ABSTRACT Introduction: Laryngeal cancer is the most common malignant neoplasm of the upper aerodigestive tract. Total laryngectomy is the treatment of choice in advanced cases, but it is associated with a high rate of complications. Objectives: To determine the prevalence of postoperative complications of total laryngectomy and associated factors in patients with laryngeal cancer. Materials and methods: Observational, descriptive, retrospective, cross-sectional study, reviewing the behavior of total laryngectomy and its main complications in the Department of Otorhinolaryngology of the Hospital de Clínicas, Faculty of Medical Sciences, National University of Asunción, Paraguay, from 2015 to 2022. Patients over 18 years of age, of both sexes, who underwent total laryngectomy, with anatomopathological diagnosis of laryngeal neoplasm were included. Non-operated patients, those with incomplete records or who abandoned treatment were excluded. Demographic, clinical, surgical and anatomopathological variables were analyzed. Results: Ten patients were included, all male, with a mean age of 56.3 ± 10.2 years. Ninety percent had toxic habits. The most frequent complication was pharyngocutaneous fistula (70%), followed by surgical site infection (10%) and postoperative bleeding (10%). Conservative measures resolved 71.4% of the fistulas. Thirty percent had supraglottic involvement and 57.1% of those who presented complications received previous radiotherapy. Conclusion: Complications of total laryngectomy are frequent, mainly pharyngocutaneous fistula. Supraglottic involvement and previous radiotherapy were associated with a higher rate of complications. Prospective studies with larger samples are required to confirm these findings.

RESUMEN Introducción: El cáncer de laringe es la neoplasia maligna más común de las vías aerodigestivas superiores. La laringectomía total es el tratamiento de elección en casos avanzados, pero se asocia a una alta tasa de complicaciones. Objetivos: Conocer la prevalencia de las complicaciones posquirúrgicas de la laringectomía total y los factores asociados en pacientes con cáncer de laringe. Materiales y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal, revisando el comportamiento de la laringectomía total y sus principales complicaciones en la Cátedra y Servicio de Otorrinolaringología del Hospital de Clínicas de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, Paraguay, de 2015 a 2022. Se incluyeron pacientes mayores de 18 años, de ambos sexos, postoperados de laringectomía total, con diagnóstico anatomopatológico de neoplasia de laringe. Se excluyeron pacientes no operados, con fichas incompletas o que abandonaron el tratamiento. Se analizaron variables demográficas, clínicas, quirúrgicas y anatomopatológicas. Resultados: Se incluyeron 10 pacientes, todos varones, con edad media de 56,3 ± 10,2 años. El 90% presentaba hábitos tóxicos. La complicación más frecuente fue la fístula faringocutánea (70%), seguida por infección del sitio quirúrgico (10%) y sangrado posoperatorio (10%). El 71,4% de las fístulas se resolvieron con medidas conservadoras. El 30% tenía afectación supraglótica y el 57,1% de los que presentaron complicaciones recibieron radioterapia previa. Conclusión: Las complicaciones de la laringectomía total son frecuentes, principalmente la fístula faringocutánea. La afectación supraglótica y la radioterapia previa se asociaron a mayor tasa de complicaciones. Se requieren estudios prospectivos con muestras más grandes para confirmar estos hallazgos.

Resumo Introdução: A informação sobre faltas às consultas de medicina geral e familiar (MGF) é escassa em Portugal. Objetivos: Estudar os motivos de falta a consultas de MGF em três Unidades de Saúde Familiar no centro de Portugal, em 2022, segundo as variáveis de contexto sexo, grupo etário, índice de Graffar, tempo decorrido desde a marcação e slot horário da consulta. Métodos: Estudo observacional transversal no centro de Portugal, realizado após parecer positivo da Comissão de Ética, com recolha, em anonimato, dos dados de utentes com consulta agendada e não realizada de maio a julho de 2022, através de entrevista telefónica efetuada por um médico interno de MGF de cada unidade, no mês de agosto. Após introdução, garantido o anonimato, era questionado há quanto tempo tinha realizado o agendamento e o motivo da falta à consulta. Resultados: Foram contactados 617 utentes que faltaram nos meses de maio a julho de 2022, tendo-se obtido 455 (73,7%) respostas. Os motivos mais frequentes foram esquecimento (27,6%), dificuldades de transporte e problema já solucionado (8,9% para cada) e “julgar o motivo já não merecer consulta” (8,1%). Em função das variáveis de contexto verificou-se diferença significativa para “há quanto tempo tinha marcado a consulta” (p<0,001) e não significativa para sexo (p=0,721), grupo etário (p=0,765), índice de Graffar (p=0,084) e slot horário (p=0,084). O grupo “outros motivos” teve prevalência de 42,8%, revelando diferença não significativa para as variáveis consideradas. Discussão: A compreensão das razões para a falta à consulta agendada implica a verificação das razões pelo utente, permitindo ao prestador adotar atitudes pró-ativas para a resolução do acesso. Conclusão: O esquecimento, as dificuldades de transporte e o problema já ter sido solucionado foram os motivos de falta a consultas mais frequentes na população em estudo.

