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

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

ABSTRACT Introduction: the postgraduate educational climate (CE) in the hospital environment can determine the way in which resident physicians (MRs) adapt to their new stage, during which professional burnout syndrome (PAS) is highly likely to occur at some point. Objective: to determine the relationship between the educational climate and professional burnout in physicians in the medical residency programs of the National Hospital 2023-2024. Methodology: cross-sectional observational study of a sample of MR convenience of both sexes from all medical specialties of the National Hospital between November 2023 and January 2024, MR with external rotation and/or vacations were excluded. Sample calculation; 136 MR. An online form from Google was sent to the MR email requesting voluntary participation. The SAP was measured with the standard Maslach Burnout Inventory (MBI) method with subscales; emotional exhaustion (EA), depersonalization (DESP), personal fulfillment (PR), with PAS with high scores of AE, DESP and low RP. The EC was assessed with the measure of the hospital postgraduate educational environment (PHEEM) with subscales; perception of role autonomy (PAR), perception of teaching (PE), perception of social support (PSS), the higher the score, the better the EC. Demographic and academic variables, MBI and PHEEM scores were collected, and the SAP was considered dependent, as the main result was the predictive relationship of the PHEEM on the SAP. Data were compared with χ², t-test or Mann-Whitney U, ANOVA and linear regression (p-significant value =<0.05). Results: of 233 participants, the mean age was 28.75 (±2.20), 63.94 % (149) women, the general prevalence of PAS; 70.38 % (164/233), PAS in men 75 % (63/84) and women 67.78 % (101/149) p=0.0014, the first 2 years with the highest frequency of PAS; 65 (85.52 %), 59 (86.76 %) respectively p=0.0009, 63 (90 %) p=0.0071 surgical specialties. The subscales of the MBI, the AE; 79.82 % (186) with an average of 35.39 (± 11.61) points. The CE of MRs with SAP; 107.9 (19.6) dots and without PAS; 136.3 (12.1) dots 95 % CI 18.1-25.0 p= 0.0001. The PHEEM predicted the AE with R2=0.619, B= -0.18 (±0.009) p=0.001, and the DESP; R2= 0.385, B= -0.001(0.004) p=0.009, PSS being a significant predictor with inverse correlation in both. Conclusion: there is an inverse relationship between the educational climate and burnout syndrome in the population studied, with a high prevalence of burnout in male residents of surgical specialties, with the social support of the hospital educational environment being a significant predictor for the development of burnout syndrome.

RESUMEN Introducción: el clima educacional (CE) de posgrado en el ambiente hospitalario puede determinar la manera en como los médicos residentes (MR) se adaptan a su nueva etapa, durante el cual el sindrome agotamiento profesional (SAP) es altamente probable de producirse en algún momento. Objetivo: determinar la relación entre el clima educacional y el agotamiento profesional en médicos de los programas de residencias médicas del Hospital Nacional 2023-2024. Metodología: estudio observacional transversal de una muestra por conveniencia de MR de ambos sexos de todas las especialidades médicas del Hospital Nacional entre noviembre 2023 y enero 2024, se excluyeron MR con rotación externa y/o vacaciones. Calculo muestral; 136 MR. Se envío un formulario en línea de Google al correo electrónico del MR solicitando la participación voluntaria. El SAP fue medido con el método estándar Maslach Burnout Inventory (MBI) con subescalas; agotamiento emocional (AE), despersonalización (DESP), realización personal (RP), existiendo SAP con puntuaciones altas de AE, DESP y bajas de RP. El CE fue valorado con la medida del entorno educativo de posgrado hospitalario (PHEEM) con subescalas; percepción autonomía de roles (PAR), percepción enseñanza (PE), percepción soporte social (PSS), a mayor puntaje mejor CE. Se recopiló variables demográficos, académicos, puntajes del MBI y PHEEM, el SAP fue considerado dependiente, como resultado principal la relación predictiva del PHEEM sobre el SAP. Se compararon datos con χ², prueba t o U de Mann-Whitney, ANOVA y regresión lineal (p-valor significativo =<0,05). Resultados: de 233 participantes, la edad media fue de 28,75 (± 2,20), el 63,94 % (149) mujeres, la prevalencia general del SAP; 70,38 % (164/233), SAP en hombres 75 % (63/84) y mujeres 67,78 % (101/149) p=0,0014, los 2 primeros años con mayor frecuencia de SAP; 65 (85,52 %), 59 (86,76 %) repectivamente p=0,0009, de especialidades quirúrgicas 63 (90 %) p=0,0071. Las subescalas del MBI el AE;79,82 % (186) con un promedio de 35,39 (± 11,61) puntos. El PHEEM de los MR con SAP; 107,9(( 19,6) puntos y sin SAP; 136,3(( 12,1) puntos IC 95 % 18,1-25,0 p= 0,0001. El PHEEM predijo el AE con R2=0,619, PPS; B= -0,18 (±0,009) p=0,001, y la DESP; R2= 0,385, PPS; B= -0,001 (±0,004) p=0,009 siendo PSS predictor significativo con correlación inversa en ambas. Conclusión: existe relación inversa entre el clima educativo y el sindrome de agotamiento profesional en la población estudiada, con alta prevalencia de este en residentes hombres de especialidades quirúrgicas, siendo el soporte social del ambiente educativo hospitalario un predictor significativo para el desarrollo del sindrome de agotamiento profesional.

