ABSTRACT Objective. To identify the food industry’s arguments against front-of-package nutrition labels in Uruguay. Methods. Content analysis and inductive coding were applied to the comments made by the food industry during the public consultation on the draft decree regulating the inclusion of front-of-package nutrition labels (warnings) in Uruguay. Results. Most of the comments expressed concern about the high prevalence of obesity and noncommunicable diseases in the country and emphasized a commitment to implementing actions to help combat these health problems. However, 81% of the comments disagreed with the draft decree presented for public consultation; these included general criticisms of its validity. The content of the comments related to seven areas: lack of rationale for the measure; violation of international commitments; criticisms of the warning system; discrimination against industrialized packaged food; criticisms of the nutrient profile model; other criticisms of aspects specific to the draft decree; and adverse economic effects. For each area, there is discussion of the technical and normative relevance and consistency of the content presented by the industry representatives. Conclusions. Despite apparent agreement about the need to adopt measures, it is clear that the food industry is strongly opposed to the policy and, in particular, to the warning system. The results of this analysis may help to facilitate the process of implementing similar regulations in other countries.

RESUMO Objetivo. Identificar os argumentos da indústria alimentícia contra a rotulagem frontal de advertência nutricional no Uruguai. Métodos. Realizou-se uma análise do conteúdo dos comentários de representantes da indústria alimentícia obtidos em uma consulta pública conduzida no Uruguai durante o processo de elaboração do decreto para regulamentar a inclusão de rotulagem frontal de advertência nutricional com uso de códigos indutivos. Resultados. Os comentários, na sua maioria, revelaram preocupação com a alta prevalência de obesidade e doenças crônicas não transmissíveis no país e destacaram o compromisso com a implementação de ações para combater estes problemas de saúde. No entanto, verificou-se que, em 81% dos comentários, os participantes discordavam da proposta do decreto apresentada na consulta pública e teceram críticas gerais quanto à sua validade. Observaram-se sete dimensões distintas no conteúdo dos comentários: falta de justificação da medida, descumprimento de compromissos internacionais, críticas ao sistema de advertência, discriminação de alimentos industrializados em embalagens, críticas ao modelo de perfil nutricional, outras críticas relativas a aspectos específicos do projeto do decreto e repercussão econômica negativa. Para cada dimensão, foram discutidas a relevância e a coerência técnica e normativa do conteúdo dos comentários feitos pelos representantes da indústria. Conclusões. Apesar de uma suposta concordância quanto à necessidade de adotar medidas, observou-se uma firme oposição da indústria alimentícia à política e, em particular, ao sistema de advertência nutricional propostos. Os resultados desta análise servem para facilitar o processo de implementação de regulamentações semelhantes em outros países.

RESUMEN Objetivo. Identificar los argumentos de la industria alimentaria en contra del etiquetado frontal de advertenciasnutricionales en Uruguay. Métodos. Se realizó un análisis de contenido de los comentarios de la industria alimentaria recibidos durante la consulta pública implementada durante el proceso de diseño del decreto que reglamenta la inclusión de rotulación nutricional frontal basada en advertencias en Uruguay mediante una codificación inductiva. Resultados. La mayoría de los comentarios manifestaron la preocupación por la elevada prevalencia de obesidad y enfermedades no transmisibles en el país y destacaron el compromiso con la implementación de acciones que contribuyan a combatir esta problemática de salud. Sin embargo, 81% de los comentarios planteó desacuerdo con la propuesta de decreto elevada a consulta pública y realizó críticas generales sobre su validez. El contenido de los comentarios se relacionó con siete dimensiones: falta de justificación de la medida, violación de compromisos internacionales, críticas al sistema de advertencias, discriminación a alimentos industrializados envasados, críticas al modelo de perfil de nutrientes, otras críticas a aspectos específicos del proyecto de decreto y efectos económicos negativos. En cada dimensión se discute la pertinencia y consistencia técnica y normativa de los contenidos vertidos por los representantes de la industria. Conclusiones. Bajo un aparente acuerdo con la necesidad de adoptar medidas, se evidenció, sin embargo, una fuerte oposición a la política y en particular al sistema de advertencias por parte de la industria alimentaria. Los resultados del análisis aportan insumos para facilitar el proceso de implementación de regulaciones similares en otros países.

