHUS in the metropolitan region of Maringa, Parana, Brazil, encompassing individuals over 18 years of age. The survey was promoted on social media, and interested participants responded to the questionnaire, which addressed topics such as identification, medication use, disease information, knowledge about NCDs, and general data related to COVID-19. The obtained and analyzed responses revealed a low bond level between this population and primary care and a lack of knowledge about NCDs and their health during the pandemic. There was a notable decrease in seeking healthcare services during this period, which may be explained by the fear of contracting the novel coronavirus. This study is essential to understand patients' responses to public health challenges during the pandemic. It can become a valuable ally in dealing with future pandemics and endemic crises, enabling improvements in care and raising awareness among the population about NCDs and the healthcare system.

RESUMO As doenças crônicas não transmissíveis (DCNTs) são consideradas uma das principais causas de morte em todo o mundo. Durante a pandemia da COVID-19, essas doenças têm sido negligenciadas devido à sobrecarga das Unidades Básicas de Saúde (BHU). Neste contexto, o objetivo deste estudo é analisar o vínculo dos pacientes com DCNTs com a atenção primária durante a pandemia da COVID-19, ao mesmo tempo em que busca identificar o nível de conhecimento da população sobre os parâmetros de saúde e o relacionamento com o sistema de saúde. Realizou-se um estudo transversal e observacional, no qual foi aplicado um questionário online para coletar informações socioeconômicas dos pacientes e seu vínculo com as BHUs na região metropolitana de Maringá/PR, abrangendo indivíduos maiores de 18 anos. A divulgação foi realizada em mídias sociais e os interessados responderam ao questionário que abordou tópicos como identificação, uso de medicações, informações sobre doenças, conhecimento acerca das DCNTs e dados gerais relacionados à COVID-19. As respostas obtidas e analisadas revelaram um baixo nível de vínculo dessa população com a atenção primária, assim como uma falta de conhecimento sobre as DCNTs e a própria saúde durante a pandemia. Observou-se uma notável redução na procura por serviços de saúde durante esse período, o que pode ser explicado pelo receio da contaminação pelo novo coronavírus. Este estudo se apresenta como uma ferramenta importante para compreender a resposta dos pacientes frente aos desafios da saúde pública durante a pandemia. Ele pode se tornar um aliado valioso para lidar com futuras pandemias e crises endêmicas, possibilitando melhorias nos cuidados e na conscientização da população sobre as DCNTs e o sistema de saúde.

RESUMEN Las enfermedades crónicas no transmisibles (ENT) son consideradas una de las principales causas de muerte a nivel mundial. Durante la pandemia de COVID-19, estas enfermedades han sido desatendidas debido a la sobrecarga de las Unidades Básicas de Salud (UBS). En ese contexto, el objetivo de este estudio es analizar el vínculo entre los pacientes con enfermedades crónicas no transmisibles (ECNT) y la atención primaria durante la pandemia de COVID-19, buscando identificar el nivel de conocimiento de la población sobre los parámetros de salud y la relación con el sistema de salud. Se realizó un estudio transversal y observacional, en el que se aplicó un cuestionario en línea para recolectar información socioeconómica de los pacientes y su vínculo con las BHU en la región metropolitana de Maringá/PR, abarcando personas mayores de 18 años. La divulgación se realizó en las redes sociales y los interesados respondieron el cuestionario que abordó temas como identificación, uso de medicamentos, información sobre enfermedades, conocimientos sobre ECNT y datos generales relacionados con el COVID-19. Las respuestas obtenidas y analizadas revelaron un bajo nivel de vinculación de esta población con la atención primaria, así como un desconocimiento sobre las ECNT y su propia salud durante la pandemia. Hubo una notable reducción en la demanda de servicios de salud durante este período, lo que puede explicarse por el temor a la contaminación por el nuevo coronavirus. Este estudio se presenta como una herramienta importante para comprender la respuesta de los pacientes a los desafíos de salud pública durante la pandemia. Puede convertirse en un valioso aliado para enfrentar futuras pandemias y crisis endémicas, posibilitando mejoras en la atención y concientización de la población sobre las ECNT y el sistema de salud.