ABSTRACT Introduction: body mass index and abdominal perimeter are anthropometric measurements that could be concordant in the Peruvian population for screening for overweight or obesity. Objective: to analyze the correlation and agreement between body mass index and abdominal circumference tests for the detection of overweight or obesity in Peruvian adults. Methodology: observational, analytical and cross-sectional study based on data from the national demographic family health survey. The population was 28,960 adults. The variables were: body mass index and abdominal perimeter. Cramer's V test, student's t, Spearman's correlation and Cohen's kappa were used. Results: there was a strong association between body mass index and abdominal perimeter in women (V=0.701), moderate in men (V=0.632). In Cohen's kappa test, both variables agreed substantially in women (kappa=0.677) and moderately in men (kappa=0.580). Using the Odds Ratio, women with a high body mass index had a 97.22 times greater probability of having a high abdominal circumference, while in men with a high body mass index it was 110.76 times greater. The Spearman correlation was very high and positive in both sexes. Conclusions: abdominal circumference and body mass index are significantly associated and correlated in Peruvian adults; they presented substantial agreement in women and moderate agreement in men. It is suggested to prioritize the use of the abdominal perimeter, because it distinguishes overweight or obesity according to sex, optimizing it by determining a cut-off point adjusted to the Peruvian population.

RESUMEN Introducción: el índice de masa corporal y el perímetro abdominal son medidas antropométricas que podrían ser concordantes en la población peruana para el cribado de sobrepeso u obesidad. Objetivo: analizar la correlación y concordancia entre las pruebas de índice de masa corporal y perímetro abdominal para la detección de sobrepeso u obesidad en adultos peruanos. Metodología: estudio observacional, analítico y transversal basado en datos de la encuesta nacional demográfica de salud familiar. La población fue de 28960 adultos. Las variables fueron: índice de masa corporal y perímetro abdominal. Se utilizó la prueba V de Cramer, t de student, correlación de Spearman y kappa de Cohen. Resultados: hubo una asociación fuerte entre índice de masa corporal y perímetro abdominal en mujeres (V=0,701), moderada en hombres (V=0,632). En la prueba kappa de Cohen, ambas variables concordaron sustancialmente en mujeres (kappa=0,677) y moderadamente en hombres (kappa=0,580). Mediante el Odds Ratio, las mujeres con índice de masa corporal elevado tuvieron una probabilidad 97,22 veces mayor de perímetro abdominal elevado, mientras que en hombres con índice de masa corporal elevado fue 110,76 veces mayor. La correlación de Spearman fue muy alta y positiva en ambos sexos Conclusiones: el perímetro abdominal y el índice de masa corporal están asociados y correlacionados significativamente en adultos peruanos, presentaron una concordancia sustancial en mujeres y moderada en hombres. Se sugiere priorizar el uso del perímetro abdominal, debido a que distingue sobrepeso u obesidad según sexo, optimizándolo mediante la determinación de un punto de corte ajustado a la población peruana.

Abstract Introduction: Positive mental health involves a mix of personal and psychosocial resources, as well as attitudes, affections, and positive behaviors that allow the person to face the challenges that arise in life, at a personal, family, social, and school level. Objective: Determine the association between personal factors and positive mental health in high school students during COVID-19. Methodology: Descriptive correlational study. Intentional non-probabilistic sampling. The sample consisted of 210 students of both sexes, ages 15 to 19, enrolled in cycle 2022-1 of the morning shift. Adolescents with visual conditions were excluded. A personal factors study and Positive Mental Health Scale were applied, with prior assent and informed consent. The statistical analysis was descriptive and inferential Results: The students were 64.8% female, 76.1% were under 17 years of age, 53.3% were in the sixth semester, 42% presented COVID-19 and 45% reported losses due to COVID-19. Global positive mental health was low in 50.5% of students. There was a significant positive statistical association in overall positive mental health with sex p=0.01, and a negative one with suffering from a mental illness p=0.01 and having family members who suffered from a mental illness p=0.05. Conclusion: Mental health of young people was not very positive. It needs to be studied to generate nursing interventions for promotion and prevention of school health to result in effective stress management of young people who are in high school when considering the family, society, and the educational field.