Resumen: El objetivo de este artículo es determinar la importancia del metamizol como analgésico en México, al conocer la frecuencia de su uso y los mecanismos de acción y así clasificar adecuadamente al medicamento dentro de la farmacopea de analgésicos. Pocos fármacos generan discusión sobre su filiación, pero el metamizol, desde que salió al mercado en 1922 hasta el día de hoy, se mantiene sin definirse claramente. Comúnmente cuando se busca una clasificación de los antiinflamatorios no esteroideos (AINE), se clasifica al metamizol dentro de los mismos como derivados de la pirazolona. Se debe comenzar entonces con los aspectos farmacológicos para relacionar las semejanzas y diferencias con otros AINEs y poder sacar conclusiones adecuadas. Aun así, el medicamento es de los más utilizados por los médicos en los hospitales de segundo y tercer nivel (82%), aunque la mayoría no sabe en realidad cuál es su mecanismo de acción (91%), por ello, la importancia de conocer el mecanismo de acción de este fármaco.

Abstract: The aim of this article is to know the importance of metamizol as analgesic in Mexico, knowing the frequency of their use and the mechanisms of action and to adequately classify the drug in the pharmacopoeia of painkillers. Few drugs generate discussion about their parentage but metamizol from that hits the market in 1922 until today, it has no clearly defined. Commonly when NSAIDs rated seeks to metamizol is classified within the same as pyrazolone derivatives. We then start with the pharmacological aspects and later to know the similarities and differences with other NSAIDs and can draw appropriate conclusions. Even so, the medicine is one of the most used by physicians in second and third level hospitals (82%), although most do not really know what their mechanism of action is (91%), so the importance of knowing the mechanism of action of this drug.

RESUMEN Existe amplia evidencia de los efectos de la ansiedad precompetitiva (e.g. Bueno, Capdevila y Fernández- Castro, 2002; Caracuel y Jaenes, 2015) en las prácticas y pruebas deportivas, así como del rol protector de las estrategias de afrontamiento que emplean los deportistas (e.g., Soto, 2003). Sin embargo, debido a que las prácticas deportivas competitivas se diferencian, entre otras cosas, en su carácter colectivo o individual, tanto la ansiedad competitiva como las estrategias de afrontamiento involucradas pudiesen diferenciarse según dicha condición (e.g., Simón y Martens,1979). El presente estudio corresponde a una exploración sobre posibles efectos diferenciales del tipo de práctica sobre la ansiedad precompetitiva, las estrategias de afrontamiento y la relación entre ambas. El diseño fue transversal de tipo correlacional, en el cual se aplico el Inventario de Ansiedad Competitiva en el Deporte (CSAI-2) y el Cuestionario de Aproximación al Afrontamiento en el Deporte (ACSQ-1) a 22 nadadores individuales y 28 jugadores de waterpolo, minutos antes de una competición oficial. Los resultados indican que existen diferencias solo en los niveles de autoconfianza, pero que la relación entre estrategias de afrontamiento y ansiedad precompetitiva es distinta entre grupos. Finalmente, se sugieren modelos diferenciados de intervención, el alcance de los resultados, las limitaciones del estudio y se sugieren nuevas investigaciones.

ABSTRACT There is extensive evidence of the effects of precompetitive anxiety (e.g. Bueno, Capdevila,& Fernández-Castro, 2002; Caracuel and Jaenes, 2015) in sports practices and events, as well as the protective role of coping strategies employed by athletes (e.g., Soto, 2003). However, because competitive sports practices differ, among other things, in their collective or individual character, both competitive anxiety and the coping strategies involved could be differentiated according to that condition (e.g., Simon and Martens, 1979). This study corresponds to an exploration of possible differential effects of the type of practice on precompetitive anxiety, coping strategies and the relationship between both. The design was transversal and correlational kind, in which the Inventory of Competitive Anxiety in Sport (CSAI-2) and the Questionnaire of Approach to Facing in Sport (ACSQ-1) were applied to 22 individual swimmers and 28 water polo players, minutes before an official competition. Results indicate that there are differences only in levels of self-confidence, but that the relationship between coping strategies and precompetitive anxiety is different between groups. Finally, differentiated models of intervention, the scope of the results, the limitations of the study, and new research are suggested.

