Seeking a viable alternative to fossil fuels as the primary energy source, bioethanol has emerged as a promising second-generation fuel derived from lignocellulosic biomass. With Brazil ranking pineapple as the third most produced fruit in temporary crops, this study aims to assess the impact of chemical pretreatment techniques, specifically organosolv and diluted acid, on the residual biomass of Pérola pineapple peel to enhance bioethanol production. Employing an experimental design that incorporates temperature, reaction time, and varying concentrations of organic solvent, the study examines their effects on the susceptibility of the substrate to saccharification for future bioethanol generation. Factors such as alphacellulose, hemicellulose, and lignin were evaluated in triplicate and subjected to statistical analysis using the Tukey test with a confidence level of 95%. Upon application of the pretreatment methods, it was observed that the organosolv solvent approach (utilizing water and ethanol) with sulfuric acid exhibited superior sugar conversion, yielding the highest concentration of xylose at 9.13 g L-1. Additionally, the pretreated biomass contained 1.38 g L 1 of cellobiose, 3.11 g L-1 of arabinose, and 3.76 g L-1 of glucose. This technique demonstrates promising potential for obtaining fermentable sugars crucial for bioethanol production. source secondgeneration second generation crops techniques production temperature time alphacellulose hemicellulose 95 95% methods utilizing ethanol conversion 913 9 13 9.1 L1. L1 1. Additionally 138 38 1.3 cellobiose 311 3 11 3.1 L- arabinose 376 76 3.7 glucose 91 9. 31 3. 37 7

Summary: A methodology is proposed for the interpretation of gas emissions that come from the soil based on the integration of the primary actors in the production systems and members of the ecosystems. The methodology presents data in units that are easy to understand by people outside the study of gas emissions in different ecosystems and production systems, and optimizes the calculation of small and medium scale predictions through estimation with a high degree of ratio and mathematical adjustment. From the use of the ideal gas equation, it was possible to develop the methodology to obtain a conversion factor taking into account variables such as the pressure and temperature of the site where the gas quantification experiment is being carried out. With the aforementioned, it is easier to obtain the constant of the molar volume of the container used and data transformation to ensure compliance with basic statistical parameters such as normality, variance similar to zero, and confidence intervals with less deviation. The present methodological development represents a tool for the generation of data at the laboratory and plot level with mathematical support that facilitates the execution of mathematical models in comparison with other methodologies.

Resumen: Se propone una metodología para la interpretación de las emisiones de gases que proceden del suelo a partir de la integración de los actores primarios en los sistemas de producción e integrantes de los ecosistemas. La metodología presenta datos en unidades de fácil comprensión por personas ajenas al estudio de emisiones de gases en los distintos ecosistemas y sistemas de producción, optimiza el cálculo de predicciones a pequeña y mediana escala mediante la estimación con alto grado de razón y ajuste matemático. A partir del empleo de la ecuación general de los gases ideales se pudo desarrollar la metodología para obtener un factor de conversión teniendo en cuenta variables como la presión y temperatura del sitio donde se esté ejecutando el experimento de cuantificación de gases, con lo anterior se facilita la obtención de la constante del volumen molar propio del contenedor utilizado y la transformación de datos para garantizar el cumplimiento de parámetros estadísticos básicos como normalidad, varianza similar a cero e intervalos de confianza con menor desviación. El presente desarrollo metodológico representa una herramienta para la generación de datos a nivel de laboratorio y parcelario con soporte matemático que facilita la ejecución de modelos matemáticos en comparación con otras metodologías.

