RESUMEN Introducción: La herida es una pérdida de continuidad de la piel o mucosa producida por algún agente físico o químico. Una herida es “compleja” cuando por su extensión, localización, profundidad o exposición de elementos nobles, necesita para su curación una terapéutica especial. Este es el caso de heridas con compromiso tisular que afecta a estructuras como músculos, fascias, tendones, huesos, vasos sanguíneos, nervios o las lesiones de lenta evolución como úlceras o escaras. Objetivos: Determinar el método de reconstrucción más utilizado en el manejo terapéutico de las heridas complejas del tercio distal de la pierna en los pacientes atendidos en el Hospital de Trauma y en la Unidad de Cirugía Plástica de la FCM - UNA. Materiales y métodos: Estudio de diseño observacional, tipo de estudio descriptivo y retrospectivo. Fueron incluidos pacientes de ambos sexos, mayores de edad, con heridas complejas en el tercio distal de la pierna, atendidos en el Hospital de Trauma y en la Unidad de Cirugía Plástica de la FCM - UNA, durante el periodo 2010 al 2019. Resultados: Se incluyó a 112 pacientes de los cuales el 80,36 % fue hombres y el 19,64 % mujeres. Las edades estaban comprendidas entre los 18 y los 73 años y una media de 33,8 ± 14 años. La edad más frecuente fue 18 años. La mediana de edad es de 30 años, lo que implica que la mitad de la muestra tuvo por lo menos dicha edad. En cuanto a la procedencia, el 41,07 % era del interior, el 30,36 % del departamento Central y el 28,57 % restante de Asunción. En cuanto al mecanismo de la lesión, se puede observar que el mecanismo más frecuente fue el accidente de tráfico, seguido por caída de altura, en un gran porcentaje. En cuanto a la evolución y complicaciones se puede ver que 92 individuos, o sea 82 % de los pacientes no tuvo ninguna evolución negativa o complicaciones. Lo más común fue la infección con 1,9% de prevalencia, la pérdida parcial del colgajo o piel representan el 2,4%, dehiscencia de la sutura el 0,9 %, hematoma 0,6 % y pérdida total del colgajo 0,54 %. En cuanto al tratamiento aplicado, se debe tener en cuenta que los pacientes pudieron haber recibido más de un tratamiento por lo que el tamaño de la muestra se refiere a las visitas. El tratamiento más frecuente fue el colgajo sural con 28,57%, tutor externo con el 20,19%, injerto de piel 16,46%, toillete 12,73% y colgajo fascio - cutáneo en 6,21%. Conclusión: La gran mayoría de los casos tratados corresponde a algún tipo de accidente de tránsito. Se necesita de un equipo multidisciplinario: ortopedistas, cirujanos plásticos, cirujanos vasculares, fisioterapeutas, etc. en trabajo coordinado para tratar estas graves lesiones de forma a obtener resultados favorables. Para la cobertura de la pierna traumatizada, con exposición ósea, recurrimos a los colgajos musculares, en el 1/3 proximal el gemelo, en el 1/3 medio el sóleo. Para la cobertura del 1/3 distal de la pierna utilizamos el colgajo neuro-veno-fascio-cutáneo (sural) a pedículo distal.

ABSTRACT Introduction: The wound is a loss of continuity of the skin or mucosa produced by some physical or chemical agent. A wound is “complex” when due to its extension, location, depth, exposure of noble elements, it requires special therapy to heal. This is the case of wounds with tissue involvement that affects structures such as muscles, fascia, tendons, bones, blood vessels, nerves, or slowly evolving lesions such as ulcers or bedsores. Objectives: Determine the reconstruction method most used in the therapeutic management of complex wounds of the distal third of the leg in patients treated at the Trauma Hospital and the Plastic Surgery Unit of the FCM - UNA. Materials and methods: Observational, descriptive, and temporally retrospective study. Patients of both sexes, of legal age, with complex wounds in the distal third of the leg, treated at the Trauma Hospital and in the Plastic Surgery Unit of the FCM - UNA, during the period 2010 to 2019, were included. Results: 112 patients were included, of which 80.36% are men and 19.64% are women. The ages range from 18 to 73 years and an average of 33.8 ± 14 years. The most common age was 18 years. The median age is 30 years, which implies that half of the sample is at least that age. Regarding origin, 41.07% are from the interior, 30.36% from the Central department and the remaining 28.57% from Asunción. Regarding the mechanism of injury, the most frequent mechanism was a traffic accident, followed by a fall from a height, in a large percentage. Regarding the evolution and complications, 92, that is, 82% of the patients do not have any negative evolution or complications. The most common was infection with 1.9%, partial loss of the flap or skin represented 2.4%, suture dehiscence with 0.9%, hematoma 0.6%, and total loss of the flap 0.54. %. Regarding the treatment applied, it must be considered that patients may have received more than one treatment, so the sample size refers to visits. The most frequent treatment was the sural flap with 28.57%, external tutor with 20.19%, skin graft 16.46%, toilette 12.73% and fasciocutaneous flap in 6.21%. Conclusion: Most cases treated correspond to some type of traffic accident. A multidisciplinary team is needed: orthopedists, plastic surgeons, vascular surgeons, physiotherapists, etc. in coordinated work to treat these serious injuries to obtain favorable results. To cover the traumatized leg, with bone exposure, we resort to muscle flaps. In the proximal 1/3, the gastrocnemius. In the middle 1/3, the soleus. To cover the distal 1/3 of the leg we used the neuro-veno-fascio-cutaneous (sural) flap to the distal pedicle.

ABSTRACT This research aimed to evaluate the application of Project-Based Learning in the Biology subject in students of the Biological Profile of the University College of the University of Havana. A sample of 31 students was selected. The students were organized into groups and assigned a real problem and a tutor, a professor. The students developed their project proposals over a period of three weeks. The students' level of satisfaction was evaluated regarding the application of this strategy according to the Iadov technique. The students proposed solutions to the problems through their projects. In the projects, the students through the consultation of a specialized bibliography, identified different entities that could work together to solve the problem. Iadov technique showed that students are highly satisfied with the application of this methodology. In turn, they recognize that through PBL they integrated knowledge of various subjects, felt motivated to search for solutions to real problems, and stimulated teamwork. These results highlight the importance of this didactic strategy in the teaching-learning process.