Resumen Introducción Los Programas de Recuperación Mejorada (PRM) en cirugía colorrectal disminuyen las complicaciones y acortan la estadía hospitalaria. La implementación de un PRM representa un desafío en nuestro sistema de salud público, dado la alta demanda y recursos limitados. Objetivo Evaluar el efecto en la estadía hospitalaria (EH) posterior a la implementación de un PRM en cirugía colorrectal electiva en un hospital público. Materiales y Método Estudio retrospectivo, que incluyó pacientes entre 15 y 85 años operados electivamente de resecciones colorrectales en un hospital público entre 1 de enero de 2015 y 31 de diciembre de 2016. Se compararon dos grupos: 1) total de pacientes operados electivamente 1 año posterior a la implementación del PRM (post-PRM) y 2) total de pacientes operados electivamente un año previo a la implementación de PRM (pre-PRM), en términos de EH, reingresos, complicaciones y mortalidad a 30 días. Se realizó análisis de tiempo a evento para comparar la EH entre ambos grupos. Resultados Un total de 144 pacientes fueron incluidos: 92 en el grupo post-PRM y 52 en el grupo pre-PRM. No hubo diferencias clínicas entre ambos grupos. La mediana de EH en el grupo post-PRM fue 2 días menor que en el grupo control (5 vs 7 días, test de log-rank, p = 0,03). No hubo diferencia en complicaciones, reingresos ni mortalidad. Conclusión La implementación de un PRM en cirugía colorrectal electiva en un hospital público se asocia a una disminución de la EH sin aumento de morbimortalidad.

Background Enhanced Recovery Programs (ERP) in colorectal surgery has proved to decrease complications and shorten hospital stay. The implementation of an ERP could be a difficult task in a high-demanding public health system with limited resources. Aim Evaluate the effect on length of stay (LOS) after the implantation of an ERP for colorectal surgery in a resource-limited public hospital. Materials and Method This retrospective study included patients aged 15-85 years who underwent elective colorectal surgery at a resource-limited public hospital in Chile between January 1, 2015 and December 31, 2016. We compared two groups: (1) total number of patients operated electively after 1-year of ERP implementation (post-ERP group) and (2) total number of patients electively operated 1-year previous ERP (pre-ERP group) in terms of LOS, readmissions, complications, and 30-day mortality. A time to event analysis was performed to evaluate differences in LOS. Results A total of 144 patients were included in this study: 92 in the post-ERP group and 52 in the pre-ERP group. There were no clinical differences between groups. The median LOS in the post-ERP group was 2 days lower than that in the control group (5 vs 7 days, log-rank test p = 0.03). There were no differences in complications, readmissions, and 30-day mortality. Conclusions The implementation of an ERP for colorectal surgery in a resource-limited hospital was associated with decreased LOS without increasing morbidity.

Resumen Introducción El uso del sistema de visión 3D en cirugía laparoscópica puede significar una mejor performance de los procedimientos quirúrgicos de mayor complejidad. Objetivo Reportar las indicaciones, los resultados y la valoración de un grupo de cirujanos de diferentes especialidades en el uso de visión 3D. Materiales y Método: Se analizan las indicaciones quirúrgicas y los resultados subjetivos y objetivos del uso del sistema óptico 3D (n = 155 pacientes) en cirugía laparoscópica compleja. Para evaluación subjetiva se aplicó a una encuesta de percepción cualitativa a los cirujanos participantes tipo Likert. Para la evaluación objetiva, se registran los tiempos quirúrgicos empleados en los diferentes procedimientos efectuados y las complicaciones postoperatorias y se comparan con los pacientes operados con sistema 2D (n = 783 pacientes) en el mismo periodo. Resultados el 70,6% concuerda tener mejor imagen con la técnica 3D, el 64,7% de los cirujanos refieren que se puede reducir el tiempo operatorio, el 58,8% considera que se puede reducir el error quirúrgico, el 92% y 100% respectivamente afirman que el confort del cirujano es mejor con el uso de óptica 3D y que esta técnica es recomendable para los procedimientos complejos. El tiempo operatorio se redujo en algunos procedimientos, especialmente urológicos. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a complicaciones postoperatorias. En la 3D no se encontró mortalidad postoperatoria, probablemente por el menor número de pacientes de ese grupo. Conclusión La laparoscopia 3D posee una buena valoración por los cirujanos que la emplearon, principalmente en calidad de imagen, reducción del tiempo operatorio y confort del cirujano en comparación con la laparoscopía 2D convencional. No se encontró diferencias sustanciales al comparar los resultados con el uso de sistema 3D versus 2D en cuanto a tiempo operatorio ni complicaciones postoperatorias.