Resumen: Introducción: Las hospitalizaciones por Ambulatory Care Sensitive Conditions es un indicador que mide la utilización de los servicios hospitalarios por problemas de salud que podrían haber sido prevenidos en el primer nivel de atención. El concepto se refiere a los procesos en que la atención ambulatoria efectiva puede ayudar a disminuir los riesgos de hospitalización, en un segundo nivel de atención. El objetivo del estudio fue construir y validar una lista uruguaya de problemas de salud sensibles a cuidados ambulatorios (PSSCA) según CIE-10. Metodología: Para la construcción de la lista inicial de códigos de PSSCA se realizó una revisión de los listados existentes y se propuso un listado inicial que fue validado a través del Método Delphi. Se propone un listado de 99 códigos diagnósticos de PSSCA adaptado a nuestro entono sanitario. Los mismos permiten identificar y cuantificar problemas de salud que pueden producir hospitalizaciones potenciamente evitables mediante cuidados ambulatorios accesibes y oportunos en el primer nivel de atención. Resultados: Se conformó un panel de 12 expertos. A partir de los datos obtenidos, considerando los 99 diagnósticos clasificados por CIE-10, éstos se pueden subclasificar en función de si la patología es infecciosa o no, obteniendo un resultado general de 62 patologías en un total de 99 que pueden ser clasificadas como infecciosas, lo que se corresponde a un 62 %. Discusión: De la comparación de la lista uruguaya de PSSCA a la que hemos arribado y las listas validadas utilizadas para la construcción inicial del listado de patologías propuesto, podemos decir que la primera presenta un mayor porcentaje de coincidencia con la lista de patologías de Bello Horizonte. Podemos mencionar que la mayoría de los problemas de salud identificados con base en el listado de PSSCA, son sensibles de ser resueltos con la atención primaria oportuna y de calidad que podría evitar o disminuir de una manera significativa su hospitalización. Conclusiones: Este trabajo describe el proceso de construcción y validación de una lista de códigos de PSSCA adaptados al contexto uruguayo a través del método Delphi. Hemos arribado a un listado que comprende un total de 99 diagnósticos, agrupadas en un total de diecinueve categorías que considera la especificidad del contexto uruguayo del indicador.

Abstract: Introduction: Hospitalizations for Ambulatory Care Sensitive Conditions is an indicator that measures the use of hospital services for health problems that could have been prevented at the first level of care. The concept refers to the processes in which effective outpatient care can help reduce the risks of hospitalization, at a second level of care. The objective of the study was to build and validate a Uruguayan list of health problems sensitive to outpatient care (PSS-CA) according to ICD-10. Methodology: To construct the initial list of PSSCA codes, a review of the existing lists was carried out and an initial list was proposed that was validated through the Delphi Method. A list of 99 PSSCA diagnostic codes adapted to our healthcare environment is proposed. They make it possible to identify and quantify health problems that can lead to potentially avoidable hospitalizations through accessible and timely outpatient care at the first level of care. Results: A panel of 12 experts was formed. From the data obtained, considering the 99 diagnoses classified by ICD-10, these can be subclassified depending on whether the pathology is infectious or not, obtaining a general result of 62 pathologies in a total of 99 that can be classified as infectious, which corresponds to 62%. Discussion: From the comparison of the Uruguayan list of PSSCA that we have arrived at and the validated lists used for the initial construction of the proposed list of pathologies, we can say that the first presents a higher percentage of coincidence with the list of pathologies of Bello Horizonte . We can mention that most of the health problems identified based on the PSSCA list are sensitive to being resolved with timely and quality primary care that could prevent or significantly reduce hospitalization. Conclusions: This work describes the process of construction and validation of a list of PSSCA codes adapted to the Uruguayan context through the Delphi method. We have arrived at a list that includes a total of 99 diagnoses, grouped into a total of nineteen categories that consider the specificity of the Uruguayan context of the indicator.

