Abstract What makes current radical right populists different from other historical radical right leaders of the 20th century? Are there more differences or similarities among populist radical right (PRR) in the Global South regarding how they perform foreign policy? How does the context – marked by contemporary globalization, regional interdependencies and power (geo)politics – influence their perceptions about their own capabilities and interests, but also about the international liberal order, its values and multilateral mechanisms? This forum addresses questions like these, offering theoretical, historical and contextual insights with concrete examples and case studies situated out of the Anglo-American spectrum. Different from traditional approaches to foreign policy analysis, the authors advance reflections about current phenomena such as illiberal foreign policymaking, anti-cosmopolitanism, religious nationalism and its transnational ties, and the re-personalization of sovereignty in the figure of the PRR. Therefore, it enriches the study of populism, radical right and foreign policymaking in IR, bringing to the debate the erosion of the liberal international order and the necessary questioning of Western-led globalization.

Resumo O que torna os atuais populistas da direita radical diferentes de outros líderes históricos da direita radical do século XX? Existem mais diferenças ou semelhanças entre a direita radical populista (PRR) no Sul Global com relação à forma como executam a política externa? Como o contexto - marcado pela globalização contemporânea, interdependências regionais e (geo)política de poder - influencia sua percepção sobre suas próprias capacidades e interesses, mas também sobre a ordem liberal internacional, seus valores e mecanismos multilaterais? Este fórum aborda questões como essas, oferecendo percepções teóricas, históricas e contextuais com exemplos concretos e estudos de caso situados fora do espectro anglo-americano. Diferentemente das abordagens tradicionais de análise de política externa, os autores apresentam reflexões sobre fenômenos atuais, como a formulação de políticas externas iliberais, o anticosmopolitismo, o nacionalismo religioso e seus laços transnacionais e a repersonalização da soberania na figura do PRR. Portanto, ele enriquece o estudo do populismo, da direita radical e da formulação de políticas externas nas RI, trazendo para o debate a erosão da ordem internacional liberal e o necessário questionamento da globalização liderada pelo Ocidente.

Resumen Introducción: La obesidad es uno de los principales problemas de salud pública en el mundo. Se considera detonante de múltiples enfermedades cardiometabólicas, como el infarto agudo de miocardio, la hipertensión arterial, la diabetes mellitus tipo 2 y el accidente isquémico cerebral. Es interesante conocer diversos factores fisiopatológicos que no dependen solo de la adiposidad, sino también de la masa muscular. Al entender que el músculo como órgano endocrino corresponde al 40% del peso corporal, las miocinas, como sustancias propias de este órgano liberadas desde la contracción, cobran importancia por su efecto antiinflamatorio y cardioprotector, y suponen un esfuerzo mayor para, a partir de su comprensión, realizar una prescripción adecuada del ejercicio. Objetivo: Estudiar las funciones de las miocinas como sustancias reguladoras de diversos procesos metabólicos, fundamentales en la homeostasis corporal. Método: Se hizo una revisión de tema, resultado de la revisión crítica de la literatura disponible sobre las miocinas, sus funciones y los efectos de la actividad física y el ejercicio en su liberación y acción. Conclusiones: El estudio de las miocinas viene en aumento y cobra relevancia clínica. Los efectos antiinflamatorios y cardioprotectores de las miocinas dependen del tipo de entrenamiento y de las cargas aplicadas al músculo una vez ha sido sometido a diferentes tipos de estímulo (aeróbico/anaeróbico, fuerza). Por tanto, la prescripción correcta del ejercicio es crucial en la modulación de estos mediadores: la optimización de su efecto, el acondicionamiento físico y el mantenimiento del peso adecuado.

Abstract Introduction: Obesity is one of the main public health problems worldwide being considered as a trigger for multiple cardiometabolic diseases such as acute myocardial infarction, high blood pressure, type 2 diabetes mellitus, cerebral ischemic accident among others. For this reason, it is of interest to know the various pathophysiological factors which depend not only on adiposity but also on muscle mass. Taking into account that the muscle as an endocrine organ corresponds to 40 % of the body weight, the importance that myokines charge as substances of this organ with an anti-inflammatory and cardioprotective character and which are released from muscle contraction is an additional study to perform an adequate Prescription of the exercise. Objective: To study the functions of myokines as regulatory substances in various metabolic processes, being essential in body homeostasis. Method: It is presented a topic review article, the result of a critical review of the available literature on myokines, their functions and the effects of physical activity and exercise on their release and action. Conclusions: that the study of myokines is increasing and is becoming more important clinical. The anti-inflammatory and cardioprotective effects of myokines depend on the type of training and loads applied to the muscle once subjected to different types of stimulation (aerobic/anaerobic, strength). Therefore, the proper prescription of exercise becomes crucial in the physical conditioning and in the maintenance of the appropriate weight.