Editorial |EN The latest trends in qualitative research clamor to include practices that are ever more creative, more visual, more critical, more reflective, more collaborative, and even more multimodal. Rethinking and validating qualitative research as a more integral practice revives the original celebratory feeling related to qualitative research in its most intimate dimension: humanity. Why do we undertake qualitative research? Essentially, we engage in qualitative research to understand more and to understand better. In becoming closer to our humanity and the constructivist experiences that shape us on a daily basis, we forge ourselves as qualitative researchers in the constant search for the very meaning of the social phenomena relevant to our realities. Human, ever more human. Part of this human reality must bring with it significant doses of individual and collective reflection, of closeness to other latitudes, of constant criticality, of the systematic questioning as to the what, how and why of our qualitative research. We must investigate more on upcoming future trends so that they can form part of the conversation in the present. This conversation must include discussion about the effective and ethical use of communication and information technologies. It must question our data collection and analysis processes. Are we promoting free, safe, artistic, and symbolic spaces for our participants to explore their experiences and perceptions? Should we rethink the interview as an official mechanism for the collection of in-depth data? Could we think about other data collection techniques in which the participants can become the true protagonists of their own realities? Do we dare to rethink new trends that could guide participants in representing their realities more organically? As qualitative researchers, we must open ourselves to more participatory processes at community and regional levels; we must open the door to internationalization. We must, in turn, internalize conductive practices of reflective and critical questioning to challenge our own biases. Could the ethical and conscientious driving force in our work revolve around our self-awareness, our taking into account our own positioning in qualitative research studies? Could we celebrate open mindedness, embracing difference and embodying humility as fundamental pillars for those of us who dare to do qualitative research? Humble, ever more humble. Volume 20, Issue 1, of the journal New Trends in Qualitative Research, presents an enriching collection of these trends in qualitative research. Mohd Anis and Olisa (2024) present a pilot study that uses artificial intelligence in focus group processes as a mechanism to rethink data collection in a way that guarantees depth and scalability. Along similar lines, De Almeida et al. (2024) problematize pedagogical practices for teacher training and to guarantee the right to education in Brazil. Veras Meira and Fernandes (2024) reflect on decolonization and the need to institute new beliefs for a more emancipatory education. Picolo Gimenes et al. (2024) show how the use of the Drawing-Story Procedure promotes graphic expression through therapeutic play, and humanizes the collection of qualitative data, establishing ludic-affective links between children and nursing staff. Another study seeks to identify appropriate practices and strategies to minimize risks and impacts for patients who suffered from COVID-19 (Miranda et al., 2024). From Peru, an article reflects on the semantic and conceptual distinctions between theses, thesis reporting and scientific articles as academic practices in higher education, while another reflects on effective marketing strategies along with the challenges faced by some exporting companies in this nation. A research team from the University of Aveiro conducted a bibliometric and systematized study asking what is meant by plagiarism and self-plagiarism. In addition, a study carried out in Canada exemplifies creativity in qualitative research by using teaching innovation and research on primary school Social Science teachers. The authors Araújo-Oliveira et al. (2024) used socio-spatial analysis and the evaluation of musical works to promote professional development in teachers. Similarly, considerations rethinking the training of teachers in teacher-training colleges are presented, such that teachers can learn about the ontological, epistemological, and methodological dimensions of their educational research. Summers et al. (2024) make a reflective call for the collection of qualitative data on online contexts. Finally, presentation is made of an exploratory compilation of arts-based methods to assist in understanding the experiences of people working in care provision for the elderly. Techniques found in the compilation include the visual arts, photoelicitation and storytelling, among others. Such techniques deepened understanding of the emotional, psychological, and social perspectives of caregivers, while also promoting processes of self-reflection and dialogue in these. Such arts-based methods promise to position themselves as integral processes in qualitative research. The articles presented in this issue position qualitative research as a driving force focusing on reflection and the constant rethinking of the what, how and why of what we do. We hope that on reading this issue, you find more questions than you do answers, because we all owe ourselves this constant questioning, knowing that the conversation arising from qualitative research will always lead on to more. Reflective, ever more reflective.