Resumo: Introdução: As Internações por Condições Sensíveis à Atenção Ambulatorial são um indicador que mede a utilização de serviços hospitalares para problemas de saúde que poderiam ter sido evitados no primeiro nível de atenção. O conceito refere-se aos processos em que um atendimento ambulatorial eficaz pode auxiliar na redução dos riscos de internação, em um segundo nível de atenção. O objetivo do estudo foi construir e validar uma lista uruguaia de problemas de saúde sensíveis à atenção ambulatorial (PSS-CA) segundo a CID-10. Metodologia: Para construir a lista inicial de códigos PSSCA foi realizada uma revisão das listas existentes e foi proposta uma lista inicial que foi validada através do Método Delphi. É proposta uma lista de 99 códigos de diagnóstico PSSCA adaptados ao nosso ambiente de saúde. Permitem identificar e quantificar problemas de saúde que podem levar a hospitalizações potencialmente evitáveis através de cuidados ambulatórios acessíveis e oportunos no primeiro nível de cuidados. Resultados: Foi formado um painel de 12 especialistas. A partir dos dados obtidos, considerando os 99 diagnósticos classificados pela CID-10, estes podem ser subclassificados consoante a patologia seja infecciosa ou não, obtendo-se um resultado geral de 62 patologias num total de 99 que podem ser classificadas como infecciosas, o que corresponde para 62%. Discussão: A partir da comparação da lista uruguaia de PSSCA a que chegamos e das listas validadas utilizadas para a construção inicial da lista de patologias proposta, podemos dizer que a primeira apresenta um maior percentual de coincidência com a lista de patologias de Belo Horizonte. Podemos mencionar que a maioria dos problemas de saúde identificados com base na lista PSSCA são sensíveis para serem resolvidos com cuidados primários oportunos e de qualidade que possam prevenir ou reduzir significativamente a hospitalização. Conclusões: Este trabalho descreve o processo de construção e validação de uma lista de códigos PSSCA adaptados ao contexto uruguaio através do método Delphi. Chegamos a uma lista que inclui um total de 99 diagnósticos, agrupados em um total de dezenove categorias que consideram a especificidade do contexto uruguaio do indicador.

ABSTRACT Introduction: Arterial hypertension is a public health problem that mainly affects the adult population, which, together with low therapeutic adherence, limits the control of the pathology and achievement of therapeutic objectives. Objective: To determine the prevalence of therapeutic adherence in people with arterial hypertension and the relationship with behavioral and metabolic risk factors in primary health care in the city of Neiva, Colombia. Materials and methods: Cross-sectional analytical study with a sample of 335 randomly selected hypertensive adults attending a cardiovascular risk program. Behavioral and metabolic risk factors, anthropometric and clinical measurements, and the level of therapeutic adherence were evaluated. Stata 15 was used for statistical analysis, applying measures of central tendency and association. Results: Therapeutic adherence was 39.4% and a statistically significant association was found with adulthood (OR: 2.46; 95% CI: 1.49 - 4.05), education (OR: 3.14; 95% CI: 1 .82 - 5.42), taking 3 or fewer medications (OR: 2.09; 95% CI: 1.27 - 3.43) and with therapeutic objectives such as normal BM1, normotension and normoglycemia. Conclusions: The prevalence of therapeutic adherence was low, similar to that evidenced in other contexts of patients with chronic pathologies, associated with behavioral and metabolic factors.

RESUMO Introdução: A hipertensão arterial é um problema de saúde pública que atinge principalmente a população adulta, o que, aliado à baixa adesão terapêutica, limita o controle da patologia e o alcance dos objetivos terapêuticos. Objetivo: Determinar a prevalência de adesão terapêutica de pessoas com hipertensão arterial e a relação com fatores de risco comportamentais e metabólicos na atenção primária na cidade de Neiva, Colômbia. Materiais e métodos: Estudo analítico transversal, com amostra de 335 adultos hipertensos selecionados aleatoriamente e atendidos em programa de risco cardiovascular. Foram avaliados fatores de risco comportamentais e metabólicos, medidas antropométricas e clínicas e nível de adesão terapêutica. Para análise estatística foi utilizado o Stata 15, aplicando medidas de tendência central e associação. Resultados: A adesão terapêutica foi de 39,4% e foi encontrada associação estatisticamente significativa com idade adulta (OR: 2,46; IC 95%: 1,49 - 4,05), escolaridade (OR: 3,14; IC 95%: 1,82 - 5,42), uso de 3 ou menos medicamentos (OR: 2,09; IC 95%: 1,27 - 3,43) e com objetivos terapêuticos como IMC normal, normotensão e normoglicemia. Conclusões: A prevalência de adesão terapêutica foi baixa, semelhante à encontrada noutros contextos de doentes com patologias crónicas, associadas a factores comportamentais e metabólicos.