Abstrato Introdução: A saúde mental positiva envolve um conjunto de recursos pessoais e psicossociais, atitudes, afetos e comportamentos positivos que permitem à pessoa enfrentar os desafios que surgem na vida, a nível pessoal, familiar, social e escolar. Objetivo: Determinar a associação entre fatores pessoais e saúde mental positiva em estudantes do ensino médio em tempos de COVID-19. Metodologia: Estudo descritivo, preditivo e correlacional. Amostragem não probabilística intencional, amostra 210 estudantes de ambos os sexos, com idades entre 15 e 19 anos, matriculados no ciclo 2022-1 do turno da manhã. Foram excluídos os adolescentes com problemas visuais. Foram aplicados inquérito de fatores pessoais e Escala de Saúde Mental Positiva, com prévio assentimento e consentimento informado. A análise estatística foi descritiva e inferencial. Resultados: Os alunos eram 64,8% do sexo feminino, 76,1% tinham menos de 17 anos, 53,3% estavam no sexto semestre, 42% apresentaram COVID-19 e 45% relataram perdas por COVID-19. A saúde mental positiva global foi baixa em 50,5% dos estudantes. Houve associação estatística positiva significativa na saúde mental geral positiva com sexo p=0,01, e negativa com sofrer de doença mental p=0,01 e ter familiares que sofriam de doença mental p=0,05. Conclusão: A saúde mental positiva dos jovens foi baixa, necessita ser estudada para gerar intervenções de enfermagem na promoção e prevenção da saúde escolar para promover o enfrentamento eficaz do manejo do estresse dos jovens que estão no ensino médio quando se considera a família, a sociedade e o campo educacional.

Resumen Introducción: La salud mental positiva involucra una mezcla de recursos personales y psicosociales, actitudes, afectos y comportamientos positivos que permiten a la persona enfrentar los retos que se le presentan en la vida, a nivel personal, familiar, social y escolar. Objetivo: Determinar la asociación entre factores personales y la salud mental positiva en estudiantes de bachillerato en tiempos de COVID-19. Metodología: Estudio descriptivo correlacional. Muestreo intencional no probabilístico, en una muestra de 210 estudiantes de ambos sexos, edades de 15 a 19 años, inscritos en ciclo 2022-1 del turno matutino. Se excluyeron adolescentes con afecciones visuales. Se aplicó encuesta de factores personales y Escala de Salud Mental Positiva, previo asentimiento y consentimiento informado. El análisis estadístico fue descriptivo e inferencial. Resultados: Los estudiantes fueron 64.8 % del sexo femenino, 76.1 % eran menores de 17 años, 53.3 % cursaban sexto semestre, 42 % presentó COVID-19 y 45 % manifestó pérdidas por Covid-19. La salud mental positiva global fue baja en 50.5 % de los estudiantes. Hubo asociación estadística significativa positiva en salud mental positiva global con sexo p=0.01, y negativa con padecer alguna enfermedad mental p=0.01 y contar con familiares que padecían alguna enfermedad mental p=0.05. Conclusión: La salud mental positiva de los jóvenes fue baja, se requiere ser estudiada para generar intervenciones de enfermería en promoción y prevención de la salud escolar para favorecer un afrontamiento efectivo del manejo el estrés de los jóvenes que cursan bachillerato al considerar a la familia, la sociedad y al ámbito educativo.

Resumo: Introdução: A doença hepática gordurosa não alcoólica é uma das principais causas de doença hepática. A citoqueratina 18 surge como um marcador não invasivo para avaliação de fibrose hepática. O objetivo do trabalho foi validar o uso da citoqueratina 18 no sangue periférico no diagnóstico e evolução de pacientes com doença hepática gordurosa não alcoólica. Metodologia: Para validar a citoqueratina 18 no diagnóstico, foi realizado um estudo caso-controle. O grupo caso foi composto por pacientes maiores de 18 anos, de ambos os sexos, com diagnóstico de doença hepática gordurosa não alcoólica ligada à síndrome metabólica, recrutados entre 02/02/2019 a 02/02/2020. O grupo controle eram doadores de sangue. Eles foram comparados em 1 a 1 por idade e sexo. A citoqueratina 18 foi quantificada no sangue periférico de ambos os grupos. Para validar a citoqueratina 18 na evolução de pacientes com doença hepática gordurosa não alcoólica, foi realizado um estudo prospectivo e longitudinal. O grupo de pacientes recrutados foi acompanhado durante um ano sob tratamento padrão, ao final do qual a citoqueratina 18 foi quantificada no sangue periférico. As variáveis contínuas são expressas com média e desvio padrão. Foi analisado com teste t de Student, erro α < 5%. Resultados: Compõem o grupo caso 13 pacientes (12 mulheres), 53 ± 11 anos, com IMC 35,01 ± 8,9 kg/m2. O valor de citoqueratina 18 pré-tratamento foi de 1410 ± 120 UI e o valor pós-tratamento foi de 117 ± 56, p < 0,005. O grupo controle foi de 13 pessoas (12 mulheres), 43,4 ± 8,1 anos e IMC 28,10 ± 5,4 kg/m2 O valor da citoqueratina 18 foi de 193 ± 7,2 UI, p < 0,005 vs. grupo de casos pré-tratamento. Conclusões: A citoqueratina 18 é maior em pacientes com doença hepática gordurosa não alcoólica, sendo estatisticamente significativa, e diminui com o tratamento com significância estatística, podendo se tornar um marcador útil neste grupo de pacientes.