Abstract Introduction: The scientific information published about the prevalence, characteristics, and motives of patients who miss general practice appointments is rare in Portugal and Europe. Objectives: Investigate the reasons for missing general practice appointments in three primary care health centers according to sex, age, Graffar’s index, the time elapsed since scheduling the appointment, and appointment time slot. Methods: After positive feedback from the Ethics Committee, a cross-sectional study was carried out in Central Portugal. The data from patients who missed appointments between May and July 2022 was collected anonymously through a telephone interview carried out by a general practice resident in August. After a brief introduction, guaranteeing anonymity and consent, patients were asked to answer how long ago the appointment had been scheduled and the reasons for missing it. Results: From May up to July of 2022, 617 patients missed appointments and were contacted, of which only 455 (73.7%) responded. The most frequent reasons for missing appointments were forgetfulness (27.6%), lack of transportation, problems already solved (8.9% for each), and thinking that the problem no longer needed an appointment (8.1%). Significant statistical differences existed between the context variables and how long they scheduled the appointment. There was no statistically significant association with sex (p=0.721), age (p=0.765), Graffar’s index (p=0.084), and appointment time slot (p=0.084). 42,8% reported other reasons, without a significant statistical difference between context variables. Discussion: To understand the reasons for missed appointments we need to know the patient's motives to implement reforms and improve attendance. Conclusions: Forgetfulness, lack of transportation, and the problems already solved were the most frequent reasons for missed appointments in this population.

Resumo Um macho de Pteronura brasiliensis (Carnivora: Mustelidae) foi encontrado morto às margens do Rio Negro, no Pantanal do estado de Mato Grosso do Sul, município de Aquidauana. Dois carrapatos encontrados aderidos à sua pele foram identificados, morfologicamente, como uma ninfa de segundo ínstar de Ornithodoros rostratus (Argasidae) e um macho de Amblyomma sculptum (Ixodidae). Para complementar a identificação morfológica, esses espécimes de carrapatos foram submetidos à extração de DNA e testados por meio de ensaios de PCR, para confirmar a identidade molecular dos espécimes. Além disso, os extraídos dos carrapatos foram testados e revelaram-se negativos nos ensaios de PCR para todos os patógenos testados. Também foram examinados 30 lotes, compostos por 174 indivíduos de O. rostratus, depositados na Coleção Acari do Instituto Butantan, e encontramos material de quatro estados brasileiros, incluindo-se um lote contendo 2 machos e 2 fêmeas de Aquidauana, estado de Mato Grosso do Sul (MS), coletado do solo. Este foi, portanto, o primeiro registro de O. rostratus parasitando P. brasiliensis e o primeiro registro de localidade (Aquidauana). Da mesma forma, A. sculptum é comumente encontrado no Pantanal e relatado aqui, pela segunda vez, parasitando a ariranha, hospedeiro pouco estudado em relação a ectoparasitas.

Abstract A male of Pteronura brasiliensis (Carnivora: Mustelidae) was found dead on the banks of the Rio Negro, in the Pantanal wetlands of Mato Grosso do Sul state, Aquidauana municipality. Two ticks found attached to its skin were morphologically identified as a second-instar nymph of Ornithodoros rostratus (Argasidae) and a male of Amblyomma sculptum (Ixodidae). In order to complement the morphological identification, these tick specimens were subjected to DNA extraction, and tested using PCR assays to confirm the molecular identity the specimens. Also, the tick DNA samples were tested and were negative in the PCR assays for all the pathogens tested. We also examined 30 batches, consisting of 174 individuals of O. rostratus deposited in the Acari Collection of the Butantan Institute, and we found material from four Brazilian states, including one batch containing 2 males and 2 females from Aquidauana, of Mato Grosso do Sul state, collected from the soil. This was therefore the first record of O. rostratus parasitizing P. brasiliensis and the first locality record (Aquidauana). Likewise, A. sculptum is commonly found in the Pantanal and is reported here for the second time parasitizing the giant otter, which is a host little studied regarding the ectoparasites.

Abstract This study examines the relationship between religion and tobacco use among university civil servants in Rio de Janeiro, Brazil, that participated in waves 1 (1999, n = 4030) and 4 (2012-13, n = 2933) of the Pro-Saúde Study. We employed self-administered questionnaires and logistic regression models to estimate cross-sectional and longitudinal associations between the independent (religion) and dependent (smoking/non-smoking) variables adjusted for age, sex, race/color, marital status, religious attendance, and schooling. Our results show that Pentecostal evangelical respondents, for example, were less likely to smoke and initiate tobacco use between the two survey waves than those of Afro-Brazilian religions. This study contributes to understanding the relationship between religion and health by including longitudinal data on the transition to smoking and its stopping. It also indicates the importance of investigating the topic in relation to other health habits and conditions.