RESUMEN La siguiente investigación se trazó como objetivo: evaluar la aplicación del Aprendizaje Basado en Proyectos en la asignatura Biología en estudiantes del Perfil Biológico del Colegio Universitario de la Universidad de La Habana. Se seleccionó una muestra de 31 estudiantes. Los estudiantes se organizaron en grupos y se les asignó un problema real y un tutor, miembro del claustro de la asignatura de Biología. Los estudiantes desarrollaron sus propuestas de proyectos en un período de tres semanas. El nivel de satisfacción de los estudiantes en cuanto a la aplicación de esta estrategia se evaluó según la técnica de Iadov. Los estudiantes propusieron soluciones a los problemas planteados mediante sus proyectos. En los mismos a través de la consulta de bibliografía especializada identificaron diferentes entidades que pudieran trabajar en conjunto para la solución del problema. La técnica de Iadov arrojó que los estudiantes tienen una alta satisfacción con la aplicación de esta metodología, a su vez reconocen que mediante el ABP integraron conocimientos de varias asignaturas, se sintieron motivados en la búsqueda de soluciones de problemas reales y estimuló el trabajo en equipo. Estos resultados destacan la importancia de esta estrategia didáctica en el proceso de enseñanza y aprendizaje.

Abstract Objective: To analyze the transversal competences of the clinical tutors in the Unique Program of Specializations in Nursing of the National Autonomous University of Mexico, in terms of the perceptions of its graduates to identify areas of opportunity regarding the formation through clinical tutoring. Material and Methods: This is a descriptive and transversal study. The unit of analysis is the graduate nursing student. Clinical tutoring was analyzed with an instrument which was validated by the panel of experts and which was adjusted after using a related pilot study with self-administered surveys through the Google platform. The sample was constituted by 448 graduates. Results: Descriptive statistics show the major frequencies in the discipline related dimension, and the minor frequencies in the clinical teaching related dimension. In general, the dimensions considered for transversal competency show weaknesses which can be related to the attention to emotional difficulties, the decision making at the site, and the management of interpersonal conflicts, besides the tutoring planning. Conclusion: Clinical tutoring in Graduate Nursing is a pivot which strengthens the bases to address clinical problems and use the scientific evidence and its expression in specialized care. The dimensions considered for transversal competency show that, in the development of interpersonal and communication skills, there are strategic actions which can be leveraged to promote the interaction with patients, families, and other health professionals within the clinical context.

Resumen Objetivo: Analizar las competencias transversales de los tutores clínicos en el Programa Único de Especializaciones en Enfermería de la Universidad Nacional Autónoma de México, en términos de la apreciación de sus alumnos para identificar áreas de oportunidad con respecto de la formación, a través de la tutoría clínica. Material y Métodos: Este es un estudio cuantitativo, descriptivo y transversal. La unidad de análisis es el alumno del posgrado de Enfermería. La tutoría clínica fue analizada con un instrumento validado por un panel de jueces expertos y que después fue ajustado usando un estudio piloto a través de la plataforma Google Forms. La muestra estuvo constituida por 448 alumnos cursando la especialización, vigentes y que estuvieran dispuestos a participar. Resultados: Las estadísticas descriptivas muestran las mayores frecuencias en la dimensión relacionada con la disciplina, y las menores frecuencias en la dimensión relacionada con la docencia clínica. En general, las dimensiones consideradas para la competencia transversal muestran debilidades que pudieran estar relacionadas con la atención a dificultades emocionales, la toma de decisiones en el sitio, y el manejo de los conflictos interpersonales, además de la planeación de la tutoría. Conclusiones: La tutoría clínica en la Enfermería de nivel posgrado es un pivote que fortalece las bases para abordar problemas clínicos, usar la evidencia científica y su expresión en el cuidado especializado. Las dimensiones consideradas para la competencia transversal muestran que, en el desarrollo de destrezas interpersonales y de comunicación, hay acciones estratégicas que pueden ser apuntaladas para promover la interacción con pacientes, las familias y otros profesionales de la salud dentro del contexto clínico.

RESUMEN Objetivo: La investigación tuvo como fin concebir un modelo pedagógico para la formación de la competencia investigación periodística en los estudiantes de Licenciatura en Periodismo. Métodos: Se emplearon el análisis y la síntesis, la inducción y la deducción, el ascenso de lo abstracto a lo concreto, la modelación y el método sistémico estructural funcional, así como las técnicas de revisión bibliográfica y análisis documental. Resultados: una construcción teórica que sintetiza saberes contextualizados para la investigación periodística de la realidad social desde el análisis reflexivo del contexto, el pensamiento crítico y la actuación profesional ética e integral, lo cual favorece el desempeño autónomo, idóneo y exitoso del estudiante de Periodismo en la indagación de la realidad social. Conclusiones: El proceso de formación de la competencia investigación periodística ha de integrarse a la formación del Licenciado en Periodismo en consonancia con el plan de estudio vigente, lo cual demanda una actividad metodológica sistemática, planificada y coordinada de los diferentes niveles organizativos de la carrera para garantizar el protagonismo del estudiante y el carácter mediador del profesor-tutor en el aprendizaje desde la vinculación de la teoría y la práctica.

ABSTRACT Objective: The research aims at devising a pedagogical model for the training of journalistic research in journalism students Methods: The author rely on the methods of analysis and synthesis, induction and deduction, the ascension of the abstract to the concrete, modeling and functional structural system, as well as the bibliographic review techniques and documentary analysis techniques. Result: The main finding is a theoretical construction that synthesizes contextualized knowledge for the journalistic research of social reality from the reflexive analysis of the context, critical thinking and ethical and comprehensive professional performance, which favors the autonomous, ideal and successful performance of the student of journalism in the investigation of social reality. Conclusions: The journalistic investigation competence training process should become part of the curriculum of journalist education. Consequently, the staff is expected to coordinate and plan a system of activities focus on promoting students’ active participation both in academic and practicum tasks under the guide of professor and tutors.