Abstract This work aimed to evaluate the influence in the addition of the Guavira Peel Flour (GPF) on bread regarding the physical-chemical and sensorial characteristics. Three formulations of bread were prepared: standard with 0% GPF (F1); with addition of 0.84% (F2) and 1.96% (F3) of GPF. The elaborate bread with 0.84% guavira peel flour (F2) showed greater acceptability by the tasters, not differing from the standard sample (F1). As for physical-chemical composition, there was a difference between the samples (p < 0.05). Higher levels of ash, carbohydrate and calories and lower moisture and lipid levels were verified for F3. There was no statistical difference (p > 0.05) for the protein contents between the formulations. The incorporation of guavira peel flour resulted in an increase of vitamin C in formulations, however, their amount was not enough to contribute with improvements in the quality of the mass. The incorporation of guavira peel flour was responsible for browning of the breads and indicated tendency towards yellow color in the bark and red color in the crust. The specific volume found in the formulations with guavira peel flour was similar to the standard formulation. In the rheological analysis of the guavira peel flour, there was no difference of tenacity between the samples with the addition of GPF, but the extensibility was higher in the sample with 1.5% of GPF. The flour with 1.5% presented a lower curve configuration index, and the increase of GPF indicated a decrease in the mechanical work. The research demonstrated that the use of this flour was viable in the elaboration of breads with sensorial quality.

Resumo O objetivo deste trabalho foi avaliar a influência da adição de farinha da casca da guavira (FCG) em pão sobre suas características físico-químicas e sensoriais. Foram elaboradas três formulações de pão: padrão com 0% de FCG (F1), com adição de 0,84% de FCG (F2) e 1,96% de FCG (F3). O pão elaborado com 0,84% de farinha de casca de guavira (F2) apresentou maior aceitabilidade pelos provadores, não diferindo da amostra padrão (F1). Quanto à composição físico-química, houve diferença entre as amostras (p < 0,05). Maiores teores de cinzas, carboidrato e calorias, e menores teores de umidade e lipídio foram verificados na formulação com maior teor de FCG (F3). Não houve diferença estatística (p > 0,05) para os conteúdos de proteína entre as formulações. A incorporação de farinha da casca da guavira resultou em acréscimo de vitamina C nas formulações, porém as quantidades testadas não foram suficientes para contribuir com melhorias na qualidade da massa. A adição de farinha da casca da guavira causou escurecimento e indicou tendência de cor para o amarelo na casca e vermelho no miolo dos pães. O volume específico encontrado nas formulações com farinha da casca da guavira se assemelharam ao da formulação padrão. Na análise reológica da farinha da casca da guavira, não houve diferença de tenacidade entre as amostras com adição de FCG, porém a extensibilidade foi maior na amostra com 1,5% de FCG. A farinha com 1,5% apresentou menor índice de configuração de curva e o acréscimo de farinha da casca da guavira resultou na diminuição do trabalho mecânico. A pesquisa demonstrou que o uso da farinha de casca de guavira adicionada à farinha de trigo é viável na elaboração de pães com boa qualidade sensorial.

Resumen La rehabilitación cardiaca es un tratamiento valioso para pacientes con enfermedades cardiacas establecidas, y en general para personas con riesgo cardiovascular elevado. La prescripción de la rehabilitación cardiaca debe ser progresiva y con metas individualizadas. Tradicionalmente se inicia en entornos hospitalarios luego de eventos cardiovasculares agudos y se continúa de manera ambulatoria en instituciones de menor complejidad. Se realizó una revisión no sistemática de la literatura sobre la evolución de la rehabilitación cardiaca en el tiempo, su relevancia en el cuidado de los pacientes con enfermedad cardiovascular, las diferentes modalidades en la prestación de este servicio con la tendencia a la rehabilitación cardiaca en casa y la telerrehabilitación, y su transformación acelerada durante la pandemia de COVID-19. Es fundamental garantizar la continuidad en el acceso, así como la suficiente participación de los pacientes en programas remodelados de rehabilitación cardiaca, capaces de transgredir hábitos en la prestación del servicio y de superar las barreras que puede representar la situación actual para la entrega de una atención de alta calidad.