Resumen Este trabajo analiza la relación entre la religión y el uso del tabaco en funcionarios públicos de campus universitarios en Rio de Janeiro y participantes del Estudio Pró-Saúde en sus versiones 1 (1999, n=4030) y 4 (2012-13, n=2933). Para esta investigación, fueron utilizados cuestionarios autoadministrados; asociaciones transversales y longitudinales entre las variables independiente (religión) y dependiente (fumar/no fumar), al igual que se estimaron razones de probabilidad en modelos de regresión logística ajustados para edad, sexo, raza/color, situación conyugal, frecuencia religiosa y escolaridad. Se identificó que los encuestados evangélicos pentecostales, en contraste con aquellos de religiones afrobrasileñas, presentaron menor probabilidad de fumar y de iniciarse en el uso del tabaco entre las dos versiones de la encuesta. Este estudio contribuye al conocimiento sobre las relaciones entre religión y salud al incluir datos longitudinales sobre la transición para el tabaquismo y su interrupción e indica la pertinencia de la investigación sobre este tema en relación con otros hábitos y condiciones de salud.

Resume Cet article analyse la relation entre religion et tabagisme chez les fonctionnaires des campi universitaires de Rio de Janeiro et les participants à l’Étude Pró-Saúde des vagues 1 (1999, n=4030) et 4 (2012-13, n=2933) . Des questionnaires auto-administrés ont été utilisés; les associations transversales et longitudinales entre les variables indépendantes (religion) et dépendantes (fumeur/non-fumeur) ont été estimées via des rapports de cotes dans des modèles de régression logistique ajustés en fonction de l’âge, du sexe, de la race/couleur, de l’état matrimonial, de la fréquence religieuse et de l’éducation. Il a été identifié que les répondants évangéliques pentecôtistes, contrairement à ceux des religions afro-brésiliennes, étaient moins susceptibles de fumer et de commencer à consommer du tabac entre les deux vagues d’enquête. Cette étude contribue à la connaissance des relations entre religion et santé en incluant des données longitudinales sur le passage au tabac et son arrêt, et indique la pertinence d’approfondir le sujet en relation avec d’autres habitudes et conditions de santé.

Resumo Este trabalho analisa a relação entre religião e uso de tabaco entre funcionários públicos de campi universitários no Rio de Janeiro e participantes do Estudo Pró-Saúde em suas ondas 1 (1999, n=4030) e 4 (2012-13, n=2933). Foram utilizados questionários auto-administrados; associações transversais e longitudinais entre as variáveis independente (religião) e dependente (fumar/não fumar) foram estimadas via razões de chances em modelos de regressão logística ajustados para idade, sexo, raça/cor, situação conjugal, frequência religiosa e escolaridade. Foi identificado que respondentes evangélicos pentecostais, em contraste com aqueles de religiões afro-brasileiras, apresentaram menor chance de fumar e de iniciar o uso de tabaco entre as duas ondas da pesquisa. Este estudo contribui para o conhecimento sobre as relações entre religião e saúde ao incluir dados longitudinais sobre a transição para o tabagismo e sua cessação e indica a pertinência da investigação do tema em relação a outros hábitos e condições de saúde.

Abstract Improving rural innovation processes requires optimizing the link between agricultural research and rural extension. Most of the authors who have studied this link have been concerned with highlighting the need for a synergetic integration between both components. However, those studies did not make explicit which are the key factors that facilitate this articulation along with the proposals to promote a harmonious and efficient link. The present work identifies and systematizes on the literature about the subject the key factors for a good link and the proposals and approaches for linking research and extension. For this, a systematic review of the literature in English, Spanish and Portuguese was performed. As results, on the one hand, two types of key factors were identified: contextual-institutional and subjective-relational; and, on the other hand, two types of proposals aimed at strengthening the bond were characterized: structural/formal mechanisms (or institutional arrangements) and operational or functional management measures. Finally, a discussion was generated on the principal characteristics of the factors and proposals identified, concluding towards limitations, questions and challenges for a better understanding of the link between agricultural research and rural extension. extension components However English performed results hand identified contextualinstitutional contextual subjectiverelational subjective relational subjective-relational characterized structuralformal structural formal arrangements measures Finally limitations

Resumen La mejora en los procesos de innovación rural requiere optimizar el vínculo entre la investigación agropecuaria y la extensión rural. La mayoría de los autores que han estudiado dicho vínculo se han ocupado de resaltar la necesidad de una integración sinérgica entre ambos componentes. Sin embargo, estos estudios no han explicitado cuáles son los factores claves que facilitan dicha articulación junto con las propuestas para promover un vínculo armónico y eficiente. El presente trabajo identifica y sistematiza en la literatura sobre el tema los factores claves para un buen vínculo y las propuestas y abordajes para la vinculación de la investigación y la extensión. Para ello, se realizó una revisión sistemática de bibliografía en inglés, español y portugués. Como resultados, por un lado, se identificaron dos tipos de factores claves: los contextuales-institucionales y los subjetivos-relacionales; y, por otro, se caracterizaron dos tipos de propuestas orientadas al fortalecimiento del vínculo: los mecanismos estructurales/formales (o arreglos institucionales) y las medidas de gestión operativas o funcionales. Por último, se generó una discusión sobre las características principales de los factores y propuestas identificadas, concluyendo hacia limitaciones, interrogantes y desafíos para una mayor comprensión sobre el vínculo entre la investigación agropecuaria y la extensión rural. componentes embargo eficiente ello inglés portugués resultados lado contextualesinstitucionales contextuales institucionales subjetivosrelacionales subjetivos relacionales subjetivos-relacionales otro estructuralesformales estructurales formales funcionales último identificadas limitaciones