Resumen Introducción. La tutoría universitaria rara vez cuenta con aportaciones innovadoras que den lugar a nuevos procedimientos que despierten el interés e impacto entre la comunidad universitaria. Objetivo. Este trabajo analiza la satisfacción del alumnado con la experiencia de innovación educativa basada en la tutoría invertida a partir del diferencial entre expectativas iniciales y percepción final. Método. La investigación se sustenta en un enfoque metodológico cuantitativo y un diseño no experimental, descriptivo y longitudinal. Participan en la investigación 164 estudiantes de los Grados de Educación Infantil, Primaria y Pedagogía, a través de un cuestionario diseñado ad hoc, válido y fiable. Resultados. Los resultados muestran satisfacción del alumnado con el método de tutoría utilizado y el uso de kahoot, por el contrario, el alumnado muestra insatisfacción con el uso de los foros virtuales. Conclusiones. Estas herramientas digitales ofrecen alternativas pedagógicas que facilitan la labor tutorial, kahoot se percibe como un acierto en la detección de necesidades formativas, mientras los foros virtuales requieren de reflexión docente para su incorporación en procesos de tutoría invertida.

Resumo Introdução. A tutoria universitária raramente contribui com inovações que suscitam interesse e impacto na comunidade universitária. Objetivo. Este artigo analisa a satisfação dos estudantes com a experiência de inovação educacional baseada na tutoria invertida, considerando a diferença entre as expectativas iniciais e a percepção final. Método. A pesquisa adota uma abordagem metodológica quantitativa e um desenho não experimental, descritivo e longitudinal. Participaram da pesquisa 164 estudantes dos cursos de Educação Infantil, Ensino Fundamental e Pedagogia, respondendo a um questionário elaborado ad hoc, considerado válido e confiável. Resultados. Os resultados demonstram que os estudantes estão satisfeitos com o método de tutoria utilizado e com o uso do Kahoot. Por outro lado, os alunos demonstram insatisfação com o uso de fóruns virtuais. Conclusões. Estas ferramentas digitais oferecem alternativas pedagógicas que facilitam o trabalho do tutor. O Kahoot é percebido como um sucesso na identificação de necessidades formativas, enquanto os fóruns virtuais demandam reflexão por parte dos docentes para sua incorporação nos processos de tutoria invertida.

Abstract Introduction. University tutoring rarely includes innovative contributions that lead to new procedures to generate interest and have an impact on the university community. Objective. This paper analyzes student satisfaction with the experience of educational innovation based on flipped tutoring, focusing on the difference between initial expectations and final perception. Method. The research was based on a quantitative methodological approach and a non-experimental, descriptive, and longitudinal design. The participants in the study, 164 students from an Early Childhood Education, Primary Education, and Pedagogy degree, answered a valid and reliable questionnaire designed ad hoc. Results. The results showed student satisfaction with the employ of the tutoring method and the Kahoot platform. On the contrary, the students expressed dissatisfaction with the use of virtual forums. Conclusions. These digital tools offer pedagogical alternatives that facilitate the work of the tutor. Kahoot is perceived as a success in detecting training needs, while virtual forums require teacher reflection for their incorporation into flipped tutoring processes.

RESUMEN Objetivo: Describir el perfil de los tutores de enseñanza-aprendizaje de los servicios de salud pública e investigar los temas de mayor interés en espacios de desarrollo de estos actores. Método: Se trata de un estudio transversal con Tutores Elegibles de Planificación de la atención en salud; con datos recopilados mediante cuestionario electrónico de preguntas cerradas sobre características sociodemográficas, formación y actuación. Se utilizó la prueba de Chi-cuadrado para comparar las proporciones según las tipologías del tutor. Resultados: Se consideraron 614 tutores que trabajaban en las cinco regiones geográficas del Brasil, la mayoría en Atención Primaria (82%), seguido de actuación estatal/regional (13%) y Atención Ambulatoria Especializada (5%). La mayoría declaró ser mujer, de piel morena, del ámbito de la enfermería, con menos de un año de actuación como tutora y sin experiencia previa como preceptora o similar. Los temas más importantes fueron las Redes de la Atención en Salud, la estratificación del riesgo de las enfermedades crónicas y el papel de la Atención Ambulatoria Especializada. Conclusión: Se identificó el predominio de ciertas características entre los tutores, distintas según los tipos de actuación. Las conclusiones pueden servir de apoyo a los gestores en el proceso de selección y desarrollo de los tutores en Planificación. Objetivo enseñanzaaprendizaje enseñanza aprendizaje actores Método sociodemográficas Chicuadrado Chi cuadrado tutor Resultados 61 Brasil 82%, 82 82% , (82%) estatalregional estatal regional 13% 13 (13% 5%. 5 5% . (5%) mujer morena enfermería similar Salud Conclusión 6 8 (82% 1 (13 (5% (82 (1 (5 (8 (

ABSTRACT Objective: To describe the profile of teaching-learning tutors in public health services and investigate which topics are of greatest interest in development spaces for these actors. Method: Cross-sectional study. Eligible tutors of Health Care Planning. Data collection using an electronic questionnaire composed of closed questions on sociodemographic characteristics, training and performance. Chi-square test used to compare proportions according to tutor typologies. Results: A total of 614 tutors worked in Brazil’s five geographic regions, the majority in primary care (82%), followed by state/regional work (13%) and specialized outpatient care (5%). The majority reported being female, of brown skin color, from the nursing field, having worked as a tutor for less than a year, and with no previous experience in preceptorship or similar. The most important topics were Health Care Networks, risk stratification for chronic conditions and the functions of specialized outpatient care. Conclusion: The predominance of certain characteristics among tutors was identified, with differences between the types of work. The findings can support managers in the process of selecting and developing tutors in Health Care Planning. Objective teachinglearning teaching learning actors Method Crosssectional Cross sectional study Planning performance Chisquare Chi square typologies Results 61 Brazils Brazil s regions 82%, 82 82% , (82%) stateregional state regional 13% 13 (13% 5%. 5 5% . (5%) female color field year similar Networks Conclusion identified 6 8 (82% 1 (13 (5% (82 (1 (5 (8 (