RESUMEN Introducción: La hipertensión arterial es un problema de salud pública que afecta principalmente a la población adulta, que, aunado a una baja adherencia terapéutica, limita el control de la patología y logro de objetivos terapéuticos. Objetivo: Determinar la prevalencia de la adherencia terapéutica de personas con hipertensión arterial y la relación con factores de riesgo conductuales y metabólicos en atención primaria de la ciudad de Neiva, Colombia. Materiales y métodos: Estudio analítico de corte transversal, con una muestra de 335 adultos hipertensos seleccionados de manera aleatoria, asistentes a un programa de riesgo cardiovascular Se evaluaron factores de riesgo conductuales y metabólicos, mediciones antropométricas, clínicas y el nivel de adherencia terapéutica. Para el análisis estadístico se usó Stata 15, aplicando medidas de tendencia central y de asociación. Resultados: La adherencia terapéutica fue 39,4% y se encontró asociación estadísticamente significativa con la adultez (OR: 2,46; IC 95%: 1,49 - 4,05), escolaridad (OR: 3,14; IC 95%: 1,82 - 5,42), tomar 3 o menos medicamentos (OR: 2,09; IC 95%: 1,27 - 3,43) y con objetivos terapéuticos como IMC normal, normotensión y normoglicemia. Conclusiones: La prevalencia de la adherencia terapéutica fue baja, similar a la evidenciada en otros contextos de pacientes con patologías crónicas, asociado a factores comportamentales y metabólicos.

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

Resumo Historicamente, são necessários, em média, 17 anos para que novos tratamentos passem da evidência clínica para a prática diária. Considerando os tratamentos altamente eficazes disponíveis atualmente para prevenir ou retardar o início e a progressão da doença renal, esse período é demasiadamente longo. Agora é o momento de reduzir a lacuna entre o que sabemos e aquilo que fazemos. Existem diretrizes claras para a prevenção e o manejo dos fatores de risco comuns para doenças renais, como hipertensão e diabetes, mas apenas uma fração das pessoas com essas condições é diagnosticada mundialmente, e um número ainda menor recebe tratamento adequado. Da mesma forma, a grande maioria das pessoas que sofrem de doença renal não têm conhecimento de sua condição, pois ela costuma ser silenciosa nos estágios iniciais. Mesmo entre pacientes que foram diagnosticados, muitos não recebem tratamento adequado para a doença renal. Levando em consideração as graves consequências da progressão da doença renal, insuficiência renal ou óbito, é imperativo que os tratamentos sejam iniciados precocemente e de maneira adequada. As oportunidades para diagnosticar e tratar precocemente a doença renal devem ser maximizadas, começando no nível da atenção primária. Existem muitas barreiras sistemáticas, que vão desde o paciente até o médico, passando pelos sistemas de saúde e por fatores sociais. Para preservar e melhorar a saúde renal para todos em qualquer lugar, cada uma dessas barreiras deve ser reconhecida para que soluções sustentáveis sejam desenvolvidas e implementadas sem mais demora. Historicamente necessários média 1 diária longo fazemos renais diabetes mundialmente forma condição iniciais diagnosticados óbito adequada maximizadas primária sistemáticas médico sociais lugar demora

Abstract Historically, it takes an average of 17 years for new treatments to move from clinical evidence to daily practice. Given the highly effective treatments now available to prevent or delay kidney disease onset and progression, this is far too long. Now is the time to narrow the gap between what we know and what we do. Clear guidelines exist for the prevention and management of common risk factors for kidney disease, such as hypertension and diabetes, but only a fraction of people with these conditions are diagnosed worldwide, and even fewer are treated to target. Similarly, the vast majority of people living with kidney disease are unaware of their condition, because it is often silent in the early stages. Even among patients who have been diagnosed, many do not receive appropriate treatment for kidney disease. Considering the serious consequences of kidney disease progression, kidney failure, or death, it is imperative that treatments are initiated early and appropriately. Opportunities to diagnose and treat kidney disease early must be maximized beginning at the primary care level. Many systematic barriers exist, ranging from the patient to the clinician to the health systems to societal factors. To preserve and improve kidney health for everyone everywhere, each of these barriers must be acknowledged so that sustainable solutions are developed and implemented without further delay. Historically 1 practice progression long diabetes worldwide target Similarly condition stages failure death appropriately level everywhere