ABSTRACT Introduction: Allergic diseases are very common in the pediatric population. Among the frequent causes are aeroallergens from the environment and the identification of these is a great help for diagnosis and treatment. Objectives: To determine the frequency of aeroallergens, through the determination of Immunoglobulin E (IgE) specific to common allergens by the skin sensitivity test in pediatric patients with symptoms of asthma and allergic rhinitis. Materials and Methods: Observational, descriptive, prospective, cross-sectional design, population of patients from 4 to 17 years old with symptoms compatible with asthma and allergic rhinitis who attended a pediatric care center during the study period. It was carried out by means of Skin Puncture Tests (PCP). Results: The mean age of the patients was 8 years, 57% male patients and 43% female. 53% of the patients presented Rhinitis and Asthma, 45% only Rhinitis and 2% only Asthma. 79% of the patients presented a positive allergic sensitization reaction through PCP. Taking into account the sensitization by type of aeroallergens, 64% of the patients had a positive reaction to mites, 19 % to animals 18% to cockroaches, 8% to pollens and 6% to fungi. Conclusion: The vast majority of patients with asthma suffered from concomitant allergic rhinitis and dust mites were the most frequently determined aeroallergens in allergic skin tests in children with asthma and rhinitis in our population.

RESUMEN Introducción: Las enfermedades alérgicas son muy comunes en la población pediátrica. Entre las causas frecuentes se encuentran los aeroalérgenos del ambiente, y la identificación de estos es de gran ayuda tanto para el diagnóstico como para el tratamiento. Objetivos: Determinar la frecuencia de aeroalérgenos, por medio de la determinación de Inmunoglobulina E (IgE) específica a alérgenos comunes por la prueba de sensibilidad cutánea en pacientes pediátricos con síntomas de asma y rinitis alérgica. Materiales y Métodos: Diseño observacional, descriptivo, prospectivo, transversal, población de pacientes de 4 a 17 años con síntomas compatibles con asma y rinitis alérgica que acudieron a un centro asistencial pediátrico en el periodo de estudio. Se realizó por medio de las Pruebas de punción cutánea (PCP). Resultados: La edad media de los pacientes fue de 8 años, 57% pacientes de sexo masculino y 43% de sexo femenino. El 53% de los pacientes presenta rinitis y asma, 45% solo rinitis y el 2% solo asma. El 79% de los pacientes presentó reacción positiva de sensibilización alérgica por medio de la PCP. Teniendo en cuenta la sensibilización por tipo de aeroalérgenos se tuvo que el 64% de los pacientes tuvo reacción positiva a ácaros, 19% a animales 18% a cucarachas, 8% a pólenes y 6% a hongos. Conclusión: La gran mayoría de pacientes con asma padecía rinitis alérgica concomitante y los ácaros del polvo fueron los aeroalérgenos más frecuentemente determinados en las pruebas cutáneas de alergia en niños con asma y rinitis de nuestra población.

Resumo Introdução: A gordofobia se refere à discriminação e estigmatização de pessoas com excesso de peso. É comum que indivíduos sofram esse tipo de preconceito por parte de profissionais da saúde, portanto a formação acadêmica pode ter um papel importante nessa dinâmica, já que o preconceito pode ser perpetuado se não houver uma reflexão crítica sobre o tema durante a graduação; Objetivos: Investigar a percepção de estudantes universitários da área da saúde sobre a gordofobia; Métodos: Estudo de abordagem qualitativo, na modalidade de Grupo Focal, realizado com estudantes de graudação em Nutrição, Medicina, Psicologia e Educação Física de uma Instituição de Ensino Superior da cidade de Fortaleza, Ceará, Brasil. A coleta de dados se deu por meio de entrevistas, a partir de um roteiro semiestruturado, e submetidas à análise de conteúdo, na modalidade temática; Resultados: Emergiram quatro categorias temáticas: 1. Percepções sobre gordofobia; 2. Gordofobia e Mídias Sociais; 3. Abordagem da gordofobia entre as profissões da saúde e 4. Inclusão da gordofobia na formação acadêmica. O entendimento predominante sobre a gordofobia foi de uma forma de comportamento que exclui e diferencia pessoas com excesso de peso ou que não atendem a um determinado padrão corporal. O excesso de peso foi entendido como uma doença que requer tratamentos, que tenham como base a humanização e o acolhimento, entendendo o indivíduo de maneira singular e não apenas como portador de um problema de saúde. Conclusões. O reconhecimento da gordofobia como um tema transversal a todas as áreas profissionais da saúde e a inclusão de conteúdos específicos sobre o assunto na formação acadêmica foram entendidos como maneiras possíveis para combater a gordofobia e promover a valorização da diversidade corporal e uma abordagem inclusiva do peso no atendimento em saúde.