Abstract Cardiac rehabilitation is a valuable treatment for patients with established heart disease, and in general, for people with high cardiovascular risk. The prescription of cardiac rehabilitation must be progressive and with individualized goals. Traditionally, it is performed in hospital settings after an acute cardiovascular event and it’s continued as outpatient basis in less complex institutions. A non-systematic review of literature was conducted in terms of the evolution of cardiac rehabilitation over time, it’s relevance in cardiovascular disease patient’s care, different access modalities, including the evolving tendency towards home based cardiac rehabilitation and tele-rehabilitation, as well as its accelerated transformation during the COVID-19 pandemics. It is essential to guarantee continuity of access as well as sufficient participation of patients in restructured cardiac rehabilitation programs, capable of surpassing service delivery habits and overcoming the barriers that the current situation may represent for the delivery of a high-quality care.

Abstract: Mexico is a country of inequalities. This study presents an analysis of causes of death related to the condition of affiliation to health services as a proxy for the location in the social structure for those who died in Mexico in the first fifteen years of the 21st century. Percentage of the main causes of death by condition of affiliation to social security and other health services of the deceased were calculated, and sociodemographic characteristics, mortality rates by sex and age and premature deaths by cause were analyzed, for the period 2000-2015. Similarities and discrepancies of the distributions found are highlighted. Considerations are made about risks constellations affecting Mexican population as a whole and its variations among the five groups identified. Some issues about the data construction come to light. It concludes with some reflextions about certain directions of recent health policies.

Resumen: En este trabajo se examinan los perfiles de la mortalidad por causas para la población fallecida en México en los primeros quince años del siglo XXI en relación con su condición de afiliación a los servicios de salud, considerada como una de las expresiones de su ubicación en la estructura social. Se analizan la distribución porcentual de la mortalidad por causa según condición de derechohabiencia del fallecido, sus características sociodemográficas, las tasas específicas de mortalidad para las principales causas observadas en cada subgrupo, y el porcentaje de muertes prematuras por las principales causas de defunción, para el período 2000-2015. Se destacan las similitudes y las discrepancias de las distribuciones encontradas. Se plantea una reflexión sobre sus posibles significados en términos de las constelaciones de riesgos que afectan al conjunto de la población mexicana y sus variaciones para los integrantes de estos subgrupos. El trabajo incluye una amplia consideración sobre la construcción de los datos, y concluye con algunas reflexiones sobre la política pública de salud reciente.

Resumen Introducción: En la enfermedad por COVID-19 se ha establecido que los pacientes con enfermedad cardiometabólica de base tienen mayor riesgo de presentar desenlaces adversos. Esto ha incrementado el interés en estudiar variables cardiovasculares relevantes, para plantear su correlación con los desenlaces clínicos en esta población. Objetivo: Describir el valor pronóstico de los biomarcadores cardíacos en la enfermedad por COVID-19. Métodos: Revisión no sistemática de la literatura en bases de datos como PubMed, Google Scholar, Clinical Key, SciELO, entre otras, utilizando palabras clave, términos planos y términos MeSh. Resultados: Se eligieron 22 bibliografías, entre ellas artículos de revisión de tema, revisiones sistemáticas, metaanálisis, estudios observacionales y artículos originales publicados hasta la fecha (mayo 13 de 2020), que en su mayoría describen la alteración de biomarcadores cardiacos y su relación con la evolución clínica de los pacientes con COVID-19. Discusión: Se encontró que la troponina y el péptido natriurético se comportan como factores de riesgo independientes para compromiso clínico severo, requerimiento de soporte ventilatorio o hemodinámico, estancia en la UCI, y aumento de la mortalidad. Conclusiones: Es razonable plantear el uso de estos biomarcadores en la estratificación del riesgo en pacientes con COVID-19 y enfermedad cardiovascular establecida.