Abstract Introduction The World Health Organization (WHO) estimates that ~ 32 million children worldwide are affected by hearing loss (HL). Cochlear implant is the first-line treatment for severe to profound sensorineural HL. It is considered one of the most successful prostheses developed to date. Objective To evaluate the oral language development of pediatric patients with prelingual deafness implanted in a reference hospital for the treatment of HL in southern Brazil. Methods We conducted a retrospective cohort study with a review of medical records of patients undergoing cochlear implant surgery between January 2009 and December 2018. Language development was assessed by reviewing consultations with speech therapy professionals from the cochlear implant group. Results A total of 152 children were included in the study. The mean age at cochlear implant surgery was of 41 months (standard deviation [SD]: ± 15). The patients were divided into six groups considering the type of language most used in their daily lives. We found that 36% of children use oral language as their primary form of communication. In a subanalysis, we observed that patients with developed or developing oral language had undergone cochlear implant surgery earlier than patients using Brazilian Sign Language (Língua Brasileira de Sinais, LIBRAS, in Portuguese) or those without developed language. Conclusion The cochlear implant is a state-of-the-art technology that enables the re-establishment of the sense of hearing and the development of oral language. However, language development is a complex process known to present a critical period to properly occur. We still see many patients receiving late diagnosis and treatment, which implies a delay and, often, the impossibility of developing oral communication. Level of Evidence Level 3 (cohort study). WHO (WHO . (HL) firstline first line date Brazil 200 2018 group 15 4 standard SD [SD] 15. 15) lives 36 communication subanalysis Língua Sinais LIBRAS Portuguese stateoftheart state art reestablishment re establishment However occur often study) (HL 20 201 1 [SD 2

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.

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 El objetivo del estudio fue determinar el nivel de conocimiento sobre enfermedades cardiovasculares en personas en un centro de salud del primer nivel de atención en salud (PNAS). Se realizó un estudio descriptivo y transversal mediante una encuesta a personas que asistieron a un establecimiento de salud del PNAS en Lima, Perú. Un puntaje menor a 6 se consideró como conocimiento inadecuado. Se encuestó a 400 personas, 66,3% mujeres, de 46,8 ± 16,2 años. La nota promedio fue de 4,52 +/- 1,85. El 71% de los encuestados tuvo un nivel de conocimiento inadecuado, independientemente de la edad, género o grado de instrucción. Nuestros hallazgos muestran que el nivel de conocimiento sobre los factores de riesgo y la enfermedad cardiovascular resultó inadecuado en la población en atención primaria. Es necesario lograr una educación específica en factores de riesgo cardiovascular, para reducir el impacto de estas enfermedades.

ABSTRACT This study aimed to determine the level of knowledge about cardiovascular diseases in people in a primary healthcare center (PHCC). A descriptive and cross-sectional study was carried out by surveying people who attended a PHCC in Lima, Peru. A score less than 6 was considered inadequate knowledge. A total of 400 people were surveyed, 66.3% were women and the mean age was 46.8 ± 16.2 years. The average score was 4.52 +/- 1.85. We found that 71% of those surveyed had an inadequate level of knowledge, regardless of age, gender or education level. Our findings show that the level of knowledge about risk factors and cardiovascular disease was inadequate in the primary care population. It is necessary to achieve proper specific education in cardiovascular risk factors in order to reduce the impact of these diseases.

Abstract The aim of this study was to identify factors associated with early identification of disabilities and developmental follow-up of children in primary health care (PHC) services under the Care Network for People with Disabilities (RCPCD). We conducted a cross-sectional study using data from a multicenter study undertaken in eight states. The data were collected using a structured questionnaire answered by PHC professionals with degree-level qualifications selected using random sampling and stratified by state and municipality. Poisson regression with robust variance was performed for the two outcomes. Of the 1,488 workers in the final sample, 63.6% performed early identification of disabilities and 49% provided developmental follow-up. Family health teams performed early identification of disabilities and follow-up more than traditional model teams, and expanded family health teams provided developmental follow-up more than both these teams. The factors that showed the strongest association with identification and developmental follow-up were profession, working in a family health team and knowledge of the RCPCD. followup follow up (PHC RCPCD . (RCPCD) crosssectional cross sectional states degreelevel degree level municipality outcomes 1488 1 488 1,48 sample 636 63 6 63.6 49 followup. up. profession (RCPCD 148 48 1,4 63. 4 14 1,

