Abstract The treatment of ST-segment elevation myocardial infarction has barriers depending on the geographic region. Primary coronary angioplasty is the treatment of choice, if it is performed on time and by experienced operators. However, when it is not available, the administration of fibrinolysis and referral for rescue angioplasty, in case of negative reperfusion, is the best strategy. In the same way, coronary angioplasty, as part of a pharmacoinvasive strategy, is the best alternative when there is positive reperfusion. The development of infarct treatment networks increases the number of patients reperfused within the recommended times and improves outcomes. In Latin America, national myocardial infarction treatment programs should focus on improving outcomes, and long-term success depends on working toward defined goals and enhancing functionality, therefore programs should develop capacity to measure their performance. The following document discusses all of these alternatives and suggests opportunities for improvement.

Resumen El tratamiento del infarto agudo de miocardio con elevación del segmento ST tiene barreras dependiendo de la región geográfica. La angioplastia coronaria primaria es el tratamiento de elección, siempre y cuando sea realizada dentro de tiempo y por operadores experimentados. Sin embargo, cuando no está disponible, la administración de fibrinólisis y el envío para angioplastia de rescate, en caso de reperfusión negativa, es la mejor estrategia. De la misma manera, la angioplastia coronaria, como parte de una estrategia farmacoinvasiva, es la mejor alternativa cuando hay reperfusión positiva. El desarrollo de redes de tratamiento del infarto aumenta el número de pacientes reperfundidos dentro de los tiempos recomendados y mejora los desenlaces. En América Latina, los programas nacionales para el tratamiento del infarto deben centrarse en mejorar los resultados y el éxito a largo plazo depende de trabajar hacia objetivos definidos y obtener métricas de rendimiento, por lo tanto, estos deben desarrollar métricas para cuantificar su desempeño. El siguiente documento discute todas estas alternativas y sugiere oportunidades de mejora.

ABSTRACT Spontaneous pneumothorax is a rare entity, and its association with electrocardiographic changes is infrequent. In these cases, the most frequent abnormalities are ST-segment elevation, T-wave inversion and poor R wave progression in precordial leads. We present the case of a 25-year-old man who experienced a left spontaneous pneumothorax secondary to a subpleural bleb. Upon admission, his electrocardiogram revealed ST-segment depression in the inferior leads and aVF. These findings resolved following management of pneumothorax through thoracotomy.

RESUMEN El neumotórax espontáneo es una entidad poco frecuente, y es poco frecuente su asociación con los cambios electrocardiográficos. En estos casos, las anormalidades más frecuentes son la elevación del segmento ST, la inversión de la onda T y la pobre progresión de la onda R en derivaciones precordiales. Presentamos el caso de un varón de 25 años quien presentó un neumotórax espontáneo izquierdo, a su ingreso el paciente tuvo un electrocardiograma con infradesnivel en el segmento ST en derivaciones inferiores, hallazgos que resolvieron posterior al tratamiento del neumotórax con una toracotomía.

RESUMEN Este estudio busca diseñar e implementar un programa educativo innovador en el Banco Internacional, sede Ibarra, inspirado en el enfoque de excelencia en el servicio de Disney, con el propósito de fortalecer las habilidades del personal en la prestación de servicios al cliente. Para ello, se adopta un enfoque cuantitativo y cualitativo con un diseño de estudio longitudinal. Se utilizan encuestas estructuradas a una muestra de empleados para evaluar percepciones sobre habilidades blandas y cultura organizacional. Los resultados respaldan la efectividad del programa implementado al revelar un aumento en las habilidades del personal, mejoras en la orientación al cliente y la adaptabilidad. De esta manera se logra un impacto positivo en la cultura organizacional. Estos resultados respaldan la efectividad de la iniciativa y ofrecen una base sólida para recomendar la continuidad de programas educativos similares.