Abstract Introduction: It has been established that patients with an underlying cardiometabolic disease and COVID-19 infections, have a higher risk of an adverse outcome. This has led to an increase in the interest of studying relevant cardiovascular variables, in order to establish their association with clinical outcomes in this population. Objective: To describe the prognostic value of cardiac biomarkers in disease caused by COVID-19. Methods: A non-systematic review of the literature was carried out in data bases that included PubMed, Google Scholar, Clinical Key, SciELO, using the key words, plain terms, and MeSH terms. Results: A total of 22 articles were chosen. They consisted of review articles on the subject, systematic reviews, meta-analyses, observational studies, and original articles published up until 13 May 2020. The majority of them described the changes in cardiac biomarkers and their relationship with the clinical outcome of patients COVID-19. Discussion: It was found that Troponin and Natriuretic Peptide behaved as independent risk factors for severe clinical compromise, requiring ventilatory or haemodynamic support, admission to ICU, and an increase in mortality. Conclusions: It is reasonable to recommend the use of these biomarkers in the risk stratification in patients with COVID-19 and an established cardiovascular disease.

Resumo Um dos grandes desafios do desenvolvimento de produtos com baixos teores de gordura é manter suas características sensoriais. A polidextrose pode ser utilizada como um substituto de gordura, sem causar grandes alterações no produto final. O objetivo deste estudo foi avaliar as características físico-químicas, propriedades nutricionais e investigar o potencial de aceitação de pães de queijo formulados com polidextrose. Foram elaboradas 4 formulações: formulação 1 (sem substituição de óleo por polidextrose); formulações 2, 3 e 4 (contendo diferentes concentrações de substituição de óleo e polidextrose). Participaram da avaliação sensorial 100 provadores não treinados, de 18 a 62 anos. Nas análises físico-químicas foram determinados os teores de água, cinzas, proteínas, lipídeos, textura, volume específico e cor, sendo realizado cálculo teórico para quantificação de carboidratos (por diferença) e fibras. Os resultados demonstraram que nos atributos avaliados as formulações obtiveram aceitabilidade superior a 70%, exceto o atributo intenção de compra da formulação padrão. Foi observado que o desenvolvimento de formulações contendo 4% de polidextrose apresentaram textura semelhante à formulação padrão. Assim, a adição de polidextrose em pães de queijo permitiu a obtenção de produtos com menores teores de lipídeos, maior teor de fibras, boa aceitação sensorial e características tecnológicas semelhantes ao padrão, indicando seu potencial de comercialização.

Abstract One of the great challenges of developing low-fat products is to maintain their sensory characteristics. Polydextrose can be used as a fat substitute without causing major changes in the final product. The objective of this study was to evaluate the physicochemical characteristics, nutritional properties and acceptance of cheese breads made with polydextrose. Four formulations were elaborated: formulation 1 (without substitution of oil for polydextrose); formulations 2, 3 and 4 (containing different concentrations of oil substitution and polydextrose). A total of 100 untrained testers aged 18-62 participated in the sensory evaluation. In the physicochemical analyzes the water moisture, ash, protein, fat, texture, specific volume and color contents were determined. Theoretical calculations were performed for the quantification of carbohydrates (by difference) and fibers. The results showed that for the attributes evaluated, acceptance of the formulations was higher than 70%, except for intention to purchase of the standard formulation. It was observed that the development of formulations included 4% polydextrose, with texture similar to the standard pattern. Thus, an addition of polydextrose in cheese breads, allows the prodution of products with lower lipid content, higher fiber content, good sensory acceptance and specific technological characteristics for the standard, which shows its commercialization potential.

Resumen La aorta shaggy se define como una degeneración ateromatosa agresiva y extensa de la aorta, cuya friabilidad predispone a ulceración y complicaciones embólicas, cursa con alto riesgo de embolia sistémica y no se conocen prevalencia ni incidencia en poblaciones de riesgo. La mayoría de casos publicados hacen referencia a complicaciones en procedimientos quirúrgicos. En la literatura no se hallaron reportes que asocien ateroembolia aórtica con obstrucción de la arteria de Adamkiewicz, cuyo diagnóstico no siempre es posible visualizando su oclusión por angiotomografía o por angiorresonancia, pues el defecto puede ser evanescente o puede existir compromiso distal con obstrucción microvascular, difícilmente aparente con arteriografía selectiva. Se presenta un caso de mielopatía isquémica embólica asociada a aorta shaggy con probable oclusión de la arteria de Adamkiewicz como responsable del deterioro neurológico agudo de la paciente, confirmado por resonancia magnética nuclear. Para caracterizar mejor esta enfermedad y para tener las estrategias diagnósticas y terapéuticas apropiadas en su abordaje oportuno, consideramos importante el reporte de casos similares aumentando así su sospecha diagnóstica.