Abstract: Introduction: Nonalcoholic fatty liver disease is one of the main causes of liver disease. Cytokeratin 18 emerges as a non-invasive marker for the assessment of liver fibrosis. The objective of the work was to validate the use of cytokeratin 18 in peripheral blood in the diagnosis and evolution of patients with non-alcoholic fatty liver disease. Methodology: To validate cytokeratin 18 in the diagnosis, a case-control study was carried out. The case group was patients over 18 years of age, of both sexes, with a diagnosis of non-alcoholic fatty liver disease linked to metabolic syndrome, recruited between 2/2/2019 to 2/2/2020. The control group were blood donors. They were matched 1-1 for age and sex. Cytokeratin 18 was quantified in peripheral blood of both groups. To validate cytokeratin 18 in the evolution of patients with non-alcoholic fatty liver disease, a prospective, longitudinal study was carried out. The group of patients recruited were followed for one year under standard treatment, at the end of which cytokeratin 18 was quantified in peripheral blood. Continuous variables are expressed with the mean and standard deviation. It was analyzed with Student's t test, α error < 5%. Results: 13 patients make up the case group (12 women), 53 ± 11 years old, with BMI 35.01 ± 8.9 kg/m2. The pre-treatment cytokeratin 18 value was 1410 ± 120 IU, and the post-treatment value was 117 ± 56, p < 0.005. The control group was 13 people (12 women), 43.4 ± 8.1 years and BMI 28.10 ± 5.4 kg/m2 The cytokeratin 18 value was 193 ± 7.2 IU, p < 0.005 vs. pretreatment case group. Conclusions: Cytokeratin 18 is higher in patients with non-alcoholic fatty liver disease, being statistically significant, and decreases with treatment with statistical significance, and may become a useful marker in this group of patients.

Resumen: Introducción: La enfermedad por hígado graso no alcohólico es una de las principales causas de afección hepática. La citoqueratina 18 surge como marcador no invasivo para la valoración de fibrosis hepática. El objetivo del trabajo fue validar el uso de la citoqueratina 18 en sangre periférica en el diagnóstico y evolución de los pacientes con enfermedad por hígado graso no alcohólico. Metodología: Para validar la citoqueratina 18 en el diagnóstico se realizó un estudio de tipo caso-control. El grupo caso fueron los pacientes mayores de 18 años, de ambos sexos, con diagnóstico de enfermedad por hígado graso no alcohólico vinculado al síndrome metabólico, captados entre 2/2/2019 al 2/2/2020. El grupo control fueron personas donantes de sangre. Se parearon 1-1 por edad y sexo. Se cuantificó la citoqueratina 18 en sangre periférica de ambos grupos. Para validar la citoqueratina 18 en la evolución de los pacientes con enfermedad de hígado graso no alcohólico se realizó un trabajo prospectivo, longitudinal. El grupo de pacientes captados fueron seguidos durante un año bajo tratamiento estándar, finalizando el mismo se realizó la cuantificación de citoqueratina 18 en sangre periférica. Las variables continuas se expresan con la media y desvío estándar. Se analizó con test de t Student, error α < 5% Resultados: 13 pacientes integran el grupo caso (12 mujeres), de 53 ± 11 años, con IMC 35.01 ± 8.9 kg/m2. El valor de citoqueratina 18 pre-tratamiento fue de 1410 ± 120 UI, y el valor post-tratamiento fue de 117 ± 56, p < 0,005.El grupo control fueron 13 personas (12 mujeres), de 43,4 ± 8,1 años e IMC 28,10 ± 5,4 kg/m2 El valor de citoqueratina 18 fue de 193 ± 7.2 UI, p < 0.005 vs grupo caso pretratamiento. Conclusiones: La citoqueratina 18 es más elevada en los pacientes con enfermedad hígado graso no alcohólico, siendo estadísticamente significativa y disminuye con el tratamiento con significación estadística, pudiendo constituirse en un marcador útil en este grupo de pacientes.