ABSTRACT This study seeks to design and implement an innovative educational program at Banco Internacional, Ibarra headquarters, inspired by Disney's approach to service excellence, with the purpose of strengthening staff skills in providing customer services. To this end, a quantitative and qualitative approach is adopted with a longitudinal study design. Structured surveys are used with a sample of employees to evaluate perceptions about soft skills and organizational culture. The results support the effectiveness of the implemented program by revealing an increase in staff skills, improvements in customer orientation and adaptability. In this way, a positive impact is achieved on the organizational culture. These results support the effectiveness of the initiative and offer a solid basis for recommending the continuation of similar educational programs.

RESUMO Este trabalho resgatou a passagem do médico sanitarista e professor universitário Antônio Sérgio da Silva Arouca pela Universidade Estadual de Campinas (Unicamp), entre 1967 e 1975, mediante estudo de três documentos importantes conservados nessa instituição, a saber, seu Processo de Vida Funcional, a Revista Comemorativa dos 25 anos do Departamento de Medicina Preventiva e Social da Faculdade de Ciências Médicas, onde consta depoimento seu, e o Relatório Final da Comissão da Verdade e Memória “Octávio Ianni”. No Departamento de Medicina Preventiva e Social da Unicamp, encontrou ambiente propício para atuar conforme suas convicções. Integrou-se à disciplina de Ciências Sociais Aplicadas à Medicina, cujo conteúdo teórico dialogava com ações extramuros desenvolvidas pelos alunos em bairro pobre da cidade, com o intuito de lhes propiciar a oportunidade de reconhecer a importância e a influência dos fatores sociais sobre o estado de saúde dos indivíduos e das populações. Tal experiência, muito provavelmente, influenciou sobremaneira o jovem docente que, anos depois, produziria uma tese de extrema relevância para formulação e consolidação da saúde coletiva brasileira e presidiria a VIII Conferência Nacional de Saúde, que estabeleceu as bases do Sistema Único de Saúde.

ABSTRACT This work recovers the passage of the public health physician and university professor Antônio Sérgio da Silva Arouca through the State University of Campinas (UNICAMP), between 1967 and 1975, through the study of three important documents kept in this institution, namely, his Functional Life File, the Commemorative Magazine of the 25th anniversary of the Department of Preventive and Social Medicine of the Faculty of Medical Sciences, where his statement is included, and the Final Report of the “Octávio Ianni” Truth and Memory Commission. At the UNICAMP’s Department of Preventive and Social Medicine, he found a favorable environment to act according to his convictions. He joined the discipline of Social Sciences Applied to Medicine, whose theoretical content dialogued with extramural actions developed by students in poor neighborhoods of the city, in order to give them the opportunity to recognize the importance and influence of social factors on the health status of individuals and populations. This experience probably had a great influence on the young professor who, years later, would produce a thesis of extreme relevance for the formulation and consolidation of Brazilian Public Health, and preside over the 8th National Health Conference, which established the bases for the Unified Health System.

ABSTRACT This work recovers the passage of the public health physician and university professor Antônio Sérgio da Silva Arouca through the State University of Campinas (UNICAMP), between 1967 and 1975, through the study of three important documents kept in this institution, namely, his Functional Life File, the Commemorative Magazine of the 25th anniversary of the Department of Preventive and Social Medicine of the Faculty of Medical Sciences, where his statement is included, and the Final Report of the “Octávio Ianni” Truth and Memory Commission. At the UNICAMP’s Department of Preventive and Social Medicine, he found a favorable environment to act according to his convictions. He joined the discipline of Social Sciences Applied to Medicine, whose theoretical content dialogued with extramural actions developed by students in poor neighborhoods of the city, in order to give them the opportunity to recognize the importance and influence of social factors on the health status of individuals and populations. This experience probably had a great influence on the young professor who, years later, would produce a thesis of extreme relevance for the formulation and consolidation of Brazilian Public Health, and preside over the 8th National Health Conference, which established the bases for the Unified Health System.