Editorial |PT As novas tendências na investigação qualitativa clamam pela inclusão de práticas mais criativas, visuais, críticas, reflexivas, colaborativas e até mesmo multimodais. Repensar e validar a investigação qualitativa como uma prática mais integral é reviver o sentimento original de celebrar a investigação qualitativa desde a sua dimensão mais íntima: a humanidade. Porque fazemos investigação qualitativa? Essencialmente, fazemos investigação qualitativa para entender mais e melhor. Ao estarmos mais próximos da nossa humanidade e das experiências construtivistas que nos moldam dia após dia, forjamo-nos como investigadores qualitativos em busca constante do próprio significado dos fenómenos sociais relevantes para as nossas realidades. Humanos, ainda mais humanos. Parte desta realidade humana deve trazer consigo uma dose significativa de reflexão individual e coletiva, de proximidade com outras latitudes, de uma criticidade constante, de um questionamento sistemático sobre o quê, como e porquê fazemos investigação qualitativa. Devemos explorar mais as novas tendências para o futuro, para que sejam a conversa do presente. Esta conversa deve incluir o uso efetivo e ético das tecnologias de comunicação e informação, deve levantar questões sobre os nossos processos de recolha e análise de dados. Estamos a promover, nas nossas “personas” participantes, espaços livres, seguros, artísticos e simbólicos sobre as suas experiências e perceções? Será que devemos repensar a entrevista como o mecanismo oficial para a recolha de dados aprofundados? Pensamos noutras técnicas de recolha de dados onde as participantes sejam as verdadeiras protagonistas das suas realidades? Atrevemo-nos a repensar novas tendências que guiem as participantes a representar as suas realidades de uma forma mais orgânica? Como investigadores qualitativos, devemos abrir-nos a processos mais participativos a nível comunitário e regional; devemos abrir a porta à internacionalização. Devemos, por sua vez, internalizar práticas que conduzam a questionamentos reflexivos e críticos para desafiar os nossos próprios preconceitos. Será que o motor ético e de responsabilidade gira em torno da consciência que temos, tendo em conta o nosso posicionamento nos estudos de investigação qualitativa? Será que celebramos a mente aberta, abraçamos o distintivo e incorporamos a humildade como pilares fundamentais para aqueles que se atrevem a fazer investigação qualitativa? Humildes, ainda mais humildes No volume 20, número 1, da revista New Trends in Qualitative Research, apresenta-se uma coleção enriquecedora destas tendências em investigação qualitativa. Mohd Anis e Mohd (2024) apresentam um estudo piloto que utiliza a inteligência artificial em processos de grupos focais como mecanismo para repensar a forma de recolher dados, garantindo profundidade e escalabilidade. Na mesma linha, De Almeida et al. (2024)problematizam as práticas pedagógicas iniciais para treinar docentes e garantir o direito à educação no Brasil. Veras Meira e Fernandes (2024) refletem sobre a descolonização e a necessidade de instituir novas crenças para uma educação mais emancipadora. Picolo Gimenes et al. (2024) evidenciam como o uso de desenho-história promove a expressão gráfica através do jogo terapêutico e humaniza a recolha de dados qualitativos para estabelecer vínculos lúdico-afetivos entre as crianças e o pessoal de enfermagem. Outro estudo procura identificar práticas e estratégias apropriadas para minimizar riscos e impactos em pacientes que sofreram de COVID-19 (Miranda et al., 2024). Dois artigos com contexto peruano refletem sobre as distinções semânticas e conceptuais entre tese, relatório de tese e artigo científico, como práticas académicas no ensino superior, e sobre as estratégias de marketing eficazes, bem como os desafios enfrentados por algumas empresas exportadoras no Peru. Uma equipa de investigação da Universidade de Aveiro abordou a questão do que se entende por plágio e auto-plágio através de um estudo bibliométrico e sistematizado. Além disso, um estudo realizado no Canadá exemplifica a criatividade na investigação qualitativa ao usar a inovação no ensino e na investigação de professores do ensino primário em Ciências Sociais. Os autores Araújo-Oliveira et al.(2024) utilizaram a análise socioespacial e a avaliação de obras musicais para promover o desenvolvimento profissional dos professores. De forma semelhante, são apresentadas considerações revistas na formação de professores em escolas superiores, com o objetivo de que os docentes aprendam sobre as dimensões ontológicas, epistemológicas e metodológicas das suas investigações educativas. Summers et al. (2024) fazem um apelo reflexivo sobre a recolha de dados qualitativos em contextos online. Por último, apresenta-se uma compilação exploratória sobre métodos baseados nas artes para compreender as experiências vividas por pessoas remuneradas que cuidam de idosos. Dentro das técnicas encontradas na compilação, destacam-se as artes visuais, a fotoelicitação e a narração de histórias, entre outras. Estas técnicas aprofundaram as perspetivas emocionais, psicológicas e sociais das pessoas cuidadoras, promovendo nelas processos de autorreflexão e diálogo. Estes métodos baseados nas artes mantêm a promessa de se posicionarem como processos integrais na investigação qualitativa. Os artigos apresentados neste volume posicionam a investigação qualitativa como um motor centrado na reflexão e no constante reexame do quê, como e porquê fazemos o que fazemos. Esperamos que ao ler este volume tenha mais perguntas do que respostas, porque devemos a nós mesmos essa constante inquisição, porque a conversa sobre investigação qualitativa sempre dará para mais. Reflexivos, ainda mais reflexivos.