Resumo Objetivou-se identificar fatores associados à atenção à saúde infantil na atenção primária à saúde (APS), na perspectiva das ações preconizadas pela Rede de Cuidados à Pessoa Deficiência (RCPCD), quanto à identificação precoce de deficiências e acompanhamento do desenvolvimento infantil. Trata-se de estudo transversal, multicêntrico, realizado em oito estados brasileiros. A coleta de dados envolveu a aplicação de questionário estruturado com profissionais de saúde de nível superior atuantes na APS, com amostra aleatória estratificada por estado e município. Foram realizadas regressões de Poisson com variância robusta para duas variáveis resposta. Entre os 1.488 trabalhadores que compuseram a amostra final, 63,6% realizam ações de identificação precoce de deficiências e 49% efetuam acompanhamento do desenvolvimento infantil. As equipes de Saúde da Família (eSF) identificam e acompanham mais do que as equipes do modelo tradicional, e os Núcleos Ampliados de Saúde da Família e Atenção Básica realizam mais ações de acompanhamento do que essas equipes. Conclui-se que os fatores mais associados com a identificação e o acompanhamento de crianças com deficiências na APS foram aqueles relativos à formação profissional, à eSF e ao conhecimento de normativas relativas à RCPCD. Objetivouse Objetivou se , (APS) RCPCD, RCPCD (RCPCD) Tratase Trata transversal multicêntrico brasileiros município resposta 1488 1 488 1.48 final 636 63 6 63,6 49 (eSF tradicional Concluise Conclui profissional (APS (RCPCD 148 48 1.4 63, 4 14 1.

BACKGROUND: Despite inpatient rehabilitation many stroke survivors struggle with community reintegration on returning home. The environment to which the stroke survivor returns affects and may limit participation in home and community-based activities. AIM: To describe stroke survivors' lived experiences of the environmental barriers and facilitators to community reintegration in an under resourced urban metropolitan sub-district in the Western Cape, South Africa. METHODS: A descriptive, qualitative study design with a phenomenological emphasis used semi-structured interviews to collect the data from purposefully selected stroke survivors who had been discharged for more than one year following inpatient rehabilitation. Supporting data were collected from interviews with two occupational therapists providing rehabilitation services to the stroke survivors. Deductive priori coding of semi-structured interviews with 11 stroke survivors, based on the environment subsystems described in the Person-Environment-Occupation-Performance (PEOP) model explored the barriers and facilitators to their community reintegration. FINDINGS: Of the six environmental sub systems in the PEOP model the systems and policy, access to information and health education, social determinants of health in the form of poor rehabilitation planning and loss of income as well as the built and natural environment presented the greatest barriers to the stroke survivor participants' community reintegration. However, reintegration was facilitated by social support and social capital, social determinants of health in the form of support groups as well as assistive technologies. CONCLUSION: Community reintegration continues to be a challenge for stroke survivors in an under-resourced urban sub-district due to environmental barriers associated with factors such as poor social support, inadequate implementation of policies and systems, poor compliance with home programmes, low socioeconomic status, poor access within the built and natural environment and inappropriate assistive devices. Several facilitators that occupational therapists can focus on to enable community reintegration included ensuring effective social support, access to community-based organisations, the introduction of home visits and provision of appropriate assistive devices. IMPLICATIONS FOR PRACTICE All stroke survivors must receive a comprehensive discharge plan to facilitate adequate access to continued rehabilitation and support for successful community reintegration. • There must be a specific referral to primary health care rehabilitation services on discharge from hospital. • Occupational therapists at community level have the responsibility to: o advocate for, or assist stroke survivors to self-advocate, the removal of inter-sectoral environmental barriers that limit their community reintegration and community participation, o where possible provide services in the home and involve midlevel workers when conducting home visits to enable successful reintegration into the home and resumption of occupational roles where possible, o look to other resources in their community that can assist in facilitating the community reintegration of stroke survivors to enable access to health, education, productive activities, and social and leisure participation opportunities, o improve their collaboration with the communities that they service.