Resumen Introducción: Las competencias socioemocionales en la comunicación cara a cara son herramientas esenciales para el ajuste personal y social desde temprana edad. La comunicación en línea ha adquirido igual importancia, especialmente durante la adolescencia. Si bien se reconoce que sus características requieren habilidades específicas, hay escasez de estudios que analicen la relación existente entre las habilidades socioemocionales generalmente adquiridas y aquellas necesarias para la comunicación en línea. Por tanto, esta investigación tiene el objetivo de analizar cómo las habilidades socioemocionales fuera de línea predicen las competencias en línea entre chicas y chicos de manera diferenciada. Método: Este estudio incluyó a 478 estudiantes de educación secundaria con edades entre los 10 y 14 años. Este es un estudio transversal que utilizó el Path Analysis diferenciado por sexo, con muestreo intencional y no probabilístico. Para evaluar las competencias socioemocionales, se utilizó el instrumento ESCQ-21 para las competencias socioemocionales generales el cuestionario e-COM para cuantificar las competencias socioemocionales en línea. Resultados: El modelo explicativo indica que las competencias socioemocionales se transfieren parcialmente al entorno en línea en ambos sexos, especialmente la Percepción y comprensión emocional. Además, se sugiere que el E-autocontrol de la impulsividad y la E-autonomía emocional requieren un desarrollo específico en ese entorno. Conclusiones: Parece razonable incorporar y mejorar las experiencias en línea fomentando el desarrollo de competencias socioemocionales para este contexto. Se examinan las repercusiones para el ámbito educativo.

Abstract Introduction: Socio-emotional competencies in face-to-face communication are an essential tool for personal and social adjustment from an early age. Online communication has become equally important, especially in adolescence. It is known that its characteristics require specific skills, but there is a lack of studies that analyse the relationship that exists between generally acquired socio-emotional skills and those necessary for online communication. Hence, this research is focused on analysing how offline socio-emotional skills predict these online competencies in girls and boys in a differentiated way. Method: This study included 478 Secondary Education students between 10 and 14 years of age. This is a cross-sectional study that used Path Analysis differentiated by sex, with intentional and non-probabilistic sampling. To assess socio-emotional competencies, we used the ESCQ-21 instrument for generally assessed socio-emotional competencies and the e-COM questionnaire to quantify online socio-emotional competencies. Results: The explanatory model indicates that socio-emotional competencies are partially transferred to the online environment in both sexes, especially Perception and comprehension. Furthermore, it is suggested that E-self-control of impulsiveness and E-emotional autonomy require specific development in that environment. Conclusions: It seems reasonable to include online experiences that encourage development in online spaces. The repercussions for the educational field are analysed.

SUMMARY: Sex estimation from skeletal remains is crucial in forensic anthropology, with growing interest in the microscopic differences in bone structure between sexes. This study compared the Haversian canal (Osteonic canal) diameter (Diameter.Hc) and Haversian system (Osteon) diameter (Diameter.Hs) in the humerus, radius, and ulna of adult males and females in a Thai population. Transverse sections from the midshaft of each bone were obtained from 20 cadavers (10 males, 10 females), processed histologically, and stained with hematoxylin and eosin. Results showed no significant differences in Diameter.Hc and Diameter.Hs between sexes or among the three bones within each sex (p > 0.05). However, both parameters were larger in humans compared to Assamese macaques, highlighting interspecific variations in bone microstructure. These findings suggest that Haversian canal and system diameters may not be reliable sex indicators in the Thai population. Nonetheless, the observed differences between humans and non-human primates underscore the importance of further research into interspecific variation in bone microstructure and its potential applications in forensic anthropology and comparative anatomy.

RESUMEN: La estimación del sexo a partir de restos esqueléticos es crucial en la antropología forense, con un interés creciente en las diferencias microscópicas en la estructura ósea entre sexos. Este estudio comparó el diámetro del canal osteónico (Canal de Havers) (Diámetro.Hc) y el diámetro de la osteona (Sistema de Havers) (Diámetro.Hs) en el húmero, el radio y la ulna de hombres y mujeres adultos en una población tailandesa. Se obtuvieron secciones transversales de la diáfisis media de cada hueso de 20 cadáveres (10 hombres, 10 mujeres), se procesaron histológicamente y se tiñeron con hematoxilina y eosina. Los resultados no mostraron diferencias significativas en Diámetro.Hc y Diámetro.Hs entre sexos o entre los tres huesos dentro de cada sexo (p > 0,05). Sin embargo, ambos parámetros eran mayores en los humanos en comparación con los monos asamés, lo que destaca las variaciones interespecíficas en la microestructura ósea. Estos hallazgos sugieren que los diámetros del canal osteónico y de la osteona pueden no ser indicadores de sexo confiables en la población tailandesa. No obstante, las diferencias observadas entre humanos y primates no humanos subrayan la importancia de realizar más investigaciones sobre la variación interespecífica en la microestructura ósea y sus posibles aplicaciones en antropología forense y anatomía comparada.