Introduction The use of the 3D vision system in laparoscopic surgery can mean better performance in more complex surgical procedures. Aim Report the indications, results and assessment of a group of surgeons of different specialties in the use of 3D vision. Materials and Method Surgical indications and subjective and objective results of the use of 3D optical system in patients (n = 155) submitted to complex laparoscopic surgery are analyzed. Subjective evaluation based on a survey of qualitative perception (Likert) was applied to the participating surgeons. For objective evaluation, the operatory times and postoperative complications were recorded and compared with the results observed with the use of the 2D system (783 patients) in the same period. Results 70.6% agree to have a better image with the 3D technique, 64.7% of surgeons report that the operative time can be reduced, 58.8% consider that it can be reduced the surgical error, 92% and 100% respectively considered that the comfort of the surgeon is better with the use of 3D optics and that this technique is recommended for complex procedures. No substantial differences were found when comparing the results with the use of 3D versus 2D system by the same surgical teams in terms of operative times and postoperative complications. In 3D, postoperative mortality was probably not found due to the lower number of patients in this group. Conclusion 3D laparoscopy has a good evaluation by the surgeons who used it, mainly in image quality, reduction of operative time and comfort of the surgeon compared to conventional 2D laparoscopy. No substantial differences were found when comparing the results with the use of 3D versus 2D system in terms of operative times or postoperative complications.

ABSTRACT Background: The functional fitness of older people may be associated with their nutritional status. Aim: To assess the association between of anthropometric measures with functional fitness in older people. Material and Methods: Cross-sectional study conducted in 75 participants aged 65 to 89 years. Body mass index (BMI), waist-to-height ratio (WHtR), fat mass (FM) and skeletal muscle mass index (SMI) were calculated from anthropometric measures. The functional fitness was determined using the Senior Fitness Test battery. Results: BMI and FM indicated obesity, and WHtR indicated cardiometabolic risk in 49%, 55% and 83% of participants, respectively. SMI indicated a low muscle mass in 91% of females. Performance standards of chair stand, arm curl, 2-min step test and 8-foot up-and-go tests were met in 1%, 8%, 1% and 89% of participants, respectively. Significant negative correlations were found between 2-min step test and BMI, WHtR and FM (r = −0.26, −0.31 and −0.48 respectively). Back scratch had a negative correlation with BMI (r = −0.23) and SMI (rho = −0.28). Significant positive correlations were found between 8-foot up-and-go, WHtR (rho = 0.28) and FM (rho = 0.23), and between 2-min step test and SMI (rho = 0.28). The coefficient of determination (R2) between 2-min step test with BMI, WHtR and FM were 0.05, 0.08 and 0.22, respectively, while the R2 between back scratch and BMI was 0.04. Multiple regression models indicated that FM affected the 2-min step test independently of BMI and WHtR (adjusted R2 = 0.22), however age and sex negatively influenced these associations. Conclusions: Functional fitness of older adults is influenced by nutritional anthropometric measures, particularly BMI, WHtR and FM for aerobic capacity, and BMI for upper limb flexibility.

Introducción: El estado nutricional y la condición física funcional (CFF) pueden estar relacionados en adultos mayores. Objetivo: Analizar la influencia de medidas antropométricas nutricionales sobre CFF. Material y Método: Estudio transversal realizado en 75 adultos de 65 a 89 años. Las variables antropométricas fueron índice de masa corporal (IMC), razón cintura-talla (RCT), masa adiposa (MA) e índice de masa muscular esquelética (IMME). La evaluación de CFF se efectuó con la batería Senior Fitness Test. Resultados: El IMC y MA indicaron obesidad, y RCT indicó riesgo cardiometabólico en 49%, 55% y 83% de los participantes, respectivamente. IMME indicó una baja masa muscular en 91% de las mujeres. El estándar de rendimiento para las pruebas sentarse-levantarse, flexión-codo, paso-2-minutos y levantarse-caminar-sentarse se logró en 1%, 8%, 1% y 89% de los participantes, respectivamente. Se encontraron correlaciones significativas negativas entre paso-2-minutos con IMC, RCT y MA (r = −0.26,-0.31 y-0.48 respectivamente. La misma asociación se observó entre juntar-manos-espalda con IMC (r = −0.23) e IMME (rho = −0.28). Se encontraron correlaciones significativas positivas entre levantarse-caminar-sentarse con RCT (rho=0.28) y MA (rho = 0.23), y entre paso-2-minutos con IMME (rho = 0.28). Los R2 entre paso-2-minutos e IMC, RCT y MA fueron 0.05, 0.08 y 0.22, respectivamente, mientras que el R2 entre juntar-manos-espalda e IMC fue 0.04. Los modelos de regresión múltiple indicaron que MA afectó la prueba paso-2-minutos independientemente de IMC y RCT (R2 ajustado = 0.22), aunque la edad y sexo afectaron negativamente estas asociaciones. Conclusiones: La CFF de adultos mayores es influenciada por alteraciones evidenciadas por medidas antropométricas nutricionales, particularmente IMC, RCT y MA sobre la capacidad aeróbica, e IMC sobre la flexibilidad de extremidad superior.