Abstract Introduction: Fatphobia refers to discrimination and stigmatization of overweight people. It is common for individuals to suffer this type of prejudice from health professionals, so academic training can play an important role in this dynamic, as prejudice can be perpetuated if there is no critical reflection on the subject during graduation; Objectives: To investigate the perception of university students in the health area about fatphobia; Methods: Study with a qualitative approach, in the form of Focus Group, carried out with undergraduate students in Nutrition, Medicine, Psychology and Physical Education at a Higher Education Institution in the city of Fortaleza, Ceará, Brazil. Data collection took place through interviews, based on a semi-structured script, and submitted to content analysis, in the thematic modality; Results: Four thematic categories emerged: 1. Perceptions about fatphobia; 2. Gordophobia and social media; 3. Addressing fatphobia among health professions and 4. Inclusion of fatphobia in academic training. The predominant understanding of fatphobia was a form of behavior that excludes and differentiates people who are overweight or who do not meet a certain body standard. Excess weight was understood as a disease that requires treatments, which are based on humanization and acceptance, understanding the individual in a unique way and not just as a carrier of a health problem. Conclusions: Recognizing fatphobia as a theme that cuts across all professional areas of health and the inclusion of specific content on the subject in academic training were understood as possible ways to combat fatphobia and promote the appreciation of body diversity and an inclusive approach to weight in the healthcare.

Com o aumento da expectativa de vida e a redução da taxa de natalidade, no Brasil, assim como no mundo todo, tem ocorrido um intenso processo de envelhecimento da população, sendo que as pessoas idosas são consideradas mais vulneráveis, devido a diminuição da autonomia, por ficarem expostas a mais fatores de risco, conflitos sociais, familiares e a violência. Sendo assim, a violência contra a pessoa idosa trata-se de um importante problema de saúde pública e carece de intervenções dos profissionais da saúde, os quais devem receber formação para tal abordagem. Objetivo: Interpretar as vivências de jovens universitários dos cursos de enfermagem e medicina, de uma instituição brasileira do interior paulista, sobre a violência contra pessoa idosa. Método: Trata-se de uma pesquisa qualitativa, que utilizou a Teoria Fundamentada nos Dados e como técnica de coleta de dados, entrevistas semiestruturadas com oito estudantes dos cursos de enfermagem e de medicina de uma instituição do interior do estado de São Paulo. Realizou-se análise dos dados no software NVIVO, seguindo as etapas propostas pelo referencial escolhido. Resultados e discussão: Os entrevistados percebem que a violência contra a pessoa idosa tem pouca visibilidade, relataram aproximações com a temática, além de citarem os tipos de violência que a pessoa idosa pode sofrer. Reconheceram as necessidades de saúde da pessoa idosa relacionando com a integralidade do cuidado, interligando com pensamentos sobre o envelhecimento como uma causa natural e propondo intervenções para diminuição deste agravo. Finalizando, expuseram suas ações caso vivenciem uma situação de violência e a possibilidade do tema violência contra a pessoa idosa ser introduzido na grade curricular formal. Conclusão: Evidenciou a pouca visibilidade da pessoa idosa, bem como a necessidade de ações e intervenções educativas para o reconhecimento deste agravo, sendo um passo possível e viável.

With the increase in life expectancy and the reduction in the birth rate, in Brazil, as well as in the whole world, there has been an intense process of aging of the population, and the elderly are considered more vulnerable, due to the decrease in the autonomy, as they are exposed to more risk factors, social and family conflicts and violence. Therefore, violence against the elderly is an important public health problem and requires interventions by health professionals, who must receive training for such an approach. Objective: To interpret the experiences of young university students of nursing and medicine courses, from a Brazilian institution in the interior of São Paulo, about violence against the elderly. Method: This is qualitative research, which used Grounded Theory and as a data collection technique, semi-structured interviews with eight students of nursing and medicine courses at an institution in the interior of the state of São Paulo. Data analysis was carried out in the NVIVO software, following the steps proposed by the chosen reference. Results and discussion: Respondents perceive that violence against the elderly has little visibility, reported approaches to the theme, in addition to mentioning the types of violence that the elderly can suffer. They recognized the health needs of the elderly in relation to comprehensive care, interconnecting with thoughts about aging as a natural cause and proposing interventions to reduce this problem. Finally, they exposed their actions if they experience a situation of violence and the possibility of introducing violence against the elderly into the formal curriculum. Conclusion: It showed the poor visibility of the elderly, as well as the need for educational actions and interventions to recognize this condition, being a possible and viable step.