SUMMARY OBJECTIVE: The aim of the study was to compare the postoperative effects of endotracheal tube cuff inflation with alkalized lidocaine in patients undergoing thyroidectomy surgery. METHODS: This is a randomized, double-blind clinical trial between August 2020 and August 2022 at the Hospital São Domingos, São Luís, Maranhão, Brazil. Patients over 18 years who underwent thyroidectomy of both sexes, American Society of Anesthesiologists (ASA) I or ASA II, were included. Patients with difficult orotracheal intubation, smoking, cuff rupture during orotracheal intubation, heart, lung, or neuropathies, previous surgery of the larynx or trachea, with risk of aspiration of gastric contents, or with the need to use a nasogastric tube were excluded. Patients were randomly selected and divided into the control group, whose cuff was filled with 0.9% saline solution, and the alkalinized lidocaine group, where the cuff was filled with 2% lidocaine and 8.4% sodium bicarbonate. RESULTS: The control group had higher systolic blood pressure [137 (94–183) mmHg] medians after extubation than the alkalinized lidocaine group [127 (82–189) mmHg] (p=0.03). The same was observed in heart rate values [control group: 86 (62–120); alkalinized lidocaine group: 80 (53–120)] (p=0.034). The alkalinized lidocaine group showed a significant increase in the ability to sustain phonation in the 24 h postoperatively, from 82.0 to 98.0% (p=0.031). CONCLUSION: There was no protective effect of the use of alkalinized lidocaine on the sensation of swallowing and complaints after thyroidectomy surgery. There was a significant improvement in hemodynamic response in the intervention group after extubation. OBJECTIVE METHODS randomized doubleblind double blind 202 Domingos Luís Maranhão Brazil 1 sexes (ASA II included intubation smoking lung neuropathies trachea contents excluded 09 0 9 0.9 solution 2 84 8 4 8.4 bicarbonate RESULTS 137 [13 94–183 94183 94 183 (94–183 mmHg 127 [12 82–189 82189 82 189 (82–189 p=0.03. p003 p p=0.03 . 03 (p=0.03) 62–120 62120 62 120 (62–120) 53–120 53120 53 (53–120) p=0.034. p0034 p=0.034 034 (p=0.034) postoperatively 820 82. 980 98 98.0 p=0.031. p0031 p=0.031 031 (p=0.031) CONCLUSION 20 0. 8. 13 [1 94–18 9418 (94–18 12 82–18 8218 (82–18 p00 p=0.0 (p=0.03 62–12 6212 6 (62–120 53–12 5312 5 (53–120 (p=0.034 98. (p=0.031 [ 94–1 941 (94–1 82–1 821 (82–1 p0 p=0. (p=0.0 62–1 621 (62–12 53–1 531 (53–12 94– (94– 82– (82– p=0 (p=0. 62– (62–1 53– (53–1 (94 (82 p= (p=0 (62– (53– (9 (8 (p= (62 (53 ( (p (6 (5

Abstract Objective Child sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. Methods The authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. Results Between 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. Conclusion The results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses. societies sexes groups serious caregivers detail SINAN (SINAN 1 years characteristics model 201 2021 13403 13 403 13,40 State 82.8% 828 82 8 (82.8% 67.8% 678 67 (67.8% environment regions variations offenses 20 202 1340 40 13,4 82.8 (82.8 67.8 6 (67.8 2 134 4 13, 82. (82. 67. (67. (82 (67 (8 (6 (

No Brasil, o controle realizado contra as defensoras de direitos humanos é fundado a partir dos princípios de uma sociedade patriarcal, o qual fundamenta-se num sistema de distribuição desigual de poder, utilizando como base fundamentos biológicos acerca dos sexos para diferenciação social de gênero. A partir deste fenômeno, revela-se uma série de práticas e políticas que limitam a atuação dessas ativistas e comprometem a capacidade de lutar por causas sociais e denunciar violações. Um dos pontos discutidos é que as manifestações e ações propostas por elas, ainda que pacíficas, enfrentam ações repressivas pelo Estado e a falta de proteção contra violência de terceiros, que as tornam alvos de ataques. O controle estrutural é, portanto, um mecanismo que enfraquece a luta por justiça e igualdade. Isso demonstra a importância de desafiar e desconstruir os estigmas associados às identidades de gênero no contexto das lutas pelos direitos humanos e na promoção de uma sociedade mais equitativa e inclusiva. Utiliza-se uma metodologia qualitativa a partir de uma pesquisa bibliográfica e uma base de dados oriunda de entrevistas realizadas com treze ativistas. Objetiva-se compreender a relação entre o controle estrutural e a legitimação implícita da utilização de distintos modos para impedir que mulheres ativistas exerçam seus direitos de livre manifestação e de expressão. Analisamos, por fim, se os direitos fundamentais das ativistas contrastam com o cenário exposto pela investigação empírica, por meio da verificação do conjunto de políticas públicas existentes e de sua (in)eficácia.