RESUMO Este trabalho resgatou a passagem do médico sanitarista e professor universitário Antônio Sérgio da Silva Arouca pela Universidade Estadual de Campinas (Unicamp), entre 1967 e 1975, mediante estudo de três documentos importantes conservados nessa instituição, a saber, seu Processo de Vida Funcional, a Revista Comemorativa dos 25 anos do Departamento de Medicina Preventiva e Social da Faculdade de Ciências Médicas, onde consta depoimento seu, e o Relatório Final da Comissão da Verdade e Memória “Octávio Ianni”. No Departamento de Medicina Preventiva e Social da Unicamp, encontrou ambiente propício para atuar conforme suas convicções. Integrou-se à disciplina de Ciências Sociais Aplicadas à Medicina, cujo conteúdo teórico dialogava com ações extramuros desenvolvidas pelos alunos em bairro pobre da cidade, com o intuito de lhes propiciar a oportunidade de reconhecer a importância e a influência dos fatores sociais sobre o estado de saúde dos indivíduos e das populações. Tal experiência, muito provavelmente, influenciou sobremaneira o jovem docente que, anos depois, produziria uma tese de extrema relevância para formulação e consolidação da saúde coletiva brasileira e presidiria a VIII Conferência Nacional de Saúde, que estabeleceu as bases do Sistema Único de Saúde.

Resumen La gestión eficiente de conflictos entre los usos y actividades en el medio marino-costero es fundamental para el éxito de la Planificación Espacial Marina (PEM). Nuestro objetivo fue el de realizar un geo-análisis de usos y actividades presentes en la jurisdicción de las Capitanías de Puerto de Tumaco y Guapi en Colombia para identificar los posibles conflictos presentes. Utilizamos información geográfica de usos y actividades del medio marino-costero disponible en geo-portales nacionales, se consultó a 23 expertos interinstitucionales para realizar la ponderación de las matrices de conflictos, se realizó un análisis de las interacciones entre los usos y actividades apoyados de análisis espacial, se identificaron los principales conflictos en función de criterios específicos y se realizó la cartografía para la ubicación de los conflictos. Se generó una base de datos con 39 capas geográficas, se encontró la mayor densidad de usos y actividades en aguas interiores, la fauna marina obtuvo el 11,81 % del total de interacciones, se identificaron 73 conflictos potenciales, donde el 23.29% correspondió a un Índice de Conflicto alto y el 57.53 % de los conflictos ocurrieron entre usuario-ambiente. Con estos resultados aportamos a la gestión de los litorales colombianos dentro del contexto de la PEM.

Abstract The efficient management of conflicts between uses and activities in the marine-coastal environment is fundamental for the success of Marine Spatial Planning (MSP). Our aim was to conduct a geo-analysis of uses and activities present in the jurisdiction of the harbor master of Tumaco and Guapi in Colombia to identify potential conflicts. We used geographic information on uses and activities of the marine-coastal environment available in national geo-portals, 23 interinstitutional experts were consulted to carry out the weighting of the conflict matrices, an analysis of the interactions between the uses and activities supported by spatial analysis was carried out, the main conflicts were identified according to specific criteria and the cartography for the location of the conflicts was carried out. A database with 39 geographic layers was generated, the highest density of uses and activities was found in inland waters, marine fauna obtained 11.81 % of the total interactions, 73 potential conflicts were identified, where 23.29 % corresponded to a high Conflict Index and 57.53 % of the conflicts occurred between user-environment. With these results, we contribute to the management of Colombian marine-coastal within the context of the MSP.