RESUMO Objetivo: Descrever o perfil de tutores de ensino-aprendizagem em serviços públicos de saúde e investigar quais são os temas de maior interesse em espaços de desenvolvimento desses atores. Método: Estudo transversal. Elegíveis tutores da Planificação da Atenção à Saúde. Coleta de dados por questionário eletrônico composto por questões fechadas sobre características sociodemográficas, formação e atuação. Teste Qui-quadrado utilizado para comparar proporções segundo tipologias de tutor. Resultados: Considerados 614 tutores, que atuavam nas cinco regiões geográficas brasileiras, sendo a maioria na Atenção Primária (82%), seguido por atuação estadual/regional (13%) e na Atenção Ambulatorial Especializada (5%). A maioria referiu ser mulher, de cor da pele parda, da área de enfermagem, atuação como tutor há menos de 1 ano, e sem experiência prévia em preceptoria ou similar. Temas considerados mais importantes destacam-se Redes de Atenção à Saúde, estratificação de risco de condições crônicas e funções da Atenção Ambulatorial Especializada. Conclusão: Identificou-se a predominância de algumas características entre tutores, com diferenças entre as tipologias de atuação. Os achados podem apoiar gestores no processo de seleção e desenvolvimento de tutores na Planificação. Objetivo ensinoaprendizagem ensino aprendizagem atores Método transversal Saúde sociodemográficas Quiquadrado Qui quadrado Resultados 61 brasileiras 82%, 82 82% , (82%) estadualregional estadual regional 13% 13 (13% 5%. 5 5% . (5%) mulher parda enfermagem ano similar destacamse destacam se Conclusão Identificouse Identificou 6 8 (82% (13 (5% (82 (1 (5 (8 (

Resumen El objetivo del estudio presentado fue evaluar la percepción de la calidad del proceso de aprendizaje en el entorno virtual de los alumnos del Programa Salud con Agentes. Se trató de un estudio transversal realizado en 2022 con 9.145 alumnos de los cursos de Técnico en Agente Comunitario de Salud y Técnico en Vigilancia Sanitaria con énfasis en la lucha contra las enfermedades endémicas. La información sobre la calidad del proceso de aprendizaje se obtuvo a través de la Encuesta Constructivist On-Line Learning Environment Survey, que consta de 24 preguntas agrupadas en seis dimensiones: relevancia, reflexión crítica, interacción, apoyo de los tutores, apoyo de los alumnos y comprensión. Se evaluó el perfil sociodemográfico de los participantes y las principales vías de acceso al curso y seguimiento. Se realizó un análisis descriptivo y se utilizó la prueba de chi-cuadrado o la prueba exacta de Fisher para analizar las asociaciones. Los participantes eran en su mayoría mujeres, en la franja de edad 40 a 49 años, de la región Nordeste; realizaban las actividades en casa y utilizaban teléfonos móviles/smartphones. Al considerar las seis dimensiones evaluadas, la relevancia, la interacción y el apoyo de los compañeros mostraron diferencias estadísticamente significativas entre los alumnos de los cursos de Técnico en Agente Comunitario de Salud y Técnico en Vigilancia Sanitaria con Énfasis en la Lucha contra las Enfermedades Endémicas. Agentes 202 9145 9 145 9.14 endémicas OnLine On Line Survey 2 relevancia crítica tutores comprensión seguimiento chicuadrado chi cuadrado asociaciones mujeres 4 años Nordeste móvilessmartphones móviles smartphones móviles/smartphones evaluadas Endémicas 20 914 14 9.1 91 1 9.

Abstract The study presented here aimed to evaluate the perception of the quality of the learning process in the virtual environment of the students of the Health Program with Agent. It was a cross-sectional study conducted in 2022 with 9,145 students from the Community Health Agent Technician and Health Surveillance Technician courses with an Emphasis on Combating Endemic Diseases. Information on the quality of the learning process was obtained through the Constructivist On-Line Learning Environment Survey, which consists of 24 questions grouped into six dimensions: relevance, critical reflection, interaction, tutor support, peer support, and understanding. The sociodemographic profile of the participants and the primary forms of access to the course and monitoring were evaluated. Descriptive analysis was performed; for association analysis, the chi-square or Fisher’s exact test was used. Most participants are females aged 40 to 49 from the Northeast region; they perform activities at home and use their cell phones/smartphones. When considering the six dimensions evaluated, relevance, interaction, and support of colleagues obtained statistically significant differences between the students of the courses of Community Health Agent Technician and Health Surveillance Technician with Emphasis on Combating Endemic Diseases. crosssectional cross sectional 202 9145 9 145 9,14 Diseases OnLine On Line Survey 2 relevance reflection interaction understanding evaluated performed chisquare chi square Fishers Fisher s used 4 region phonessmartphones phones smartphones phones/smartphones 20 914 14 9,1 91 1 9,

Resumo O estudo aqui apresentado teve por objetivo avaliar a percepção da qualidade do processo de aprendizagem no ambiente virtual dos estudantes do Programa Saúde com Agente. Tratou-se de um estudo transversal, realizado em 2022, com 9.145 estudantes dos cursos de Técnico em Agente Comunitário de Saúde e Técnico em Vigilância em Saúde com Ênfase no Combate às Endemias. Informações sobre a qualidade do processo de aprendizagem foram obtidas por meio do questionário Constructivist On-Line Learning Environment Survey, que consiste em 24 questões agrupadas em seis dimensões: relevância, reflexão crítica, interação, apoio dos tutores, apoio dos colegas e compreensão. Avaliaram-se o perfil sociodemográfico dos participantes e as principais formas de acesso ao curso e acompanhamento. Realizou-se análise descritiva; para análise de associação, utilizou-se o teste qui-quadrado ou exato de Fisher. A maioria dos participantes é do sexo feminino, faixa etária de 40 a 49 anos, da região Nordeste; realiza as atividades em casa e usa o celular/smartphone. Ao se considerarem as seis dimensões avaliadas, relevância, interação e apoio dos colegas obtiveram diferenças estatisticamente significativas entre os estudantes dos cursos de Técnico em Agente Comunitário de Saúde e Técnico em Vigilância em Saúde com Ênfase no Combate às Endemias. Tratouse Tratou transversal 2022 9145 9 145 9.14 Endemias OnLine On Line Survey 2 relevância crítica tutores compreensão Avaliaramse Avaliaram acompanhamento Realizouse Realizou descritiva associação utilizouse utilizou quiquadrado qui quadrado Fisher feminino 4 anos Nordeste celularsmartphone celular smartphone celular/smartphone avaliadas 202 914 14 9.1 20 91 1 9.