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Conocer los procedimientos didácticos que favorezcan adquirir de forma correcta el uso de la acentuación gráfica mediante el juego resulta muy relevante a nivel educativo para el niño. El objetivo del presente artículo es establecer la importancia de las estrategias lúdicas aplicadas para el aprendizaje de acentuación y tildación en el nivel primario. Para ello fue realizada una revisión sistemática de documentos y para el proceso de búsqueda se siguió la metodología PRISMA. El registro consistió en la revisión de documentos en Latindex, Dialnet, Scopus, SciELO y Elsevier, cuyo lapso de publicación se encuentre entre 2019 y 2023, como palabras clave fueron consideradas: estrategias, juegos, acentuación, primaria y ortografía, encontrándose 80 manuscritos en idioma español e inglés, de los cuales 30 fueron escogidos conforme a los criterios de inclusión. Los documentos afines a la revisión realizada muestran la importancia de introducir el juego como estrategia didáctica para conseguir que el estudiante de primaria aprenda a tildar y acentuar correctamente. Se concluye que, aunque las estrategias lúdicas de manera aislada no garantizan el aprendizaje integral respecto a competencias de acentuación y tildación, sí constituyen herramientas esenciales para alcanzar dicho aprendizaje.

Conhecer os procedimentos didáticos que auxiliam na aquisição correta do uso da acentuação gráfica por meio da brincadeira é muito relevante no nível educacional da criança. O objetivo deste artigo é estabelecer a importância das estratégias lúdicas aplicadas para a aprendizagem da acentuação e da acentuação no nível primário. Para tanto, foi realizada uma revisão sistemática de documentos e seguida a metodologia PRISMA para o processo de busca. O registro consistiu na revisão de documentos em Latindex, Dialnet, Scopus, SciELO e Elsevier, cujo período de publicação é entre 2019 e 2023, como foram consideradas palavras-chave: estratégias, jogos, acentuação, primária e ortografia, encontrando 80 manuscritos em espanhol e inglês idioma, dos quais 30 foram escolhidos de acordo com os critérios de inclusão. Os documentos relativos à revisão realizada mostram a importância da introdução do jogo como estratégia de ensino para garantir que os alunos do ensino fundamental aprendam a marcar e acentuar corretamente. Conclui-se que, embora as estratégias lúdicas isoladamente não garantam uma aprendizagem integral em termos de acentuação e habilidades de acentuação, constituem ferramentas essenciais para alcançar essa aprendizagem.

Knowing the didactic procedures that help to acquire the correct use of graphic accentuation through play is very relevant at an educational level for the child. This article aims to establish the importance of playful strategies applied for learning accentuation and accentuation at the primary level. For this purpose, a systematic review of documents was carried out, and the PRISMA methodology was followed during the search process. The registry consisted of the review of documents in Latindex, Dialnet, Scopus, SciELO, and Elsevier, whose publication period is between 2019 and 2023, as keywords were considered strategies, games, accentuation, primary and spelling, finding 80 manuscripts in Spanish and English, of which 30 were chosen according to the inclusion criteria. The documents related to the review carried out show the importance of introducing the game as a teaching strategy to ensure that primary school students learn to mark and accentuate correctly. It is concluded that although playful strategies in isolation do not guarantee comprehensive learning regarding accentuation and accentuation skills, they do constitute essential tools to achieve said learning.