Resumen Escherichia coli es uno de los principales patógenos humanos causantes de diferentes infecciones de inicio hospitalario y comunitario. Se determinó que el 1,96% (32/1.632) de los aislamientos de E. coli recuperados entre enero de 2013 y marzo de 2015 en el Hospital Regional de Ushuaia, provincia de Tierra del Fuego, fueron resistentes a cefalosporinas de tercera generación (CTG). Estos aislamientos fueron resistentes a cefotaxima (91%) y/o a ceftazidima (28%). No se detectó resistencia a los carbapenemes. Veintiséis aislamientos fueron positivos para el gen blaCTX-M, agrupados como CTX-M-1/15 (54%), CTX-M-9/14 (25%), CTX-M-2 (17%) y CTX-M-1/15 más CTX-M-9/14 (4%). Cinco cepas resistentes a CTG dieron positivo para el gen blaCMY, mientras que un aislamiento presentó la BLEE TEM-19. Doce aislamientos se identificaron como clon hiperepidémico E. coli ST131 y uno como ST69. El análisis de las secuencias del genoma de siete aislamientos seleccionados de E. coli blaCTX-M-15 confirmó la circulación de los clones internacionales de alto riesgo ST131, ST617 y ST405 en la ciudad de Ushuaia.

Abstract Escherichia coli is one of the main human pathogens causing different hospital- and community-acquired infections. During the period from January 2013 to March 2015, 1.96% (32/1632) of E. coli isolates recovered at the Hospital Regional de Ushuaia, Tierra del Fuego province, were resistant to third-generation cephalosporins (TGCs). These isolates were resistant to cefotaxime (91%) and/or ceftazidime (28%). No resistance to carbapenems was detected. Twenty-six isolates were positive for blaCTX-M gene, grouped as CTX-M-1/15 (54%); CTX-M-9/14 (25%); CTX-M-2 (17%); and CTX-M-1/15 plus CTX-M-9/14 (4%). Five TGC-resistant strains were positive for blaCMY gene, while one strain harbored TEM-19 ESBL. Twelve isolates were identified as ST131 E. coli hyperepidemic clone, and one as ST69. Genome sequence analysis of seven blaCTX-M-15 E. coli selected isolates confirm the circulation of ST131, ST617 and ST405 international high-risk clones in the city of Ushuaia.

Resumen Contexto: Existe una creciente necesidad de monitorear y predecir variables críticas en procesos productivos; por tanto, a partir del enfoque de control estadístico, se ha asumido desde el uso de cartas de control para mediciones individuales. Así, en este artículo se presentan los resultados del diseño de una red neuronal recurrente long short term memory (LSTM) para predecir el valor promedio de la variable temperatura en mediciones individuales, y así evaluar la capacidad de la red para obtener valores similares a los cálculos del promedio móvil ponderado EWMA para mediciones individuales. Método: Se obtuvieron 1768 registros de mediciones individuales de temperatura realizadas por un sensor, en el conjunto de datos denominado gas sensors for home activity monitoring data set. Los datos de temperatura se representaron en una carta de control de promedios móviles ponderados exponenciales EWMA, con el fin de obtener los valores de la media del proceso y de identificar que este estuviera dentro del control estadístico. Posteriormente, se entrenó una red neuronal LSTM a una muestra de entrenamiento de 1184 datos con algoritmo backpropagation que permitiera obtener valores similares a EWMA, los cuales se validaron en una muestra de prueba de 584 datos de temperatura. Resultados: Se obtuvo el diseño de una red neuronal con una unidad en la puerta de entrada, cuatro en la puerta de olvido y una en la puerta de salida entrenada con el algoritmo Backpropagation, la cual permitió calcular valores muy cercanos a los representados en la carta de control EWMA, con un MSE de 1.1405e-04. Conclusiones: Las redes neuronales LSTM son una buena alternativa para el cálculo de valores EWMA, cuando se requiera hacer control estadístico de un proceso que genera gran cantidad de datos obtenidos de mediciones y no se cuente con un software para procesarlos. Financiación: Fundación Universitaria Los Libertadores