Resumo: A questão central que norteia este trabalho é se uma câmera de registro filmográfico, que é um objeto utilizado inicialmente com fins metodológicos, poderia ter uma função terapêutica. Objetiva-se apresentar e discutir as repercussões e possibilidades referentes à presença de uma câmera em atendimentos de casos de fechamento autístico no Programa de Intervenção Precoce, em uma perspectiva psicanalítica. É uma pesquisa clínico-qualitativa, com análise de conteúdo, a partir de vinhetas clínicas de três casos de crianças entre 2 e 3 anos. São discutidas três abordagens sobre os usos e os tipos de objetos pertencentes ao universo de um bebê, a fim de interrogar se elas poderiam auxiliar na clínica do autismo: objeto transicional, objeto tutor e objeto de mediação. Considerou-se que a câmera promoveu e sustentou encontros intersubjetivos importantes e o despertar da atenção de crianças, antes pouco interessadas por aquilo que lhes era ofertado, inaugurando um espaço de coconstrução e interludicidade. Resumo filmográfico metodológicos terapêutica Objetivase Objetiva Precoce psicanalítica clínicoqualitativa, clínicoqualitativa clínico qualitativa, qualitativa clínico-qualitativa conteúdo anos bebê autismo transicional mediação Considerouse Considerou ofertado interludicidade

Resumen: La pregunta central que guía este trabajo gira en torno de la posibilidad de una cámara cinematográfica, un objeto inicialmente utilizado con fines metodológicos, para ser utilizada en sesiones terapéuticas. El objetivo es presentar y discutir las repercusiones y posibilidades relacionadas con la presencia de una cámara en la atención a casos de cierre autista en un Programa de Intervención Temprana, desde una perspectiva psicoanalítica. Se trata de una investigación clínico cualitativa, con análisis de contenido, a partir de viñetas clínicas de tres casos de niños, con edades de entre 2 y 3 años. Se discuten tres enfoques sobre los usos y tipos de objetos pertenecientes al universo de un bebé para observar si esto podría ayudar en la clínica del autismo: el objeto transicional, el objeto tutor y el objeto mediador. Se considera que la cámara promovió y sostuvo importantes encuentros intersubjetivos y el despertar de la atención de niños previamente poco interesados en lo que se les ofrecía, inaugurando un espacio de coconstrucción e interjuego. Resumen cinematográfica metodológicos terapéuticas Temprana psicoanalítica cualitativa contenido años autismo transicional mediador ofrecía interjuego

Résumé : La question centrale guidant ce travail porte sur l’éventuelle fonction thérapeutique d’une caméra, qui est un objet initialement utilisée à des fins méthodologiques. L’objectif est de présenter et de discuter, dans une perspective psychanalytique, les répercussions et les possibilités d’une caméra dans la prise en charge d’enfants présentant un repli autistique suivis au sein du Programme d’Intervention Précoce. C’est une recherche clinique-qualitative, avec analyse de contenu, à partir de vignettes cliniques de trois enfants, âgés de 2 à 3 ans. Trois approches concernant les usages et les types d’objets appartenant à l’univers d’un bébé seront repris, afin d’interroger s’ils pourraient aider à la clinique de l’autisme : l’objet transitionnel, l’objet tuteur et l’objet de médiation. Nous considérons que la caméra a favorisé et soutenu des rencontres intersubjectives importantes et a éveillé l’attention des enfants, auparavant peu intéressés par ce qui leur était offert, en créant un espace de co-construction et d’interludicité. léventuelle l éventuelle dune d méthodologiques Lobjectif L objectif discuter psychanalytique denfants enfants dIntervention Intervention Précoce Cest C cliniquequalitative, cliniquequalitative qualitative, qualitative clinique-qualitative contenu ans dobjets objets lunivers univers dun repris dinterroger interroger sils s ils lautisme autisme lobjet transitionnel médiation lattention attention offert coconstruction co construction dinterludicité. dinterludicité interludicité. interludicité d’interludicité

Abstract: The central question that guides this work is about whether a film recording camera, which is an object initially used for methodological purposes, could have a therapeutic function. The aim is to present and discuss the repercussions and possibilities related to the presence of a camera in cases of autistic shutdown in the Early Intervention Program, from a psychoanalytic perspective. This is clinical-qualitative research, with content analysis, based on clinical vignettes of three cases of children, between 2 and 3 years old. Three approaches are discussed regarding the uses and types of objects belonging to a baby’s universe, to ask if they could assist in the autism clinic: the transitional object, the tutor object, and the mediation object. It is considered that the camera promoted and sustained important intersubjective meetings and the awakening of children’s attention, previously less interested in what was offered to them, initiating a space for co-construction and interludicity. Abstract purposes function Program perspective clinicalqualitative qualitative research analysis children old babys baby s universe clinic childrens attention them coconstruction co construction interludicity

Abstract This trial-based economic evaluation aimed to estimate the incremental cost of implementing an active learning strategy (theoretical-practical workshop) to substitute the didactic lecture as the sole method for students training in caries detection. We also provided a budget impact analysis and explored the composition of costs related to the activity. Data from the coordinating centre of a multicentre randomized and controlled study (IuSTC01) was analyzed as the first part of our main economic analysis plan. The perspective of the educational provider (the institution implementing the activity) was considered, and an immediate time horizon was adopted. All used resources were valued in Brazilian Real by adopting a microcosting strategy. Costs for each strategy were estimated and converted into international dollars. The incremental Cost per student and the total cost of implementing the complete teaching strategy for 80 students were calculated. Monte Carlo simulations were used to estimate the uncertainties. The incremental Cost estimated for the workshop implementation would be $7.93 per student (interquartile range (IQR): $7.8–8.1), and the total cost of the teaching activity would be $684 (IQR:672–696). The laboratory training comprised more than 50% of the total amount spent, and a higher percentage of this value was related to human resources costs (72%). Saving 40% of the costs could be expected for the next rounds of activities in the institution, assuming no need for additional preparation of didactic materials and tutor training. A modest incremental cost per student and an acceptable organizational budget impact should be expected for the institution when including active learning training in caries detection for undergraduate students, mainly related to the human resources involved. trialbased trial based theoreticalpractical theoretical practical IuSTC01 IuSTC (IuSTC01 plan considered adopted dollars 8 calculated uncertainties 793 7 93 $7.9 interquartile IQR (IQR) $7.8–8.1, 7881 $7.8–8.1 , 1 $7.8–8.1) 684 $68 IQR672–696. IQR672696 672–696 . 672 696 (IQR:672–696) 50 spent 72%. 72 72% (72%) 40 involved IuSTC0 (IuSTC0 79 9 $7. (IQR 788 $7.8–8. 68 $6 IQR672 IQR672–696 IQR67269 672696 672–69 67 69 (IQR:672–696 5 (72% 4 (IuSTC $7 78 $7.8–8 6 $ IQR67 IQR672–69 IQR6726 67269 672–6 (IQR:672–69 (72 $7.8– IQR6 IQR672–6 6726 672– (IQR:672–6 (7 $7.8 IQR672– (IQR:672– ( (IQR:672 (IQR:67 (IQR:6 (IQR:

RESUMO A hepatite crônica (HC) é caracterizada pela substituição dos hepatócitos por tecido fibrótico após injúria, em vez de regeneração do parênquima funcional, e a terapia não é curativa. A terapia com células-tronco tem mostrado potencial para reduzir a fibrose hepática. Este relato descreve o manejo de um cão com HC com abordagem baseada em células mesenquimais. Uma cadela de 13 anos foi atendida com perda de peso, êmese, diarreia e letargia. Previamente, fora diagnosticada com HC. Exames de sangue mostraram hipoalbuminemia, aumento das atividades da alanina aminotransferase (ALT) e fosfatase alcalina (FA), e anemia. Três transfusões de 2,5x106 células mesenquimais derivadas foram realizadas. Após a primeira transfusão, o tutor relatou melhora nos sinais clínicos. A bioquímica sérica evidenciou redução na atividade da FA. Após a segunda administração, houve redução nas atividades séricas da ALT e da FA, que continuaram caindo após a terceira transfusão. Houve aumento nas concentrações de albumina e proteína plasmática total. Após seis meses, o cão retornou para controle. Foram observados avanço na melhora dos sinais clínicos, nova redução na atividade da ALT e leve aumento da FA. A terapia baseada em células-tronco pode ser considerada alternativa promissora para doenças hepáticas crônicas. Neste relato, demonstrou segurança e eficácia. (HC injúria funcional curativa célulastronco tronco hepática 1 peso êmese letargia Previamente hipoalbuminemia (ALT FA , (FA) anemia 25x106 x 2 5x106 2,5x10 realizadas transfusão clínicos administração total meses controle crônicas eficácia (FA 25x10 5x10 2,5x1 25x1 5x1 2,5x 25x 5x

ABSTRACT Chronic hepatitis (CH) is characterized by the replacement of hepatocytes for fibrotic tissue after injury, and treatment is not curative. Stem cell therapy has shown potential to reduce liver fibrosis. This report describes the management of a dog with CH with a mesenchymal cell-based approach. A 13-year old dog was presented with weight loss, vomiting, diarrhea, and lethargy. She was previously diagnosed with CH. Blood analysis showed hypoalbuminemia, increased serum activities of alanine aminotransferase (ALT) and alkaline phosphatase (ALP), and anemia. Three 2.5x106 bone marrow-derived mesenchymal cells transplantations were performed. After the first transplantation, the owner reported an improvement in clinical signs. Biochemistry evidenced a reduction in ALP activity. After the second administration, serum biochemistry showed a decrease in serum ALT and ALP activities, which kept falling after the third transplantation. There was an increase in albumin and total plasmatic proteins concentration. After six months, the dog came back for control and further improvement in clinical signs, new decrease in ALT activity and a mild increase in ALP concentration was observed. Increase in total and plasmatic protein were also observed. Stem cell-based therapy may be considered a promising alternative for liver diseases. It was safe and showed efficacy in this report. (CH injury curative fibrosis cellbased based approach 13year year 13 loss vomiting diarrhea lethargy hypoalbuminemia (ALT ALP, , (ALP) anemia 25x106 x 2 5x106 2.5x10 marrowderived marrow derived performed transplantation signs administration months observed diseases 1 (ALP 25x10 5x10 2.5x1 25x1 5x1 2.5x 25x 5x

Tutor training is an essential component of any university's tutoring programme, but the role of tutor training is often understudied. Underpinned by a reflective practice theoretical lens, this study investigated the perceptions of tutors regarding the tutor training they receive at the beginning of the semester, with the thesis that tutor training imbues tutors with essential skills. A quantitative approach was assumed, buttressed by a positivist worldview. A sample was drawn from tutors who participated in the tutor training (n=69), whereas a self-administered questionnaire was used to collect data. Statistical analysis was conducted through the Independent Samples t-test (One-sample t-test). Results reveal that tutors who participated in the survey felt more confident, personally developed, more empathetic, and skilled in academic areas such as writing and student diversity. Training appears to help them understand the dynamics of teaching and learning and contributes positively to their work as tutors. The main implication of the study is that universities should invest in tutor training.

ABSTRACT Ludwig van Beethoven's life underwent an existential change when his brother died and left his son Karl in shared tutorship with his mother Johanna. 2. Almost without having had any relationship with his nephew, an intense and unexpected emotional need to become his sole guardian is triggered, an objective that he achieves by legally defeating his mother. 3. The Beethoven-Karl relationship develops plagued by disputes, surveillance, demands, control, as if the composer were experiencing for the first time what he had always denied himself, becoming a father.4. The nephew's suicide attempt points out to Beethoven that becoming a father means allowing the son to become different from the arrogant and inordinate personal ambitions and expectations, but this extreme signal was insufficient to make him understand that the other is always a danger because it shows a hidden and painful truth of one´s own self.

RESUMEN 1). La vida de Ludwig van Beethoven experimentó un cambio existencial al morir su hermano y dejar a su hijo Karl en tutoría compartida con su madre Johanna. 2). Casi sin haber tenido relación con su sobrino, se desencadena una necesidad emocional intensa e inesperada de convertirse en su único tutor, objetivo que consigue derrotando legalmente a su madre. 3). La relación Beethoven-Karl se desarrolla plagada de disputas, vigilancia, exigencias, control, como si el compositor viviera por vez primera lo que siempre se había negado, llegar a ser padre. 4). El intento de suicidio del sobrino le señala a Beethoven que convertirse en padre significa permitir que el hijo llegue a ser diferente a las arrogantes y desmesuradas ambiciones y expectativas personales, pero esta señal extrema fue insuficiente para hacerle entender que el otro siempre es un peligro porque muestra una verdad oculta intolerable y dolorosa del propio sí-mismo.