Abstract Background: The identification of land-uses (e.g., crop types) that generate the loss of different vegetation types, degradation trends, and biodiversity loss has been poorly explored in most studies on land-use dynamics in agricultural landscapes. Questions: What areas are occupied by the different land-use types and vegetation? What are the permanence, rate of change, and loss rate of the different land-use types and vegetation? What kind of land-uses and vegetation is driving the observed changes? Study area and dates: The Soconusco region of Chiapas, Mexico. Analysis period, 2000-2017. Methods: Land-use cover maps were created using Google Earth images and employing the image interpretation method and field verification. Matrixes of permanence and transition were created, and relative change rates and loss area were calculated for the different land-uses types and vegetation. Results: Agricultural activity and natural vegetation were the categories with the largest surface and permanence. The agricultural activity showed the highest annual rates of gain, and it was promoted by the expansion of economically important crops, mainly mango and the African oil palm. Natural vegetation had the highest annual loss rate, mainly for tular and secondary vegetation that changed to agricultural areas. Conclusions: Considering the limited secondary forest formation and the high permanence and increment of agricultural areas, it is important to consider actions that diversify these agricultural landscapes.

Resumen Antecedentes: La identificación de los usos de suelo particulares (e.g., tipo de cultivo) que generan la pérdida de los diferentes tipos de vegetación, las tendencias de degradación y la pérdida de biodiversidad ha sido limitadamente explorada en estudios sobre dinámica del uso de suelo en paisajes agropecuarios. Preguntas: ¿Cuáles son las superficies ocupadas por los diferentes usos de suelo y vegetación? ¿cuál es la permanencia, tasa de cambio y tasa de pérdida de los diferentes usos de suelo y vegetación? ¿qué usos de suelo dirigen los cambios observados? Área de estudio y fechas: Soconusco, Chiapas, México. Período: 2000-2017. Métodos: Se usaron imágenes de Google Earth, el método de fotointerpretación y la verificación en campo para generar mapas de cambio de uso de suelo y vegetación. Se crearon matrices de permanencia/transición y se calcularon tasas de cambio relativo y de pérdida de superficie para los diferentes usos de suelo y vegetación. Resultados: La zona de actividad agropecuaria y la vegetación natural fueron las categorías con mayor superficie y permanencia. La mayor tasa de ganancia anual de superficie se observó en la zona de actividad agropecuaria, influenciada por el incremento de cultivos de importancia económica (mango y palma africana). La mayor tasa de pérdida anual se registró en la vegetación natural, y fue dirigida principalmente por la transición de tular y de vegetación secundaria hacia zonas agropecuarias. Conclusiones: Ante la limitada formación de vegetación secundaria y la alta permanencia/incremento de zonas agropecuarias, es importante considerar acciones que diversifiquen estos paisajes agropecuarios.

RESUMEN INTRODUCCIÓN: El suicidio constituye una de las principales causas de muerte consideradas como violentas y evitables. El objetivo fue estimar la incidencia y modalidad de suicidios en la serie histórica 2009-2020, considerando este último año como contexto pandémico por COVID-19. MÉTODOS: Se realizó un estudio transversal, observacional y retrospectivo de línea histórica. Los datos fueron obtenidos de la Dirección de Estadística e Información en Salud del Ministerio de Salud de la Provincia de Buenos Aires. Se clasificaron según tres modalidades de suicidio: intervención de un agente invasivo, un agente externo o sin agente. Para evaluar la posible variación de la densidad poblacional sobre las tasas de incidencia, se distribuyeron las defunciones sobre la base del tamaño poblacional de residencia. Finalmente, se obtuvieron dos índices: escore p y estimación de mortalidad observada (MO). RESULTADOS: Entre 2009 y 2020 se produjeron 13 221 muertes por lesiones autoinfligidas, con un promedio de 1110 suicidios al año. Al comparar 2020 (916 suicidios) con el quinquenio inmediato anterior (2015-2019, con una media de 1139 suicidios ±26 en su error estándar), el escore p mostró una reducción del 23,1% (275 muertes menos de lo esperado) y la MO, un descenso de 19,6% (223 muertes por debajo del intervalo superior esperado). DISCUSIÓN: En 2020 se redujo la incidencia absoluta y relativa de suicidios, aunque se mantuvo la diferencia según modalidad y género observada en la línea histórica.

ABSTRACT INTRODUCTION: Suicide is one of the main causes of death classified as violent and preventable. The objective was to estimate the incidence and mode of suicide in the 2009-2020 historical series, considering year 2020 as COVID-19 pandemic context. METHODS: A cross-sectional, retrospective, observational, historical timeline study was conducted. Data were obtained from the Department of Health Statistics and Information of the Ministry of Health of the Province of Buenos Aires. They were classified according to three modes of suicide: intervention of an invasive agent, an external agent or no agent. In order to evaluate the possible variation of population density on suicide incidence rates, deaths were distributed based on the population size of residence. Finally, two indices were obtained: the p-score and the estimate of observed mortality (OM). RESULTS: During 2009-2020 there were 13221 deaths due to self-inflicted injuries, with an average of 1110 suicides per year. When comparing the year 2020 (916 suicides) with the previous five-year period (2015-2019, with a mean of 1139 suicides ±26 in its standard error), the p-score showed a reduction of 23.1% (275 deaths less than expected) and OM, a decrease of 19.6% (223 deaths below the expected upper interval). DISCUSSION: During 2020 there was a reduction in the absolute and relative incidence of suicides, while maintaining the difference according to mode and gender observed through the historical timeline.