Abstract A shaggy aorta is defined as an aggressive and extensive atheromatous degeneration of the aorta. Its friability predisposes to ulceration and embolic complications. It carries a high risk of systemic embolisms, and its prevalence and incidence in risk populations is unknown. The majority of published cases mention complications in surgical procedures. No reports have been found in the literature that associate aortic atheroembolism with obstruction of the artery of Adamkiewicz. Its diagnosis is not always possible by visualising its occlusion by computed tomography angiography or by magnetic resonance angiography, since the defects may be evanescent, or there may be a distal compromise with a microvascular obstruction, hardly apparent with selected angiography. A case is presented of embolic ischaemic myelitis associated with a shaggy aorta, with probable occlusion of the artery of Adamkiewicz being responsible form the acute neurological deterioration of the patient, confirmed by a nuclear magnetic resonance scan. In order to better describe the features of this disease and to have the appropriate diagnostic and therapeutic strategies for its timely approach, it is considered important to report all similar cases, thus increasing its diagnostic suspicion.

Resumen El síndrome de la plaqueta pegajosa en un trastorno cualitativo plaquetario en el que bajas concentraciones de epinefrina y adenosina difosfato producen hiperagregabilidad plaquetaria considerable. Se ha especulado mucho sobre la etiología de este trastorno sin que sean claros sus mecanismos fisiopatológicos. Desde el punto de vista clínico, se asocia a trombosis arteriales y venosas recurrentes en pacientes jóvenes, pérdidas gestacionales, otras complicaciones obstétricas y cefalea recurrente.En la literatura se ha descrito su presentación familiar, lo que hace sospechar su comportamiento hereditario autosómico dominante; también se ha reportado un fenotipo adquirido de la enfermedad en algunas poblaciones especiales como pacientes con enfermedad renal crónica en terapia de reemplazo renal o posterior al trasplante renal y en pacientes con cuadros inflamatorios o inmunosupresión. Se expone el caso de una paciente con antecedente de cefalea de difícil manejo, síndrome hipertensivo asociado al embarazo y mortinato, con síndrome del nodo enfermo y disautonomía manejadas con implantación de marcapasos definitivo bicameral con sensor CLS, que desarrolló trombosis de la vena subclavia, asociada al electrodo de marcapasos, recurrente a pesar de anticoagulación con warfarina y rivaroxabán e incluso a pesar de antiagregación con ácido acetilsalicílico, con posterior diagnóstico de síndrome de la plaqueta pegajosa.

Abstract Sticky platelet syndrome is a qualitative platelet disorder in which low concentrations of adrenaline and adenosine diphosphate produce considerable platelet hyperaggregability. There has been much speculation on the origin of this disorder as its pathophysiological mechanisms of action are not yet clear. From a clinical point of view, it is associated with recurrent arterial and venous thrombosis in young patients, miscarriages, other obstetric complications and recurrent headaches.Its familial presentation has been described in the literature, suspecting that it is of a dominant autosomal hereditary nature. An acquired phenotype of the disease has also been reported in some particular patients, such as patients with chronic kidney disease on renal replacement therapy or after a kidney transplant, as well as in patients with inflammatory processes or immunosuppression. The case is presented of a patient with a history of difficult to manage headaches, a hypertensive syndrome associated with the pregnancy, and a foetal death. She also had sick sinus node syndrome and dysautonomia managed with a definitive dual-chamber pacemaker with a CLS sensor. There was then a thrombosis in the subclavian vein associated with the pacemaker electrode, being recurrent despite anticoagulation with warfarin and rivaroxaban, and even despite anti-aggregation treatment with acetyl salicylic acid. She was subsequently diagnosed with sticky platelet syndrome.