In Brazil, the control carried out against human rights defenders is based on the principles of a patriarchal society, which is based on a system of unequal distribution of power, using biological foundations regarding sexes as a basis for social gender differentiation. This phenomenon reveals a series of practices and policies that limit the actions of these activists and compromise their ability to fight for social causes and denounce violations. One of the points discussed is that the demonstrations and actions proposed by them, although peaceful, face repressive actions by the State and the lack of protection against violence by third parties, which make them targets of attacks. Structural control is, therefore, a mechanism that weakens the fight for justice and equality. This demonstrates the importance of challenging and deconstructing the stigmas associated with gender identities in the context of the fight for human rights and in the promotion of a more equitable and inclusive society. A qualitative methodology is used based on bibliographic research and a database of interviews conducted with thirteen activists. The aim is to understand the relationship between structural control and the implicit legitimization of the use of different methods to prevent women activists from exercising their rights to free expression and demonstration. Finally, we analyze whether the fundamental rights of activists contrast with the scenario exposed by empirical research, by verifying the set of existing public policies and their (in)effectiveness.

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

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

Abstract Introduction Williams syndrome (WS) is a genetic disorder caused by a microdeletion in chromosome 7, affecting ~ 28 genes. Studies have demonstrated conductive losses seemingly related to the absence of the elastin gene and mild to profound sensorineural losses due to cochlear fragility. Objective To characterize and compare the peripheral auditory system and auditory brainstem response (ABR) of adults with WS and neurotypical adults matched by age and gender. Methods We conducted a cross-sectional observational study with 30 individuals of both sexes, aged 18 to 37 years – 15 of them with WS (study group) and 15 with neither the syndrome nor hearing complaints (control group), matched for sex and age. The subjects underwent pure-tone and speech audiometry, acoustic immittance, transient-evoked otoacoustic emissions (TEOAEs), and ABR. Results Early-onset sensorineural hearing loss was found in 53.3% of the study sample, mostly mild, occurring above 3 kHz. The TEOAEs were absent in 53.3% of assessed subjects; for those in whom they were present, the signal-to-noise responses were significantly lower than in the control group. In the ABR, increased absolute latencies were observed in waves I and III. Conclusion Individuals with WS have early and progressive cochlear impairments, mainly affecting the basal region of the cochlea. They may have low brainstem changes which seem to begin in adulthood. (WS 7 2 genes fragility ABR (ABR gender crosssectional cross sectional sexes 1 group group, , puretone pure tone audiometry immittance transientevoked transient evoked TEOAEs, (TEOAEs) Earlyonset Early onset 533 53 53.3 sample kHz present signaltonoise signal noise III impairments cochlea adulthood (TEOAEs 5 53.

Resumen En un contexto donde la dinámica familiar y la autoestima de los adolescentes se erigen como elementos fundamentales para su desarrollo, esta investigación propone desentrañar las intrincadas conexiones entre ambas variables a través de un estudio cuantitativo, no experimental, correlacional y de corte transversal, y teniendo como objetivo principal determinar la relación entre el funcionamiento familiar y la autoestima durante los meses de noviembre y diciembre de 2022, en 870 estudiantes de bachillerato de la ciudad de Guayaquil. Los datos se obtuvieron a partir del cuestionario de funcionamiento familiar FF-SIL y la escala de Autoestima de Rosenberg aplicados previamente por el personal del Departamento de Consejería Estudiantil. El análisis mostró el predominio de familias moderadamente funcionales en la población estudiada (43,3 % mujeres y 53,9 % hombres), con diferencias estadísticamente significativas, la población femenina (45,54 %) y la masculina (47,90 %) con relación a la variable funcionamiento familiar. La autoestima valorada como baja prevaleció en ambos sexos (51,5 % mujeres y 38,8 % hombres), exhibiendo diferencias estadísticamente significativas entre la población femenina (25,54) y la masculina (27,54) respecto a esta variable. La correlación del funcionamiento familiar con la autoestima concluyó como estadísticamente significativa directamente proporcional y de baja intensidad. Estos resultados proporcionan una base significativa para futuras intervenciones y políticas destinadas a fortalecer el bienestar psicológico de los adolescentes.

Abstract In a context where family dynamics and adolescent self-esteem stand as fundamental elements for their development, this research proposes to unravel the intricate connections between both variables through a quantitative, non-experimental, correlational, and cross-sectional study and taking This study aimed to determine the relationship between family functioning and self-esteem during November and December 2022, in 870 high school students in the city of Guayaquil. The data were obtained from the FF-SIL family functioning questionnaire and the Rosenberg Self-Esteem scale previously applied by the Student Counseling Department staff. The analysis showed the predominance of moderately functional families in the studied population (43.3% women and 53.9% men), with statistically significant differences between the female population (45.54 %) and the male population (47.90) concerning the family functioning variable. Self-esteem was valued as low prevailed in both sexes (51.5% women and 38.8% men), exhibiting statistically significant differences between the female population (25.54) and the male population (27.54 %) regarding this variable. The correlation of family functioning with self-esteem was statistically significant, directly proportional, and low intensity. These results provide a significant basis for future interventions and policies to strengthen adolescents' psychological well-being.