Resumen Los enfoques actuales de los Planes de Estudio de la Educación Media Superior y Superior en México demandan desarrollar conocimientos interdisciplinarios que exigen una articulación de saberes provenientes de distintas disciplinas a fin de abordar problemas complejos. Ante estas demandas, los docentes enfrentan desafíos para, entre otros asuntos, diseñar e implementar estrategias de enseñanza que atiendan el trabajo interdisciplinar en sus aulas. En este artículo reportamos avances de una investigación más amplia que estudia el uso de proyectos estadísticos como un recurso para fomentar una competencia interdisciplinar. Basados en la revisión de literatura, definimos cuatro características de esa competencia: comprensión disciplinar, integración disciplinar, reflexividad, y, producción e intercambio de objetos limitáneos. El objetivo del artículo es explorar el desarrollo de esas características por parte de formadores de docentes de diferentes áreas disciplinares durante la planificación de un proyecto estadístico. Los resultados dan cuenta de, por un lado, la complejidad que demanda para los formadores encontrar y formular un problema de investigación que articule sus conocimientos disciplinares; por otro, la potencialidad que parece tener el diseño y planificación de proyectos estadísticos para impulsar el desarrollo de las características que definen una competencia interdisciplinar.

Abstract The current approaches of the curricula of the Mexican Higher Secondary and Higher Education demand the development of interdisciplinary knowledge that requires the articulation of knowledge from different disciplines to address complex problems. Faced with these demands, teachers encounter challenges to, among other issues, design and implement teaching strategies that address interdisciplinary work in their classrooms. In this article, we report advances of broader research that studies the use of statistical projects as a resource to promote interdisciplinary competence. Based on the literature review, we defined four characteristics of this competence: disciplinary comprehension, disciplinary integration, reflexivity, and, production and exchange of boundary objects. This article aims to explore the development of these characteristics by teacher educators from different disciplinary areas during the planning of a statistical project. The results show, on the one hand, the complexity required the teacher educators to find and formulate a research problem that articulates their disciplinary expertise; on the other hand, the potential of the design and planning of statistical projects seems to have for promoting the development of the characteristics that define an interdisciplinary competence.

ABSTRACT BACKGROUND: The relationship between spirituality and health has been the object of growing discussion. There is a lack of data on spiritual needs assessments in Brazil. OBJECTIVE: This study aimed to assess the spiritual needs of patients admitted to a public tertiary hospital and perform a comparative analysis between patients with and without indications for palliative care. DESIGN AND SETTING: A cross-sectional observational study included patients hospitalized between August and December 2020 in Hospital do Servidor Publico Municipal, Sao Paulo, Brazil. METHODS: The included patients answered a questionnaire consisting of sociodemographic data, the Duke religiosity scale, and the Spiritual Needs Assessment for Patients (SNAP) tool for a spiritual needs assessment. The World Health Organization Palliative Needs tool (NECPAL) was used to evaluate the indications for palliative care. The level of significance adopted was 5%. RESULTS: A total of 66 patients were included in this study. Most participants (97%) declared themselves as belonging to a religion. The group without indication for palliative care by the NECPAL showed greater spiritual (P = 0.043) and psychosocial needs (P = 0.004). No statistically significant difference was observed in the religious needs domain (P = 0.176). There were no statistically significant differences in the Duke scale scores between the two groups. CONCLUSION: Spiritual, psychosocial, and religious needs are prevalent among hospitalized patients, and multidisciplinary teams must consider these needs in their management approach. In addition, this study suggests that psychosocial and spiritual needs can be even higher in patients who do not receive palliative care.

Resumen: Introducción: la proteína C ultrasensible (PCRus) es un biomarcador inflamatorio producido principalmente en el hígado. La obesidad ha sido ligada a un proceso inflamatorio crónico y tiene una conexión cercana con dicho biomarcador al sobreexpresar citocinas proinflamatorias derivadas del tejido adiposo. Objetivo: estudiar la asociación de la obesidad con la elevación de la PCRus como marcador proinflamatorio en población mexicana. Material y métodos: estudio retrospectivo y transversal. Se utilizaron registros de PCRus en pacientes de la clínica de medicina preventiva en un hospital privado de la Ciudad de México, de enero a junio de 2019. Población: 672 pacientes mayores de 20 años; 419 hombres y 253 mujeres, con datos de índice de masa corporal (IMC) y PCRus < 10 mg/L. Se realizó regresión lineal múltiple con transformaciones logarítmicas de PCRus, IMC y sexo. Resultados: el coeficiente para el logaritmo natural de IMC resultó positivo y estadísticamente significativo (p < 0.001), el coeficiente para sexo masculino resultó negativo y estadísticamente significativo (p < 0.001), el modelo obtuvo una R(2) = 0.17. Conclusiones: la elevación de PCRus se encontró asociada de manera positiva con el IMC y positiva con el sexo femenino; sin embargo, el modelo es poco explicativo, ya que existen elevaciones del PCRus en ambos grupos, aunque fue mayor en pacientes con obesidad, con o sin comorbilidades, esto sugiere que la PCRus es un marcador inflamatorio asociado a obesidad en población mexicana.