Resumen La endocarditis bacteriana es una enfermedad con alta morbimortalidad, causada principalmente por cocos gram positivos, menos frecuentemente por organismos del grupo HACEK e inusualmente por otras enterobacterias. La Escherichia coli es la principal causa de bacteriemia nosocomial, pero en la literatura existen reportes de no más de 50 casos de endocarditis por este microorganismo. El tracto genitourinario es la fuente usual del compromiso infeccioso favorecido por factores de riesgo como diabetes mellitus, cardiopatía estructural, antecedente de malignidad, uso de drogas intravenosas, material protésico y edad avanzada. La E. coli en válvulas nativas presenta tropismo por válvulas del lado izquierdo. Así mismo, se han descrito presentaciones inusuales en relación con material protésico y organismos resistentes, aunque es mucho más frecuente encontrar cepas silvestres. La endocarditis por E. coli se asocia fuertemente con complicaciones locales y necesidad de manejo quirúrgico. La filogenética de las cepas de E. coli aisladas en infecciones endocárdicas y los factores de virulencia que le permiten adherirse a este tejido en presencia o no de material protésico, han sido bastante discutidas. Se expone un caso de endocarditis asociada a electrodo de marcapasos por E. coli y posteriormente se hace una revisión de la literatura disponible sobre esta enfermedad.

Abstract Bacterial endocarditis is a disease with high morbidity and mortality, and is mainly caused by gram positive cocci, less frequently due to organisms of the HACEK group (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella), and unusually by other bacteria. Escherichia coli is the principal cause of nosocomial bacteraemia, but there are no more than 50 cases reported in the literature of due to this microorganism. The genitourinary tract is the usual sources of infectious compromises favoured by risk factors such as, diabetes mellitus, structural heart disease, history of malignancy, use of intravenous drugs, prosthetic material, and advanced age. E. coli in native valves have tropism for valves of the left side. Furthermore, unusual presentations have been described as regards prosthetic material and resistant organism, although it is much more common to find wild strains. Endocarditis due to E. coli is strongly associated with local complications, and a need for surgical management. The phylogenetics of the E. coli isolated in endocardial infections, and the virulence factors that enable it to adhere to this tissue whether in the presence or not of prosthetic material, has been widely discussed. A case is presented of endocarditis associated with a pacemaker electrode due to E. coli, followed by a review of the available literature on this disease.

This article addresses some questions regarding the exclusion of the subjectivity derived from the ideals of objectivity and neutrality that characterize the modern scientific parade gm. Several consequences of this exclusion with respect to health care and illness are considered. Five problem areas are discussed, emphasizing the contributions of qualitative inquiry for the recovery of the importance of the individual. These include health and disease as subjective experiences, the gap between the experts' perspective and that of the layman, as well as disagreements among health professionals and common people, both in the preventive and in the curative fields. They also include the omission of the patients' voice when dealing with their illness and the sterilization of subjective creativity to establish new avenues to health care. The paper concludes by pointing out that, despite the challenges involved, certain currents of qualitative research whose foundations are located in the most advanced area of current epistemological, ethical and aesthetic reflection, can help to open new routes towards richer alternatives for health care and illness in Latin American societies.

En este artículo se cuestiona la exclusión de la subjetividad derivada de los ideales de objetividad y neutralidad del paradigma científico moderno. Se exponen algunas de sus consecuencias en lo que atañe a la construcción de la salud y el cuidado de la enfermedad. Se discuten cinco nudos problemáticos en los que la investigación cualitativa tiene valiosos aportes qué ofrecer para la recuperación del lugar del sujeto: la salud y la enfermedad como experiencias subjetivamente percibidas y significadas; la brecha que separa a la visión de los expertos y de quienes no lo son; los desencuentros entre los profesionales de la salud y la población, tanto en el frente curativo como en el preventivo; el silenciamiento de la voz del enfermo sobre su vivencia de la enfermedad; y la esterilización de la creatividad subjetiva en la construcción de rutas más diversas para el cuidado de la salud. Se postula que, con todos los retos implicados, ciertas corrientes de la investigación cualitativa cuyos fundamentos se ubican en el polo más avanzado de la reflexión epistemológica, ética e incluso estética de nuestros días, pueden ayudar a abrir nuevas rutas hacia alternativas más ricas e imaginativas para el cuidado de la salud y la atención de la enfermedad en las sociedades latinoamericanas.

This article addresses some questions regarding the exclusion of the subjectivity derived from the ideals of objectivity and neutrality that characterize the modern scientific parade gm. Several consequences of this exclusion with respect to health care and illness are considered. Five problem areas are discussed, emphasizing the contributions of qualitative inquiry for the recovery of the importance of the individual. These include health and disease as subjective experiences, the gap between the experts' perspective and that of the layman, as well as disagreements among health professionals and common people, both in the preventive and in the curative fields. They also include the omission of the patients' voice when dealing with their illness and the sterilization of subjective creativity to establish new avenues to health care. The paper concludes by pointing out that, despite the challenges involved, certain currents of qualitative research whose foundations are located in the most advanced area of current epistemological, ethical and aesthetic reflection, can help to open new routes towards richer alternatives for health care and illness in Latin American societies.