RESUMEN El proceso de superación profesional de los tutores de alumnos ayudantes de la carrera de Estomatología, constituye un eslabón esencial en la educación médica. Después del triunfo de la Revolución cubana, el proceso formativo de posgrado comenzó a germinar. Actualmente, la educación exhorta la preparación constante del profesional, debido a que la población demanda la presencia de un personal altamente calificado en los centros educativos, con elevado compromiso social con su país y una adecuada preparación político-ideológica. El objetivo se centró en fundamentar la importancia de la superación profesional de los tutores de alumnos ayudantes de la carrera de Estomatología. Se revisaron artículos originales y de revisión publicados entre 2000 y 2023, en español e inglés. La búsqueda fue realizada en la base de datos SciELO y a través del motor de búsqueda Google Académico. Las palabras clave utilizadas fueron: “superación profesional”, “tutor de alumno ayudante”, “componente investigativo”. La superación del tutor de alumno ayudante se orientó a la transformación del proceso de enseñanza-aprendizaje y, en la misma medida, contribuyó a su propio cambio. Desde este referente, se delinean los desafíos de este importante proceso en las instituciones universitarias, como es el caso de las universidades de ciencias médicas, específicamente en la carrera de Estomatología. La superación profesional debe estar encaminada a las nuevas demandas de la sociedad, donde la preparación, el desarrollo y el intercambio de conocimientos deben integrar al profesional.

ABSTRACT The process of professional improvement of the tutors of assistant students in the Stomatology studies is an essential linkage in Medical Education. After the triumph of the Cuban revolution, the postgraduate training process began to develop. Currently, education urges the constant training of professionals, because the population demands the presence of highly qualified personnel in educational centers, with a high social commitment to their country and adequate political-ideological preparation. The objective focused on substantiating the importance of the professional improvement of the tutors of assistant students in the Stomatology courses. Original and review articles published between 2000 and 2023 in English and in Spanish were reviewed. The search was carried out in the SciELO database and through the Google Scholar search engine. The keywords used were: “professional improvement”, “assistant student tutor”, “research component”. The improvement of the assistant student tutor was aimed at the transformation of the teaching-learning process and, to the same extent, contributes to its own transformation. From this point of reference, the challenges of this important process in university institutions are outlined, as it is the case of the universities of medical sciences, specifically, in the studies of Stomatology. Professional improvement must be aimed at the new demands of society, where training, development and exchange of knowledge must integrate the professional.

RESUMEN Introducción: El tutor juega un rol importante en el proceso de enseñanza-aprendizaje. En la sociedad científica, el conocimiento crece de forma acelerada, lo que contribuye a la necesidad de aprender a gestionarlo; bajo este precepto resultó necesario actualizar a los profesionales de la salud que ejercen función docente en la educación en el trabajo, con la finalidad de proveerles de herramientas pedagógicas. Objetivo: Evaluar la estrategia de superación para el desempeño profesional pedagógico del tutor en la educación en el trabajo, en la formación del técnico superior en Análisis Clínico y Medicina Transfusional. Métodos: Se realizó un estudio mixto, longitudinal, descriptivo. La población y muestra quedó constituida por 107 tutores. Se empleó la observación del desempeño profesional pedagógico y la consulta a expertos. Se utilizó la estadística descriptiva, en particular el análisis porcentual, con los programas Microsoft Excel y SPSS, método Delphi para criterio de expertos y la técnica de Iadov, para la satisfacción de los tutores. Resultados: El procesamiento y análisis de la información obtenida con la aplicación de la guía de observación, después de la estrategia, arrojó cambios positivos en las dimensiones Pedagógica, Didáctica, Superación Profesional, Científico-investigativa, Función del tutor. La evaluación de los expertos fue de muy adecuada. El índice de satisfacción grupal fue satisfactorio. Conclusiones: Los resultados expresaron valor científico al evidenciar el mejoramiento en el desempeño profesional pedagógico del tutor en la educación en el trabajo, luego de la implementación de la estrategia de superación.

ABSTRACT Introduction: The tutor plays an important role in the teaching-learning process. In scientific society, knowledge grows rapidly, which contributes to the need to learn to manage it; under this precept it was necessary to update health professionals who exercise a teaching role in on-the-job education in order to provide them with pedagogical tools. Objective: To evaluate the improvement strategy for the professional pedagogical performance of the tutor in on-the-job education in the training of senior technicians in Clinical Analysis and Transfusion Medicine. Methods: A mixed, longitudinal, descriptive study was carried out. The population and sample consisted of 107 tutors. Observation of pedagogical professional performance and consultation with experts were used. Descriptive statistics were used, in particular the percentage analysis, with the Microsoft Excel and SPSS programs, the Delphi method for expert criteria and the Iadov technique for the satisfaction of tutors. Results: The processing and analysis of the information obtained with the application of the observation guide, after the strategy, showed positive changes in the Pedagogical, Didactic, Professional Improvement, Scientific-investigative, and Tutor Function dimensions. The experts’ evaluation was very adequate. The group satisfaction index was satisfactory. Conclusions: The results expressed scientific value by evidencing the improvement in the professional pedagogical performance of the tutor in on-the-job education, after the implementation of the improvement strategy.