Resumen La moderna Sociedad del Conocimiento percibe una innovadora característica basada en manejar los contenidos curriculares, potenciando el pensamiento lógico matemático por medio de plataformas y aplicaciones digitales. El objetivo del presente trabajo se centraliza en analizar estrategias didácticas aplicadas por docentes para potenciar las habilidades matemáticas en los estudiantes del nivel de Bachillerato General Unificado dentro de la Unidad Educativa “Eidan Abel Erique Cercado” del cantón San Vicente. El aspecto metodológico se basó en el enfoque mixto, empleando como instrumento primordial una prueba pedagógica que mide las destrezas del pensamiento numérico, así como los indicios de una entrevista semi estructurada y los aportes de docentes del área de matemáticas como participantes dentro de un grupo focal. Se comprobó la predisposición para un trabajo orientado bajo la plataforma Khan Academy, necesaria para beneficiar las habilidades del pensamiento numérico poco perfeccionadas en el estudiante. Finalmente, se denotaron aquellas estrategias empleadas por los docentes las cuales no afirman una estimulación consistente para potenciar las habilidades numéricas, demostradas bajo un nivel poco aceptable en el afianzamiento de la resolución de problemas con enfoque matemático en los estudiantes.

Abstract The modern knowledge society perceives an innovative characteristic based on managing curricular contents, promoting mathematical logical thinking through digital platforms and applications, the purpose of this work is focused on determining the existing perception with the use of the Khan Academy platform in the mathematical skills and how teachers focus didactic strategies to enhance mathematical skills in students of the Unified General Baccalaureate level within the "Eidan Abel Erique Cercado" Educational Unit of the San Vicente canton. The methodological aspect was based on the paradigm of the mixed approach, using as a primary instrument a pedagogical test that measures the skills of numerical thinking, as well as the indications of a semi-structured interview and the contributions of teachers in the area of mathematics as participants within a focus group. The predisposition for a work oriented under the Khan Academy platform, necessary to benefit the slightly improved numerical thinking skills in the student, was verified. Finally, those strategies used by teachers were denoted which do not affirm a perennial stimulation to enhance numerical skills, demonstrated under an unacceptable level in the consolidation of problem solving with a mathematical approach in students.

ABSTRACT Introduction: Oral health is crucial for children's development, speech, nutrition, and self-esteem. Maintaining good oral health during childhood prevents serious dental issues in adulthood and reduces the need for costly treatments later on. Objective: To assess the knowledge level, attitudes, and practices regarding oral health among children aged 6 to 12 years at a school located in the metropolitan area of Asunción. Results: A total of 202 children participated in the study, of whom 51.0% were male, with a mean age of 9 years (SD = 4.24 years). Approximately 55% of the children had gingivitis. Primary teeth cavities were present in 35.6% of the participants, while 48.9% had cavities in their permanent teeth. Regarding dietary knowledge, 98.02% of the participants correctly identified foods harmful to dental health. Most children learned brushing techniques from their parents; however, consistent parental supervision was reportedly lacking. Conclusion: Despite demonstrating good knowledge and generally adequate oral hygiene practices, nearly half of the children had cavities in their permanent teeth. The data suggest that the lack of regular parental supervision of brushing techniques could be a significant contributing factor to dental caries.

RESUMEN Introducción: La salud bucal en niños es esencial para su desarrollo, habla, nutrición y autoestima. Además, previene problemas odontológicos graves en la edad adulta y evita costosos tratamientos futuros. Objetivo: Determinar el nivel de conocimiento, actitud y práctica sobre salud oral en niños de 6 a 12 años de una escuela del área metropolitana de Asunción. Resultado: Participaron 202 niños, donde el 51,0% correspondió al sexo masculino, con edad media de 9 ± 4,24 años. El 55% de los niños presentó gingivitis. El 35,6% posee caries en dientes primarios mientras que el 48,9% presenta caries en dientes permanentes. El 98,02% de los participantes respondió correctamente la pregunta sobre alimentos perjudiciales para los dientes. Sobre la práctica de higiene bucal, en la mayoría de los niños la enseñanza de la técnica de cepillado estuvo a cargo de los padres, sin embargo, reportan que estos no siempre los controlan. Conclusión: Los niños tuvieron buen conocimiento, actitud positiva y prácticas adecuadas de higiene bucal, sin embargo, la mitad de ellos presentaba caries en dientes permanentes. Se sugiere que la falta de supervisión diaria por parte de los padres en la técnica de cepillado podría ser un factor contribuyente.