RESUMEN Introducción: La toxoplasmosis es una enfermedad de distribución universal producida por el toxoplasma gondii. Objetivo: Describir las características epidemiológicas y clínicas de los pacientes con toxoplasmosis ocular, que son atendidos en el Centro Oftalmológico de Santiago de Cuba Juan Bruno Zayas Alfonso. Método: Se realizó un estudio observacional, descriptivo, transversal. La población estudiada estuvo conformada por los 29 pacientes de ambos sexos diagnosticados con toxoplasmosis ocular, que fueron atendidos en el Centro Oftalmológico de Santiago de Cuba, entre diciembre del 2020 y diciembre del 2022. Se analizaron variables tales como edad, sexo, condiciones higiénico-sanitarias de la vivienda, zona de residencia, ojo afectado, afectación visual, topografía, forma de presentación de la lesión y complicaciones. Resultados: Predominó el sexo masculino (5,2 %), en las edades de 34 a 49 años (44,4 %). Según las condiciones de vida, 48 % eran regulares y 70 % vivían en zona rural. La afectación visual fue grave (55,5 %) con localización en zona I (81.5 %). Predominaron las lesiones recurrentes (55,6 %) y 92,6 % un solo ojo afectado. Dentro de las complicaciones, el glaucoma secundario (22,2 %). Conclusiones: La toxoplasmosis ocular es la causa más frecuente de uveítis posterior. La presencia de animales domésticos y los hábitos alimentarios no adecuados se erigieron como factores de riesgo fundamentales en este estudio.

ABSTRACT Introduction: Toxoplasmosis is a universally distributed disease caused by toxoplasma gondii. Objective: To describe the epidemiological and clinical characteristics of patients with ocular toxoplasmosis who were treated at the Santiago de Cuba Opthalmological Center Juan Bruno Zayas Alonso. Methods: An observational, cross-sectional study was conducted. The study population consisted of 29 patients of both sexes diagnosed with ocular toxoplasmosis, who were treated at the Santiago de Cuba Opthalmological Center, between December 2020 and December 2022. Variables such as age, sex, sanitary and hygienic conditions of the house, area of residence, affected eye, visual impairment, topography, presentation of the lesion and complications were analyzed. Results: The majority of the population was men (5.2 %) aged 34-49 (44.4 %). According to conditions of the houses, 48 % were regular and 70 % lived in rural areas. The visual impairment was severe (55.5 %) with location in zone I (81.5 %). Recurrent lesions (55.6 %) and one eye affected (92.6 %) predominated. Among the complications, secondary glaucoma (22.2 %). Conclusions: Ocular toxoplasmosis is the most common cause of posterior uveitis. The presence of domestic animals and inappropriate eating habits were identified as key risk factors in this study.

RESUMEN Introducción: La validación de métodos de predicción de riesgo es importante para establecer medidas preventivas adecuadas. Objetivo: Evaluar la validez interna de una escala de mortalidad por afección cardiovascular en ancianos. Métodos: Se efectuó un estudio analítico, observacional, retrospectivo, de tipo caso-control, de 58 pacientes fallecidos (casos) y 134 vivos (controles), pertenecientes a 3 áreas de salud (policlínicos Ramón López Peña, Municipal y 28 de septiembre) del municipio de Santiago de Cuba, durante el 2021. Para realizar la validación de dicha escala se evaluó la capacidad discriminativa y la calibración; la validez de apariencia, criterio y constructo, así como su fiabilidad y consistencia interna. Resultados: La escala diseñada discriminó mejor que la EPICARDIAN en ambos sexos; 68,8 % de los fallecidos del grupo de validación fueron clasificados de alto riesgo. El valor del coeficiente alfa de Cronbach fue de 0,639 y el estandarizado de 0,564. Conclusiones: La escala evaluada calibra adecuadamente al aplicarla en otra población con similar característica a la que le dio origen y discrimina de manera pertinente a las personas clasificadas como alto riesgo de fallecer por una enfermedad cardiovascular aterosclerótica.

ABSTRACT Introduction: The validation of risk prediction methods is important to establish appropriate preventive measures. Objective: To evaluate the internal validity of a mortality scale due to cardiovascular affection in elderly. Methods: An analytic, observational, retrospective and case-control study was carried out, in 58 dead patients (cases) and 134 alive patients (control), belonging to 3 health areas (Ramón López Peña, Municipal and 28 de Septiembre polyclinics) in Santiago de Cuba municipality, during 2021. To validate this scale the discriminative capacity and calibration; appearance, criterion and construct validity were evaluated, as well as its reliability and internal strength. Results: The designed scale discriminated better than the EPICARDIAN scale in both sexes; 68.8 % of the deaths in the validation group were classified as high risk. The value of Cronbach´s alpha coefficient was 0.639 and the standardized one was 0.564. Conclusions: The evaluated scale calibrates appropriately when applied to another population with similar characteristics to the one it gave rise to and it pertinently discriminates against people classified as high risk of dying due to atherosclerotic cardiovascular disease.