ABSTRACT Context: There is a growing need to monitor and predict critical variables in production processes, from the statistical process control approach it has been assumed from the use of control charts for individual measurements, for that reason this article presents the results of the design of a long short term memory (LSTM) recurrent neural network to predict the average value of the variable temperature in individual measurements and thus evaluate the ability of the network to obtain values similar to the EWMA weighted moving average calculations for individual measurements. Being this Methodology: 1768 records of individual temperature measurements made by a sensor were obtained, in the data set called: Gas sensors for home activity monitoring data set. Temperature data was plotted on an EWMA exponential weighted moving average control chart to obtain process mean values and identify that the process was within statistical control. Subsequently, an LSTM neural network was trained on a training sample of 1184 data with a Backpropagation algorithm that allowed obtaining values similar to EWMA, which were validated in a test sample of 584 temperature data. Results: The design of a neural network with a unit in the input gate, 4 units in the forgetting gate and 1 unit in the output gate was obtained, trained with the Backpropagation algorithm, it allowed to calculate values very close to those represented in the control chart. EWMA, with an MSE of 1.1405e-04. Conclusions: LSTM neural networks are a good alternative for calculating EWMA values, when statistical control of a process that generates a large amount of data obtained from measurements is required and there is no software to process them. Financing: Fundación universitaria Los Libertadores

ABSTRACT OBJECTIVE To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS This is a cross-sectional study conducted with baseline data from the 2015–2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42–2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21–1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89–4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02–2.57) and 32% (OR = 1.32, 95%CI: 1.10–1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions.

ABSTRACT OBJECTIVE This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion. METHODS This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls. RESULTS A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions. CONCLUSIONS Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction.

ABSTRACT: Leptospirosis is a zoonosis that can infect buffaloes and other mammalians, and it’s caused by Gram-negative bacteria of the genus Leptospira spp. The infection occurs through contact with urine or a contaminated environment with the mucous membranes of the animals, and the disease has two phases: leptospiremia and leptospiruria. The objective of this study was to determine the frequency of leptospirosis in buffaloes in the state of Paraná, Brazil, as well as the main serovars present in this area. A total of 276 blood samples were collected from buffaloes from 18 properties located in different cities and mesoregions of Paraná state. A microscopic agglutination test (MAT) was performed to detect the presence of anti-Leptospira spp. antibodies and to identify its serovars. The prevalence was 77.17% (213/276) of buffaloes seropositive for at least one serovar. The most frequent serovar was Icterohaemorrhagiae, followed by the Pomona serovar and serovar Hardjo. This study seems to be the first to determine the frequency of buffaloes with leptospirosis in the state of Paraná. Prevention and control measures are important to control the disease in herds.

RESUMO: Leptospirose é uma zoonose que infecta búfalos e outros mamíferos e é causada por bactérias Gram-negativas do gênero Leptospira spp. A infecção ocorre por meio do contato com a urina ou ambiente contaminado com as membranas mucosas dos animais e a doença possui duas fases: leptospiremia e leptospirúria. O objetivo deste trabalho foi determinar a frequência da leptospirose em bubalinos provenientes do estado do Paraná, assim como determinar os principais sorovares presentes no estado. Um total de 276 amostras de sangue foram coletados de búfalos provenientes de 18 propriedades localizadas em 14 municípios de diferentes mesorregiões do estado do Paraná. O teste de soroaglutinação microscópica (SAM) foi realizado para detecção da presença de anticorpos anti-Leptospira spp. e identificação dos respectivos sorovares. A prevalência de búfalos soropositivos para ao menos um sorovar foi de 77,17% (213/276). O sorovar mais frequente identificado nestes búfalos foi o Icterohaemorrhagiae, seguido pelos sorovares Pomona e Hardjo. Este é o primeiro estudo a determinar a frequência de búfalos com leptospirose no estado do Paraná. Medidas de controle e prevenção são importantes para o controle do agente nos rebanhos.

ABSTRACT OBJECTIVE To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS This is a cross-sectional study conducted with baseline data from the 2015–2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42–2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21–1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89–4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02–2.57) and 32% (OR = 1.32, 95%CI: 1.10–1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions.

ABSTRACT OBJECTIVE This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion. METHODS This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls. RESULTS A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions. CONCLUSIONS Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction.