En este artículo se cuestiona la exclusión de la subjetividad derivada de los ideales de objetividad y neutralidad del paradigma científico moderno. Se exponen algunas de sus consecuencias en lo que atañe a la construcción de la salud y el cuidado de la enfermedad. Se discuten cinco nudos problemáticos en los que la investigación cualitativa tiene valiosos aportes qué ofrecer para la recuperación del lugar del sujeto: la salud y la enfermedad como experiencias subjetivamente percibidas y significadas; la brecha que separa a la visión de los expertos y de quienes no lo son; los desencuentros entre los profesionales de la salud y la población, tanto en el frente curativo como en el preventivo; el silenciamiento de la voz del enfermo sobre su vivencia de la enfermedad; y la esterilización de la creatividad subjetiva en la construcción de rutas más diversas para el cuidado de la salud. Se postula que, con todos los retos implicados, ciertas corrientes de la investigación cualitativa cuyos fundamentos se ubican en el polo más avanzado de la reflexión epistemológica, ética e incluso estética de nuestros días, pueden ayudar a abrir nuevas rutas hacia alternativas más ricas e imaginativas para el cuidado de la salud y la atención de la enfermedad en las sociedades latinoamericanas.

This paper presents the rationale for the choice of participants in qualitative research in contrast with that of probability sampling principles in epidemiological research. For a better understanding of the differences, concepts of nomothetic and ideographic generalizability, as well as those of transferability and reflexivity, are proposed, Fundamentals of the main types of sampling commonly used in qualitative research, and the meaning of the concept of saturation are mentioned. Finally, some reflections on the controversies that have arisen in recent years on various paradigmatic perspectives from which to conduct qualitative research, their possibilities of combination with epidemiological research, and some implications for the study of health issues are presented.

En este trabajo se presentan los fundamentos de la elección de los participantes en una investigación cualitativa, en contraste con los que rigen al muestreo probabilístico en la investigación epidemiológica. Se proponen los conceptos de generalizabilidad nomotética e ideográfica, y los de transferibilidad y reflexividad, para una mejor comprensión de las diferencias. Se mencionan los fundamentos de los principales tipos de muestreo que suelen utilizarse en investigación cualitativa, el significado del concepto de saturación y algunos de sus cuestionamientos. Por último, se plantean algunas reflexiones en torno a las controversias suscitadas en los últimos años sobre las diversas perspectivas paradigmáticas desde las cuales se puede efectuar hoy día la investigación cualitativa, sus posibilidades de combinación con la investigación epidemiológica, y algunas implicaciones para el estudio de los problemas de salud.

This paper presents the rationale for the choice of participants in qualitative research in contrast with that of probability sampling principles in epidemiological research. For a better understanding of the differences, concepts of nomothetic and ideographic generalizability, as well as those of transferability and reflexivity, are proposed, Fundamentals of the main types of sampling commonly used in qualitative research, and the meaning of the concept of saturation are mentioned. Finally, some reflections on the controversies that have arisen in recent years on various paradigmatic perspectives from which to conduct qualitative research, their possibilities of combination with epidemiological research, and some implications for the study of health issues are presented.

En este trabajo se presentan los fundamentos de la elección de los participantes en una investigación cualitativa, en contraste con los que rigen al muestreo probabilístico en la investigación epidemiológica. Se proponen los conceptos de generalizabilidad nomotética e ideográfica, y los de transferibilidad y reflexividad, para una mejor comprensión de las diferencias. Se mencionan los fundamentos de los principales tipos de muestreo que suelen utilizarse en investigación cualitativa, el significado del concepto de saturación y algunos de sus cuestionamientos. Por último, se plantean algunas reflexiones en torno a las controversias suscitadas en los últimos años sobre las diversas perspectivas paradigmáticas desde las cuales se puede efectuar hoy día la investigación cualitativa, sus posibilidades de combinación con la investigación epidemiológica, y algunas implicaciones para el estudio de los problemas de salud.