RESUMEN Introducción: A nivel mundial, la cobertura de vacunación contra el COVID-19, así como contra la influenza es baja tanto en la población general como en los profesionales de la salud a pesar de que la vacuna es gratuita y obligatoria en el personal sanitario. Objetivo: Describir la cobertura de vacunación contra el COVID -19, y la influenza en personal de salud y administrativo de un hospital de referencia del Ministerio de Salud Pública y Bienestar Social en el periodo 2021-2022. Metodología: Estudio observacional descriptivo de corte trasverso. Se hizo la revisión de los registros del personal sanitario y administrativo del centro vacunatorio del Hospital Nacional de Itauguá de la campaña vacunal contra el COVID-19 y de anti-influenza en el periodo 2021- 2022. Resultados: De los 3.586 funcionarios, 999 (27,9 %) eran médicos, 1494 (41,7 %) personal de enfermería, 366 (10,2 %) otra categoría de personal sanitario, y 727 (20,3 %) personal administrativo. En forma global, el 86,5 % de los funcionarios recibió por lo menos las dos dosis que constituyen el esquema primario y el 73 % la dosis de refuerzo. El 2,1 % del personal no recibió ninguna dosis de vacuna anti covid-19, la cifra fue mayor en el personal administrativo (4,8 %). La cobertura de vacunación contra la influenza fue de 20 % en el 2021 y 25 % en el 2022. Discusión: Si bien cobertura de vacunación anti-COVID-19 fue comparable a otros países, la vacunación contra la influenza fue muy baja. Es urgente implementar estrategias dirigidas a aumentar la percepción de riesgo y aceptabilidad de las vacunas obligatorias para el personal sanitario.

ABSTRACT Introduction: Worldwide, vaccination coverage against COVID-19, as well as against influenza, is low both in the general population and in health professionals, despite the fact that the vaccine is free and mandatory for health personnel. Objective: To describe the COVID -19 and influenza vaccination coverage in health and administrative personnel of a reference hospital of the Ministry of Public Health and Social Welfare in the period 2021-2022. Methods: Cross-sectional descriptive observational study. Charts of the health and administrative personnel of the vaccination center of the Itauguá National Hospital of the COVID-19 and influenza vaccination campaign in the period 2021-2022 were reviewed. Results: Of the 3,586 personnel, 999 (27.9%) were medical personnel, 1,494 (41.7%) nursing personnel, 366 (10.2%) other category of health personnel, and 727 (20.3%) administrative personnel. Overall, 86.5% of the employees received at least the two doses that constitute the primary schedule and 73% the booster dose; 2.1% of the staff did not receive any dose of the anti COVID-19 vaccine, which was higher in the administrative staff (4.8%). Influenza vaccination coverage was 20% in 2021 and 25% in 2022. Discussion: Even though the vaccination coverage of anti-COVID-19 was comparable to other countries, vaccination anti-influenza was very low. It is urgent to implement strategies aimed at increasing the perception of risk and acceptability of mandatory vaccines for health personnel.

ABSTRACT Nowadays, the offer of specialized palliative care has been overcome by the demand, reason why care to patients with terminal illness or in end-of-life period is usually in charge of the doctor from primary care level. In that sense, primary palliative care includes the diagnosis, palliative treatment, early planning, administration and coordination of multidisciplinary interventions and referring to specialized care when it is necessary and the service is available. In this respect, some elements on the topic are shortly exposed in this work and, also, a practical and easy implementation algorithm in primary care is proposed that will allow identifying population suffering from pain in those stages, with differentiation as for neoplastic or non neoplastic affections.