RESUMEN Introducción: La Organización Mundial de la Salud considera al síndrome doloroso lumbar la primera causa de consulta a nivel mundial, representa un importante problema de salud por su impacto, magnitud y repercusión socioeconómica; constituye la principal causa de vivir con discapacidad durante años, genera alto costo económico por incapacidades otorgadas, gastos en medicamentos y rehabilitación. Una de las principales causas del desarrollo de esta patología es la exposición a agentes ergonómicos en el trabajo. Objetivo: Evaluar la detección del síndrome doloroso de etiología laboral en Mexicali en el año 2022, con posterioridad a una intervención educativa. Métodos: Estudio cuasi experimental en médicos familiares adscritos al Órgano de Operación Administrativa Desconcentrada de Baja California en Mexicali, a quienes se realizó una intervención educativa y posteriormente se cuantificaron los casos detectados de Síndrome doloroso lumbar de etiología laboral en Mexicali en el año 2022; analizando el historial estadístico y comparándolo con el reportado posterior a la intervención educativa. Se midió el nivel de conocimiento con un cuestionario exprofeso antes y después de la intervención. Resultados: La detección del síndrome doloroso lumbar de etiología laboral se incrementó posterior a la intervención educativa realizada en 114 médicos familiares, el nivel de conocimiento sobre esta patología incremento el promedio inicial del 94 al 100 % posterior a la intervención en las 5 unidades de medicina familiar. Sobre este síndrome predominaron: la edad de 31 a 50 años, el sexo masculino y las ocupaciones de operadores de maquinaria industrial, choferes, mecánicos y técnicos en mantenimiento. Conclusiones: La intervención educativa a los médicos de primer nivel de atención mejora la detección del síndrome doloroso lumbar de etiología laboral.

ABSTRACT Introduction: The World Health Organization considers lumbar pain syndrome the first cause of consultation worldwide, it represents an important health problem due to its impact, magnitude and socioeconomic repercussion; It constitutes the main cause of living with a disability for years, generates a high economic cost due to disabilities granted, expenses in medicines and rehabilitation. One of the main causes of the development of this pathology is exposure to ergonomic agents at work. Objective: To evaluate after an educational intervention, Pain Syndrome of occupational etiology in Mexicali in the year 2022. Methods: Quasi-experimental study in family doctors assigned to the Deconcentrated Administrative Operation Body of Baja California in Mexicali, to whom an educational intervention was carried out and subsequently the detected cases of Lumbar Pain Syndrome of occupational etiology in Mexicali in the year 2022 were quantified; analyzing the statistical history and comparing it with that reported after the educational intervention. The level of knowledge was measured with an express questionnaire before and after the intervention. Results: The detection of lumbar pain syndrome of occupational etiology increased after the educational intervention carried out in 114 family physicians, the level of knowledge about this pathology increased the initial average from 94 % to 100 % after the intervention in the 5 family medicine units. Regarding this syndrome, the following prevailed: the age of 31 to 50 years, the male sex and the occupations of industrial machinery operators, drivers, mechanics and maintenance technicians. Conclusions: The educational intervention for primary care physicians improves the detection of low back pain syndrome of occupational etiology.

Resumen Este artículo versa sobre el contexto histórico y las características de funcionamiento de la Universidad de Buenos Aires entre los años 1958 y 1962, durante la presidencia de Arturo Frondizi a nivel nacional y del rectorado de su hermano Risieri Frondizi en la Universidad de Buenos Aires (UBA). En especial, se describe y analiza a la teoría desarrollista en relación con lo sucedido en la UBA en el período de tiempo citado con el objetivo de evidenciar continuidades y rupturas entre ambos elementos. Este es un estudio de caso a través de los archivos de Sesiones del Concejo Superior de la Universidad, los Archivos de la Universidad de Buenos Aires y otras fuentes -primarias y secundarias- que permitieron complementar el abordaje.

Abstract This article deals with the historical context and the characteristics of the operation of the University of Buenos Aires between 1958 and 1962, during the presidency of Arturo Frondizi at the national level and the rectorate of his brother Risieri at the University of Buenos Aires. In particular, the development theory is described and analyzed in relation to what happened in the UBA in the aforementioned period of time with the aim of evidencing continuities and ruptures between both elements. This is a case study through the files of Sessions of the Superior Council of the University, the Archives of the University of Buenos Aires and other sources -primary and secondary- that allowed to complement the analysis carried out here.