RESUMO Introdução: A Aprendizagem Baseada em Problemas ocorre por meio do trabalho em pequenos grupos, facilitado pelos tutores, devendo haver contribuição de todos para o alcance dos objetivos de aprendizagem. O estudante com perfil dominante pode desequilibrar essa dinâmica do grupo. Objetivo: Este estudo teve como objetivo compreender, na perspectiva da aprendizagem colaborativa, os significados atribuídos pelos docentes e discentes à presença do estudante com perfil dominante no grupo tutorial. Método: Realizaram-se dois estudos, de natureza qualitativa, com tutores e estudantes de uma faculdade do Nordeste do Brasil. O primeiro estudo objetivou compreender a percepção dos docentes sobre presença do estudante dominante no grupo tutorial. Para tanto, utilizaram-se entrevistas semiestruturadas para coleta das informações. A população foi composta por tutoras da graduação de Fisioterapia, com mais de dois anos facilitando grupos tutoriais. O segundo estudo objetivou compreender os significados atribuídos por discentes à presença do perfil de dominância nas tutorias. Utilizou-se o grupo focal como método de coleta. Participaram estudantes de Medicina dos quatro primeiros anos do curso. O processo de análise e interpretação das falas dos dois estudos foi ancorado nos pressupostos teóricos da aprendizagem colaborativa, os quais também serviram de referência para elaboração do roteiro das entrevistas e do grupo focal. Adotou-se a técnica da análise de conteúdo de Bardin. Os estudos foram aprovados pelo Comitê de Ética em Pesquisa com CAAE nº 26191119.5.0000.5569 e CAAE nº 38005320.5.0000.5569, respectivamente. Resultado: Os tutores e estudantes enfatizaram a diversidade encontrada no perfil de dominância. Caracterizaram o estudante com esse perfil como colaborativo, participativo e preparado. Apontaram também características de impaciência, dificuldade em escutar e aceitar colocações contrárias às suas, além de comportamento intrusivo, silenciando e limitando a participação de outros. As tutoras reforçaram a dificuldade em lidar com o estudante dominante, inclusive em dar feedback. Os discentes relataram que os tutores, perante o estudante dominante, não percebiam a ausência de colaboração no grupo e apresentavam insegurança para intervir. Conclusão: Os discentes expressaram tolhimento e insegurança diante da presença do estudante dominante, com prejuízo na construção do conhecimento do grupo e no desempenho individual, bem como decepção quanto à atuação do tutor. Os tutores demonstraram reconhecer as sutilezas dentro do perfil de dominância, apesar de suas dificuldades em intervir adequadamente. Introdução Objetivo colaborativa tutorial Método Realizaramse Realizaram se qualitativa Brasil tanto utilizaramse utilizaram informações Fisioterapia tutoriais tutorias Utilizouse Utilizou curso Adotouse Adotou Bardin 26191119500005569 26191119 5 0000 5569 26191119.5.0000.556 38005320500005569 38005320 38005320.5.0000.5569 respectivamente Resultado colaborativo preparado impaciência intrusivo outros feedback Conclusão individual tutor adequadamente 2619111950000556 2619111 000 556 26191119.5.0000.55 3800532050000556 3800532 38005320.5.0000.556 261911195000055 261911 00 55 26191119.5.0000.5 380053205000055 380053 38005320.5.0000.55 26191119500005 26191 0 26191119.5.0000. 38005320500005 38005 38005320.5.0000.5 2619111950000 2619 26191119.5.0000 3800532050000 3800 38005320.5.0000. 261911195000 261 26191119.5.000 380053205000 380 38005320.5.0000 26191119500 26 26191119.5.00 38005320500 38 38005320.5.000 2619111950 2 26191119.5.0 3800532050 3 38005320.5.00 261911195 26191119.5. 380053205 38005320.5.0 26191119.5 38005320.5. 26191119. 38005320.5 38005320.

ABSTRACT Introduction: Problem-Based Learning occurs through work in small groups, facilitated by tutors, and everyone is expected to contribute to the achievement of the learning objectives. The presence of a dominant profile student could lead to some imbalance in the group dynamics. Objective: to understand, from the perspective of collaborative learning, the meanings attributed by tutors and students to the presence of the dominant profile student in the tutorial group. Methods: two qualitative studies with tutors and students were conducted at a university in northeastern Brazil. The first aimed to understand the tutor’s perception of the presence of the dominant student in the tutorial group. Semi-structured interviews were used to collect information. The population consisted of tutors from the physiotherapy undergraduate course with more than two years facilitating tutorial groups. The second study aimed to understand the meanings attributed by students about the presence of the dominance profile in tutoring. Information was collected by focus group. The study population consisted of medical students from the first four years of the course. The process of analysis and interpretation was anchored in the theoretical assumptions of collaborative learning, which also served as a reference for the development of the interviews and focus group scripts. Bardin’s content analysis technique was adopted. The studies were approved by the Research Ethics Committee, CAAE: 26191119.5.0000.5569 and CAAE: 38005320.5.0000.5569. Results: tutors and students highlighted the diversity within the dominance profile. They characterized the student with this profile as collaborative, participatory and prepared. They also pointed out characteristics of impatience, difficulty in listening and accepting arguments contrary to their own. In addition, they reported intrusive behavior, silencing and limiting the participation of others. The tutors reinforced the difficulty in dealing with the dominant student, especially when giving feedback. The students reported that tutors, when facing the dominant student, did not perceive the lack of collaboration in the group and were insecure to intervene. Conclusion: the students expressed embarrassment and insecurity when faced with presence of the dominant student, leading to losses in the construction of group knowledge and individual performance, as well as disappointment in relation to the tutor’s performance. The tutors showed they recognize subtleties within the dominance profile, despite difficulties in adequately intervening. Introduction ProblemBased Problem Based groups objectives dynamics Objective Methods Brazil tutor s Semistructured Semi structured information tutoring scripts Bardins Bardin adopted Committee CAAE 26191119500005569 26191119 5 0000 5569 26191119.5.0000.556 38005320500005569 38005320 38005320.5.0000.5569 Results prepared impatience own addition behavior others feedback intervene Conclusion performance intervening 2619111950000556 2619111 000 556 26191119.5.0000.55 3800532050000556 3800532 38005320.5.0000.556 261911195000055 261911 00 55 26191119.5.0000.5 380053205000055 380053 38005320.5.0000.55 26191119500005 26191 0 26191119.5.0000. 38005320500005 38005 38005320.5.0000.5 2619111950000 2619 26191119.5.0000 3800532050000 3800 38005320.5.0000. 261911195000 261 26191119.5.000 380053205000 380 38005320.5.0000 26191119500 26 26191119.5.00 38005320500 38 38005320.5.000 2619111950 2 26191119.5.0 3800532050 3 38005320.5.00 261911195 26191119.5. 380053205 38005320.5.0 26191119.5 38005320.5. 26191119. 38005320.5 38005320.