RESUMEN En la actualidad, la oferta de cuidados paliativos especializados ha sido superada por la demanda, por lo cual la atención a pacientes con enfermedades en estado terminal o en fase final de la vida suele estar a cargo del médico del nivel primario de asistencia. En ese sentido, los cuidados paliativos primarios incluyen el diagnóstico, el tratamiento paliativo, la planificación anticipada, la gestión y coordinación de intervenciones multidisciplinarias y la transferencia a cuidados especializados cuando sea necesario y haya disponibilidad para ello. Al respecto, en este artículo se exponen brevemente algunos elementos sobre el tema y se propone, además, un algoritmo práctico y fácil de aplicar en la atención primaria, que permitirá identificar a la población aquejada por dolencias en esas etapas, con diferenciación en cuanto a afecciones neoplásicas o no neoplásicas.

Abstract Objective: It consisted of describing the dynamics of subsequent teenage pregnancy in a municipality with urban and rural communities in the state of Morelos, and the conditions that influence the change in the mother's life plan, through a qualitative perspective, the adolescent's perception of dating stage, your first pregnancy, second pregnancy and your social environment in your life plan. Materials and methods: Cross-sectional study with multiple methods, the quantitative phase allowed us to analyze the trend and rates of teenage pregnancy, the qualitative phase consisted of the application of semi-structured interviews, previously prepared, emptied into a matrix for analysis, carried out from discourse analysis. A database was built in Microsoft Excel 365. Subsequently, with Stata v.14.2, univariate and bivariate analysis was performed to obtain mean, standard deviation, proportions with 95% confidence intervals. Results: They were grouped by ages of 17-20 years old (n=160) and 15-16 years old (n=5), the predominant education, primary 25.49% and secondary 52.94%. 87.18% work at home as housewives. 69.88% have had 2 pregnancies and 23.49% have had 3 pregnancies, 64.46% have had 2 births and 7.23% have had 3 or more births. 16.88% reported 2 cesarean sections, for the 17-20 years old group and 40% in the 15-17 years old group. 21.69% reported an abortion. The intergenic period was 12 to 24 months. The median age of the mothers was 19 years old with a minimum age of 15 and a maximum of 20 years. In the 17 to 20 years old group, the median was 19 years old and in the 15 to 16 years old group, the median was 16 years old. Conclusions: Both the rate and prevalence of subsequent teenage pregnancies showed an irregular increase until 2019, before showing a decrease thereafter. Educational level is a determining factor for primary and subsequent teenage pregnancy.

Resumen Objetivo: Describir la dinámica del embarazo adolescente subsecuente en un municipio con comunidades urbanas y rurales del estado de Morelos, y las condicionantes que influyen en el cambio del plan de vida de la madre, mediante una perspectiva cualitativa. Materiales y métodos: Estudio transversal con métodos múltiples, la fase cuantitativa permitió analizar la tendencia y tasas de embarazo adolescente, la fase cualitativa consistió en la aplicación de entrevistas semiestructuradas, previamente elaboradas, vaciadas en una matriz para el análisis, realizado a partir del análisis del discurso. Se construyó una base datos en Microsoft Excel 365. Posteriormente, con Stata v.14.2 se realizó análisis uni-variado y bivariado para obtener media, desviación estándar, proporciones con intervalos de confianza del 95%. Resultados: Se agrupó por edades de 17-20 años (n=160) y 15-16 años (n=5), la escolaridad preponderante, primaria 25.49% y secundaria 52.94%. El 87.18% se ocupa en el hogar como ama de casa. El 69.88% ha cursado 2 embarazos y el 23.49 % 3 embarazos, el 64.46% ha tenido 2 partos y 7.23% 3 o más partos. El 16.88% refiere 2 cesáreas, para el grupo de 17-20 años y el 40% en el grupo de 15-17 años. El 21.69% reportó un aborto. El periodo intergenésico fue de 12 a 24 meses. La mediana de edad de las madres fue de 19 años con un mínimo de edad de 15 y un máximo de 20 años. En el grupo de 17 a 20 años, la mediana fue de 19 años y en el grupo de 15 a 16 años, la mediana fue de 16 años. Conclusiones: Tanto la tasa como la prevalencia de embarazos adolescentes posteriores mostraron un aumento irregular hasta 2019, antes de mostrar una disminución posteriormente. El nivel educativo es un factor determinante para el embarazo adolescente primario y posterior.