ABSTRACT Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. Conclusion: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.

RESUMO Raciona l: A gastrectomia é o tratamento principal para o câncer de junção esofagogástrica (EGJ) e Siewert tipo II-III. Ela está associada à morbidade significativa. As taxas de morbidade total variam entre os diferentes estudos e poucos avaliaram a morbidade pós-operatória de acordo com a gravidade da complicação. Objetivo: Identificar os preditores de morbidade pós-operatória grave. Métodos: Este foi um estudo de coorte retrospectivo de um banco de dados prospectivo. Foram incluídos pacientes tratados com gastrectomia para câncer gástrico ou EGJ em um único centro. A morbidade severa foi definida como escore de Clavien-Dindo ≥3. Análise multivariada foi realizada para identificar preditores de morbidade grave. Resultados: Duzentos e oitenta e nove gastrectomias foram realizadas (67% homens, mediana de idade: 65 anos). A localização do tumor foi EGJ em 14%, o terço superior do estômago em 30%, o terço médio em 26% e o terço inferior em 28%. Em 196 (67%), foi realizada gastrectomia total com dissecção de linfonodos D2 em 85%. Duzentos e onze pacientes (79%) foram submetidos à gastrectomia aberta. O estado T foi T1 em 23% e T3/T4 em 68%. A mortalidade pós-operatória foi de 2,4% e a taxa de morbidade foi de 41%. A morbidade severa foi de 11% e foi representada principalmente por fístula esofagojejunal (2,4%), fístula duodenal (2,1%) e complicações respiratórias (2%). Na análise multivariada, a localização do EGJ e os tumores T3/T4 foram associados com maior morbidade pós-operatória grave. Conclusão: Morbidade pós-operatória severa após gastrectomia foi de 11%. A localização do tumor na junção esofagogástrica e o estado T3/T4 são fatores de risco para a morbidade pós-operatória grave.

Abstract: This paper analyzes the relationship between custom, one of the main sources of public international law, and the need of consent of the State to which the customary rule should apply. The two main answers that the authors gave in connection to that relationship are reviewed: on the one hand, the authors who require consent as a condition for enforceability of the customary law and, on the other hand, the authors who deny the need of such consent. We adopt the doctrinal opinion that international customary law is compulsory only for those States that had, expressly or tacitly, consented to it.

Resumen: El presente trabajo analiza la relación existente entre una de las principales fuentes del Derecho Internacional Público, la costumbre y el consentimiento de los Estados. En particular, se repasarán las dos grandes respuestas que los autores han intentado ensayar al respecto, agrupándose a los mismos entre los consensualistas y aquellos que niegan la necesidad de contar con el consentimiento del Estado al cual se pretende obligar mediante la norma consuetudinaria. Finalmente, se concluye adoptando la posición doctrinal según la cual la norma consuetudinaria internacional es únicamente obligatoria para aquellos Estados que, en forma expresa o tácita, la han consentido.

Resumo: Este artigo analisa a relação entre uma das principais fontes do Direito Internacional Público, o costume e o consentimento dos Estados. Em particular, serão revisadas as duas grandes respostas que os autores tentaram ensaiar a esse respeito, agrupando-as entre os consensualistas e aqueles que negam a necessidade de ter o consentimento do Estado ao qual pretendem dar por meio da norma costumeira. Finalmente, conclui-se adotando a posição doutrinária segundo a qual a norma internacional consuetudinária é obrigatória apenas para os Estados que, expressa ou tacitamente, a consentiram.

Abstract: Rodrigo Lira’s poetry is marked by the use of black humor and polyphony, both to refer to the poetic voice and its literary, cultural, social and political context. These strategies for the configuration of their identity and discursive positioning, of a fragmentary nature are used to conjure his sense of belonging, loneliness and guilt of being.

Resumen: La poesía de Rodrigo Lira está marcada por el uso del humor negro y la polifonía, tanto para referirse a la voz poética como a su contexto literario, cultural, social y político. Estas estrategias para la configuración de su identidad y posicionamiento discursivo, de carácter fragmentario, se utilizan para conjurar su sentido de despertenencia, soledad y culpa de ser.