Resumen En la etapa inicial de la formación estudiantil, surgen dificultades durante el desarrollo de elementos requeridos para el desempeño académico, intelectual y emocional, especialmente falencias relacionadas con la adquisición de la escritura. Este estudio, de enfoque mixto, diseño secuencial exploratorio, modalidad derivativa y alcance descriptivo, identificó los problemas evidenciados por estudiantes de grado segundo de primaria de una institución educativa de carácter público de Colombia, en su proceso de adquisición de la escritura, y su relación con las estrategias pedagógicas utilizadas por los docentes. La investigación partió del análisis cualitativo de variables observadas y estudiadas, para después dar paso a un estudio cuantitativo. Los resultados indican que existe la necesidad de fomentar el desarrollo motriz, de tal manera que se puedan evitar problemas como trazos fuertes, trazos débiles, grafías inconsistentes y ausencia de grafías en las palabras. Además, muestran que las estrategias pedagógicas utilizadas por los docentes lograron avances significativos en la escritura del estudiantado como poca cantidad de omisión, inversión y distorsión de grafías en los escritos de los estudiantes.

Resumo Na fase inicial da instrução, surgem dificuldades durante o desenvolvimento dos elementos necessários para o desempenho acadêmico, intelectual e emocional, especialmente deficiências relacionadas com a aquisição da escrita. Este estudo, com uma abordagem mista, desenho exploratório sequencial, modalidade derivada e escopo descritivo, identificou os problemas evidenciados pelos alunos da segunda série do ensino fundamental em uma instituição pública de ensino na Colômbia, em seu processo de aquisição de escrita, e sua relação com as estratégias pedagógicas utilizadas pelos professores. A pesquisa começou com uma análise qualitativa das variáveis observadas e estudadas, e depois deu lugar a um estudo quantitativo. Os resultados indicam que há necessidade de incentivar o desenvolvimento motor para evitar problemas como traços fortes, traços fracos, ortografia inconsistente e falta de ortografia nas palavras. Além disso, elas mostram que as estratégias pedagógicas utilizadas pelos professores alcançaram progressos significativos na escrita dos alunos, tais como pouca omissão, inversão e distorção da ortografia nos escritos dos alunos.

Résumé Pendant l'éducation initiale, il y a souvent des difficultés lors du développement des éléments nécessaires aux performances scolaires, intellectuelles et émotionnelles, notamment des lacunes liées à l'acquisition de l'écriture. Cette étude, avec une approche mixte, un design exploratoire séquentiel, sur une modalité dérivée et une portée descriptive, a identifié les problèmes manifestés par des élèves de la deuxième année de lenseignement primaire au cours de leur processus d'acquisition de l'écriture, et leur relation avec les stratégies pédagogiques utilisées par les enseignants. La recherche commence avec une analyse qualitative des variables observées et étudiées, et ensuite elle a laissé place à une étude quantitative. Les résultats indiquent qu'il est nécessaire d'encourager le développement moteur afin d'éviter des problèmes tels que les traits trop forts, les traits trop faibles, l'orthographe incohérente et l'orthographe manquante dans les mots. De plus, ils montrent que les stratégies pédagogiques utilisées par les enseignants ont permis d'obtenir des progrès significatifs dans l'écriture des élèves, tels que peu d'omission, d'inversion et de déformation de l'orthographe dans les écrits des élèves.

Abstract In the early stage of students' instruction, difficulties arise during the development of skills required for academic, intellectual and emotional performance. These are related particulary to the acquisition of writing. This study, with a mixed approach, exploratory sequential design, derivative modality and descriptive scope, identified the problems evidenced by second grade students of a public educational institution in Colombia, in their process of acquiring writing, and their relationship with the pedagogical strategies used by teachers. The research started with a qualitative analysis of observed and studied variables, and then gave way to a quantitative study. The results indicate that there is a need to promote motor development, so that problems, which have generated difficulty in writing, such as strong strokes, weak strokes, inconsistent spellings and absence of graphs in words. In addition, they show that the pedagogical strategies used by the teachers achieved significant advances such as a small amount of omission, inversion and distortion of spellings in the students' writings.