RESUMEN Objetivo: Este artículo tiene como propósito describir una estrategia para la formación de intereses profesionales pedagógicos en los estudiantes de la especialidad Maestro Primario de la Escuela Pedagógica de Camagüey. Métodos: Se emplearon los métodos de investigación siguientes: análisis de documentos, el histórico lógico, la observación y la modelación. Resultado: Los autores diseñaron y fundamentaron una estrategia que permitió la formación y consolidación de intereses profesionales pedagógicos a partir del fortalecimiento de la preparación teórica metodológica de los docentes y la familiarización progresiva de los estudiantes con el contenido de la profesión. Conclusión: La elevación del nivel de preparación de los docentes y la familiarización progresiva de los estudiantes en el contenido de la profesión favorecen la formación de intereses profesionales pedagógicos de los maestros en formación.

ABSTRACT Objective: This article aims at describing a pedagogical strategy for the education of pedagogical professional motives in primary teacher being trained at the Pedagogical School of Camagüey., Cuba. Methods: The authors rely on document analysis, historical and logical procedures, observation, and modeling. Results: The authors devise a pedagogical strategy that promotes the education of professional pedagogical motives based on teachers’ developmental procedures and a progressive immersion of trainees in professional tasks. Conclusion: Teachers’ development and progressive immersion of trainees in professional tasks promotes the education of motives towards pedagogical professional activity.

Abstract Background: Clavicle fractures represent 2.5-4% of all fractures observed in emergency services. 80% occurs in the middle third. Treatment by plating requires a higher level of evidence. Objective: To compare the functional outcomes of mid-shaft clavicle fractures managed with superior plating compared to anteroinferior plating. Trial Design: A randomized, double-blind, parallel, superiority clinical trial. Patients and methods: Patients with fractures of the clavicles AO15B1 and AO15B2 were studied. Patients were randomized to be treated with either 3.5 mm superior or anteroinferior plating. A rehabilitation program was designed for both groups. The primary outcome measure was the Disability of Arm, Shoulder, and Hand (DASH) score; secondary outcomes included pain, union rate, and complication rates. Results: Twenty-eight patients were studied and were eligible for analysis. Significant differences were found in the function assessed with the DASH score at 30 days for the superior plating compared with anteroinferior (43.74 vs. 29.26, respectively, p = 0.027), 60 days (23.97 vs. 11.18, p = 0.021), and 90 days (9.52 vs. 3.5, p = 0.016). One loosening with superficial infection was found with superior plating. Conclusions: Using an anteroinferior reconstruction plate in diaphyseal fractures offers better functional results than the upper plate in patients with fractures of the middle third of the clavicle.

Resumen Antecedentes: Las fracturas de clavícula comprenden el 2.5-4% de todas las fracturas observadas en los servicios de emergencia. El 80% se presentan en el tercio medio. La posición de la placa como tratamiento requiere mayor nivel de evidencia. Objetivo: Comparar los resultados funcionales de las fracturas diafisarias de clavícula manejadas con placa superior versus placa anteroinferior. Método: Ensayo clínico aleatorizado, doble ciego, paralelo, de superioridad. Se estudiaron pacientes con fractura diafisaria de clavícula AO15B1 y AO15B2. Se manejaron con placa de reconstrucción de 3.5 mm colocada en forma superior o anteroinferior. Se diseñó un programa de rehabilitación para ambos grupos. El resultado primario fue medido con el cuestionario DASH y los resultados secundarios incluyeron dolor, presencia de consolidación y complicaciones. Resultados: Fueron elegibles para análisis 28 pacientes. Se encontraron diferencias significativas de la escala DASH a los 30 días para la maniobra superior comparada con la inferior (43.74 vs. 29.26, respectivamente; p = 0.027), a los 60 días (23.97 vs. 11.18; p = 0.021) y a los 90 días (9.52 vs. 3.5; p = 0.016). Conclusiones: El uso de placa de reconstrucción anteroinferior en las fracturas diafisarias ofrece mejores resultados funcionales en comparación con la placa superior en pacientes con fracturas de tercio medio de clavícula.