Abstract: This study investigated the ability of formulation containing Zingiber officinale (ginger) to reverse health changes promoted by unhealthy diet in Wistar rats. Five compounds from the gingerol family and three from the shogaol family were identified in the chromatographic analyzes of the extract. The animals were fed a combination of unhealthy foods, the cafeteria diet, which promoted increases in body weight, hepatocyte nucleus area, total hepatocyte area and liver fat accumulation, as well as reduced hepatic glutathione S-transferase concentration, compared to the control group, which received commercial chow. The treatment with ginger improved all these results, highlighting the reduction of 10% of body weight and 66% of the total area of lipid droplets deposited, compared to the group that received the cafeteria diet. Ginger treatments also attenuated lipid peroxidation, with a mean reduction of 41% in malondialdehyde levels and a mean increase of 222% in glutathione S-transferase activity in the liver. The cafeteria diet and ginger extract did not promote significant changes in glycemic and lipid profile, liver weight and liver enzymes compared to the control group. We suggest that ginger can have beneficial effects on health complications associated with unhealthy diet, such as excessive adiposity, oxidative stress and hepatic injury.

OBJECTIVES: Feedback is a powerful learning tool, but a lack of appropriate feedback is a very common complaint from learners to teachers. To improve opportunities for feedback on objective structured clinical examinations (OSCEs), a modified examiner role, termed the “shadow” examiner, was tested. This study aims to present and analyze comparisons between the “shadow” examiner and the original OSCE examiner format. METHODS: In 2011, experiments were carried out with modifications to the examiner’s role to define the “shadow” examiner format. From February 2012 to May 2014, research was conducted with 415 6th-year medical students. Of these students, 316 were randomly assigned to assessments by both “shadow” and “fixed” examiners. Pearson correlation analysis with linear regression, Student’s t-tests and Bland-Altman plots were the statistical methods used to compare the assessment modes. To strengthen the analysis, checklist items were classified by domain. RESULTS: High correlations between the “shadow” and “fixed” examiners’ global scores were observed. The results of the analysis of specific domains demonstrated higher correlations for cognitive scores and lower correlations for affective scores. No statistically significant differences between the mean examiner global scores were found. The Bland-Altman analysis showed that the “shadow” examiners’ affective scores were significantly higher than those of the “fixed” examiners, but the magnitude of this difference was small. CONCLUSION: The modified examiner role did not lead to any important bias in the students’ scores compared with the original OSCE examiner format. This new strategy may provide important insights for formative assessments of clinical performance.

ABSTRACT Objective: to describe biosecurity of respiratory diseases practiced by workers in fourteen cities of Peru. Methodology: a descriptive multicenter cross-sectional study was carried out in February through a self-administered questionnaire, where some concepts related to biosecurity of respiratory diseases and hygiene practices were asked. These were described in frequencies and percentages. Results: Of 4287 respondents, 68% (2913) were men; the average age was 31 years (interquartile range: 24-40 years). 91% and 53% knew what respiratory masks are used for and how respiratory diseases are transmitted, respectively. 46% self-medicate when they have the cold; 31-41% of workers, relatives or co-workers have been vaccinated against seasonal flu, these percentages go up when they were asked if they would be vaccinated in current year and most would not be vaccinated because they do not know where (Range: 35-40%); the arm and the hand are the most used to cover when sneezing. Conclusion: These characteristics show a population that may be susceptible to get and transmit respiratory diseases, so educational measures and interventions should be taken to improve knowledge/attitudes and to create good practices.

RESUMEN Objetivo: caracterizar la bioseguridad respiratoria que practican los trabajadores en catorce ciudades del Perú. Metodología: trabajo transversal descriptivo de tipo multicéntrico, a través de una encuesta auto-aplicada, donde se consultó temas relacionados con la bioseguridad respiratoria y de las prácticas de higiene que tenían. Estos se describieron con frecuencias y porcentajes. Resultados: de los 4287 encuestados, el 68% (2913) fueron hombres, la mediana de edades fue de 31 años (rango intercuartílico: 24-40 años). El 91% y el 53% sabían para que se usan las mascarillas respiratorias y la forma de trasmisión de las enfermedades respiratorias, respectivamente. El 46% se auto-medica cuando está resfriado; se han vacunado contra la gripe estacional entre 31-41% para los trabajadores, familiares o compañeros de trabajos, estos porcentajes suben cuando se les preguntó si se vacunarían el año en curso y la mayoría de los que no se vacunarían es porque no saben dónde (rango: 35-40%); el brazo y la mano son los más usados para cubrirse cuando estornudan. Conclusión: estas características muestran a una población que puede ser susceptible a contraer y trasmitir enfermedades respiratorias, por lo que se deben tomar medidas de educación e intervenciones para la mejora del conocimiento/actitudes y la generación de prácticas adecuadas.