Abstract: Introduction: usCRP is an inflammatory biomarker produced in the liver. Obesity has been associated with a chronic inflammatory process and linked with said biomarker by overexpressing pro-inflammatory cytokines produced in adipose tissue. Objectives: study the association between elevated usCRP as a pro-inflammatory marker in patients with a diagnosis of obesity in the Mexican population. Material and methods: retrospective and cross-sectional study; registries of usCRP in patients of the preventive medicine clinic in a private hospital in Mexico City were reviewed from January to June 2019. The population included 672 patients, of which 419 were male and 253 female at least 20 years of age, in whom usCRP values < 10 mg/L. We performed a multiple linear regression with logarithmic transformations of usCRP, BMI, and sex. Results: the coefficient for the natural logarithm for the BMI was positive and statistically significant (p < 0.001), the coefficient for the male sex turned a negative and statistically significant result (p < 0.001), and the model obtained an R(2) = 0.17. Conclusions: a positive association between elevated usCRP, female sex, and BMI were found; however, this model does not manage to explain all elevations in usCRP, meaning that we found elevations in both groups. More significant elevations were found in obese patients, with or without comorbidities, thus suggesting that usCRP is an inflammatory marker associated with obesity in Mexican population.

Resumo A articulação temporomandibular pode ser afetada por diversas afecções, como disfunções articulares, alterações degenerativas, doenças inflamatórias ou infecciosas, tumores e trauma. Este ensaio iconográfico visa auxiliar de forma prática o radiologista a identificar e descrever os principais achados nos exames de ressonância magnética da articulação temporomandibular, tendo em vista que o diagnóstico correto das alterações mais comuns é essencial para o tratamento adequado desses pacientes. afecções articulares degenerativas infecciosas trauma pacientes

Abstract The temporomandibular joint can be affected by various conditions, such as joint dysfunction, degenerative changes, inflammatory processes, infections, tumors, and trauma. The aim of this pictorial essay is to help radiologists identify and describe the main findings on magnetic resonance imaging evaluation of the temporomandibular joint, given that the correct diagnosis is essential for the appropriate treatment of patients with temporomandibular joint disorders. conditions dysfunction changes processes infections tumors trauma disorders

Resumen La inmunonutrición es una ciencia que engloba aspectos relacionados con la nutrición, la inmunidad, la infección, la inflamación y el daño tisular. Las fórmulas inmunomoduladoras han demostrado beneficios en una amplia variedad de situaciones clínicas. El objetivo de este trabajo es revisar la evidencia disponible en inmunonutrición (IN). Para ello, se ha realizado una búsqueda bibliográfica con las palabras clave: inmunonutrición, arginina, glutamina, nucleótidos, ácidos grasos omega-3, ERAS, fast-track. Se han incluido ensayos clínicos, revisiones y guías de práctica clínica. La IN ha demostrado reducir las fístulas en el postoperatorio en pacientes con cáncer de cabeza y cuello. En pacientes con cáncer gástrico y cáncer de esófago, la IN se asocia a una disminución de las complicaciones infecciosas y la estancia hospitalaria. Otras situaciones clínicas que se benefician del uso de la IN son la cirugía del cáncer de páncreas, la cirugía del cáncer colorrectal y los grandes quemados. Son necesarios más estudios controlados, prospectivos y aleatorizados para confirmar los potenciales beneficios de la IN en otras situaciones clínicas como la cirugía torácica no esofágica, el cáncer vesical, la cirugía ginecológica, la fractura de cadera, la patología hepática y la COVID-19, entre otros.

Abstract Immunonutrition is a science that encompasses aspects related to nutrition, immunity, infection, inflammation and tissue damage. Immunomodulatory formulas have shown benefits in a wide variety of clinical situations. The objective of this work was to review the available evidence in immunonutrition (IN). For this, a bibliographic search has been carried out with the keywords: immunonutrition, arginine, glutamine, nucleotides, omega-3 fatty acids, ERAS, fast-track. Clinical trials, reviews and clinical practice guidelines have been included. IN has been shown to reduce postoperative fistulae in head and neck cancer patients and in gastric and esophageal cancer patients, infectious complications and hospital stay. Other clinical situations that benefit from the use of IN are pancreatic cancer surgery, colorectal cancer surgery and major burns. More controlled, prospective, and randomized studies are necessary to confirm the potential benefits of IN in other clinical situations such as non-esophageal thoracic surgery, bladder cancer, gynecological surgery, hip fracture, liver pathology and COVID-19, among others.