Resumen Introducción: Los reportes extranjeros dan cuenta de la presencia de esta patología en cifras que varían entre 10 y 70%, con sólo un reporte nacional centrado en ancianos institucionalizados. Existen diferentes formas de evaluar la presencia de constipación; en nuestra experiencia utilizamos los nuevos criterios de ROMA IV que define como constipación funcional cuando se cumplen dos o más criterios. Objetivos: Determinar la prevalencia y el perfil epidemiológico de pacientes adultos sanos con constipación. Material y Método: Estudio de corte transversal realizado entre enero y marzo de 2018. Se incluyen mayores de 18 años que acceden a completar la encuesta. Se excluye aquellas personas con antecedentes quirúrgicos o mórbidos gastrointestinales. Se realiza encuesta aplicando los criterios de ROMA IV considerando aspectos demográficos. Se utiliza estadística descriptiva. Resultados: De 1.500 encuestas realizadas se seleccionan 1.223. Un 68,4% cumplían con dos o más criterios de constipación funcional, con diferencias estadísticamente significativas en el grupo de sexo femenino y en pacientes de mayor edad. El análisis específico de cada criterio de ROMA IV muestra que los síntomas más frecuentes fueron deposiciones duras, esfuerzo defecatorio excesivo y sensación de evacuación incompleta. Hubo diferencias estadísticamente significativas en mujeres en los ítems: menor frecuencia, deposiciones duras y esfuerzo defecatorio mientras que la mayor edad se asocia a evacuación incompleta. Las maniobras digitales fueron poco frecuentes. Conclusiones: La constipación es frecuente en la población adulta sana afectando, principalmente, a mujeres de mayor edad. Los síntomas más frecuentes fueron deposiciones duras, esfuerzo defecatorio y sensación de evacuación incompleta.

Introduction: The prevalence of this condition has been reported in foreign studies in around 10-70%, with only one national report focused in the institutionalized elderly. There are different diagnostic approaches to determine the presence of functional constipation, in our experience, we use the ROME IV diagnostic criteria, which requires the presence of two or more criteria for confirmation. Aim: To determine the prevalence and epidemiologic profile of healthy adults with constipation disorder. Materials and Method: Transversal cohort study between January-March 2018. Inclusion criteria are 18 years and above. We exclude patients with gastrointestinal medical or surgical comorbidities. Data are collected from a face-to-face survey based on the ROME IV criteria, considering demographic features. Descriptive statistics are used to analyze the results. Results: From a total of 1,500 questionnaire surveys, 1,223 are selected. Two or more criteria for functional constipation were present in 68.4%, with significant statistical differences in the female and elderly population. When analyzing each criterion separately, hard stools, straining and sensation of incomplete evacuation were the most common responses. In women, less frequency, hard stools and straining items showed significant statistical differences, whereas sensation of incomplete evacuation was the highlight in the elderly. Manual maneuvers to facilitate defecation was the less selected item. Conclusions: Functional constipation is a frequent condition seen in healthy adults. Older female population are particularly prone to it. Hard stools, straining, and incomplete evacuation sensation were the most common symptoms.

Resumen Introducción: El entrenamiento estandarizado mediante simulación ha demostrado mejorar habilidades de residentes y cirujanos. Sin embargo, los centros de simulación que imparten programas validados son escasos y centralizados. Favorecer el acceso de la comunidad quirúrgica a estos programas constituye el desafío actual. Objetivo: Describir el primer “Learning Center” (LC) realizado durante el 90° Congreso Chileno de Cirugía, evaluar su impacto y percepción de los asistentes sobre simulación en cirugía mínimamente invasiva (CMI) en los programas de formación actual. Materiales y Método: Estudio de corte transversal. Se describieron las características del LC. Se aplicó una encuesta tipo Likert para evaluar impacto y percepción de los asistentes. Criterios de inclusión: completar ≥ 1 sesión de entrenamiento, exclusión: encuesta incompleta. Se aplicó estadística descriptiva y analítica no paramétrica. Resultados: LC se compuso de 10 estaciones de entrenamiento con distintos niveles de dificultad. Un equipo de 9 instructores monitorizaron y entregaron feedback efectivo a los asistentes. 84 asistentes contestaron la encuesta completa, 39% mujeres. La muestra se conformó por 41,6% residentes de cirugía general, 35,7% cirujanos, 17,9% internos de medicina, y 4,8% médicos generales. 85% manifestó acuerdo con el impacto positivo del LC como recurso educacional continuo durante el congreso, y la utilidad de la práctica simulada para el desarrollo de habilidades en CMI. No hubo diferencias significativas según sexo o nivel de formación. Conclusión: El primer LC se desarrolló con una amplia aceptación entre sus participantes, constituyendo un posible recurso permanente. El entrenamiento simulado en CMI parece ser un recurso aceptado y percibido como una necesidad por la comunidad quirúrgica nacional.

Background: Standardized Simulated Training (SST) has shown to improve both resident and surgeon skills. However, Simulation Centers with validated training programs are scarce and centralized. The current challenge is to provide the surgical community access to these programs. Aim: To describe the first Learning Center (LC), launched during the 90th Chilean Surgical Congress, and to assess its impact and attendees’ perception on simulation in Minimally Invasive Surgery (MIS) in current surgery residency programs. Materials and Method: Cross-sectional study. LC characteristics are described. A Likert survey was applied to assess its impact and attendees’ perception. Inclusion criteria: to have performed ≥ 1 training sessions. Exclusion criteria: incomplete surveys. Descriptive and non-parametric analytical statistics were applied. Results: The LC was composed of 10 training stations with different difficulty levels. Nine instructors monitored and gave attendees effective feedback. 84 attendees answered the survey adequately. 39% were women. The sample was composed of 41.6% General Surgery Residents, 35.7% Surgeons, 17.9% Medicine Clerks and 4.8% General Practitioners. 85% of participants agreed regarding both the positive impact of the LC as a continuous educational resource during the congress and SST usefulness in development of MIS skills. There were no significant differences according to sex or medical degree. Conclusion: The first LC was widely accepted amongst its participants, constituting a possible permanent resource in the Chilean Surgical Congress. SST in MIS seems to be an accepted resource and perceived as a necessity by the national surgical community.

ABSTRACT Introduction Maternal Mortality is considered a significant indicator of the quality of the health services in any country. It is known that approximately 95% of these deaths in Latin America and the Caribbean are preventable. Objectives Our objective is to determine whether or not the Maternal Mortality Ratio (MMR) in Yucatan is higher than the national mean during the years 2013 to 2015. Materials and methods Transversal-observational study in pregnant women who died from direct causes related to pregnancy during the years 2013 to 2015 in Yucatan. Data from the National Institute of Statistics and Geography (INEGI) were used. Results In 2013 the MMR in Yucatan was 38,11% higher than the national mean, in 2014 the MMR of this state was 34,68% higher in comparison to the national mean and in 2015 the MMR was 21,14% higher than the national mean. The main causes of dead in the state of Yucatan are in agreement with the national causes which are hypertensive disorders and hemorrhagic disorders. Conclusions The MMR during the years 2013 to 2015 in the state of Yucatan was higher than the national average. It is important to implement preventive measures to reduce this disparity in terms of maternal mortality in the state of Yucatán.

RESUMEN Introducción La mortalidad materna se considera un indicador significativo de la calidad de los servicios de salud, así se conoce que aproximadamente un 95% de estas muertes en América Latina y el Caribe son prevenibles. Objetivos Determinar si la razón de muerte materna (RMM) en Yucatán es mayor a la media nacional durante los años 2013 a 2015. Material y Métodos Estudio transversal observacional en el que se analizaron los datos contenidos en los certificados de defunción de mujeres que fallecieron por causas directas relacionadas con el embarazo durante los años 2013 a 2015 en el estado de Yucatán. Los resultados obtenidos fueron comparados con los datos del Instituto Nacional de Estadística y Geografía (INEGI) mediante chi cuadrada. Resultados La RMM en Yucatán fue de 38,11%, 34,68% y 21,14%, para los años 2013, 2014 y 2015 respectivamente; en todos los casos mayores que la nacional. Las principales causas de muerte en el estado concuerdan con lo expuesto en la bibliografía, siendo éstas los desórdenes hipertensivos y las hemorragias. Conclusión La RMM durante los años 2013 a 2015 en el estado de Yucatán fue mayor a la media nacional. Es importante implementar medidas preventivas que permitan reducir esta disparidad en términos de mortalidad materna en el estado de Yucatán.