Abstract Introduction: Thyroid surgery carries significant risks and complications such as recurrent laryngeal nerve paralysis and postoperative suffocating hematoma. The most recent advancement providing safety is intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) and the advances in hemostasis systems. Objective: The main objective of the study was to explore our experience regarding safety measures and the reduction of complications in thyroid surgery. Materials and Methods: We present a review of 400 neck surgeries performed by the same surgeon, from September 2011 to February 2020. The main variables studied were intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve and vascular sealing hemostasis systems. Results: Out of the total 400 patients, a total of 625 RLNs were studied, using IONM. Thirteen unilateral vocal cord paralyses were recorded, 8 of which were temporary and only 5 definitive. The predominant hemostasis system utilized was the vascular sealing system and bipolar clamp 87%, and in 13%, ligation of a thyroid artery. Only 1 patient experienced postoperative hemorrhage, which was resolved without incidents. Conclusions: Intermittent intraoperative neuromonitoring of the RLN and advances in hemostasis systems have proven to be valuable in thyroid surgery, improving safety and saving surgical time.

Abstract Trichoderma is a cosmopolitan fungus widely distributed around the world. The different uses of this beneficial fungus are varied in several industries, like agriculture, textile, and paper, including the pharmaceutical industry. The genus Trichoderma has other mechanisms of action, including the production of different enzymes and secreted secondary metabolites used in various industries. The genomes of different Trichoderma species have been sequenced to identify the mechanisms for producing several compounds. The advancement of multiple technologies has allowed the development of transformation tools for the genetic improvement of Trichoderma, thus increasing biomass, primary and secondary metabolites, and enzymes. Therefore, genetic modification aims to increase compound production in several Trichoderma strains. Characterization of Trichoderma through gene expression analysis is essential for biotechnology applications. It helps counteract one of the most challenging problems for agriculture today, including climate change and the appearance of pathogens that attack crops with high commercial and food demand. In conclusion, this review analyzes various strategies to improve Trichoderma strains genetically and their multiple applications in the agricultural, textile, paper, and pharmaceutical industries. As a recommendation for future studies with potential impact, the optimization of specific genetic modifications in Trichoderma strains is recommended to improve their adaptability and effectiveness in combating emerging challenges in agriculture, especially those linked to climate change. Investigating possible synergies between genetically modified Trichoderma strains and environmentally sustainable agricultural practices could contribute to developing solutions for crop protection and yield improvement.

Abstract Agroecological tools and strategies will be identified in the European project AGROSUS, to prevent and manage the occurrence of weeds in the most economically relevant crops in the eleven biogeographical regions of Europe (Continental-Mediterranean-Atlantic-Macaronesian-Pannonian-Anatolian-Black Sea-Boreal-Alpine-Septic-Arctic), while reducing the release of synthetic herbicides into the environment, increasing biodiversity and agroecosystems’ health. The designed agroecological tools and strategies will be developed in collaboration with stakeholders (farmers, advisors, small sellers, associations, policy-makers, etc.). These strategies will be implemented in the most economically relevant crops in the 11 biogeographical regions of Europe in conventional, organic and mixed farming systems. In addition, agroecological strategies will be compared with classical chemical control, assessing the health of crop plants, the quality of agricultural products, and the quality and health of the soil. Also, the environmental impact, economic and social costs and benefits of the combined agroecological strategies will be evaluated in short, medium and long-term in different trial fields.

Resumen El proyecto europeo AGROSUS identificará herramientas y estrategias agroecológicas para prevenir y manejar la aparición de malas hierbas en los cultivos económicamente más relevantes de las once regiones biogeográficas de Europa (Continental-Mediterránea-Atlántica-Macaronésica-Panónica-Anatolia-Ártica- Mar Negro-Boreal-Alpina-Estépica), al tiempo que reducirá la liberación de herbicidas sintéticos al medio ambiente, aumentando la biodiversidad y la salud de los agroecosistemas. Las herramientas y estrategias agroecológicas diseñadas se desarrollarán, para las malas hierbas más problemáticas de las diferentes regiones, en colaboración con las partes interesadas (agricultores, asesores, vendedores, asociaciones, políticos, etc.), y se implementarán en los cultivos de mayor relevancia económica en las 11 regiones biogeográficas de Europa y en sistemas de agricultura convencional, orgánica y mixta. Además, en todos los casos, se compararán las estrategias agroecológicas implementadas en los campos de estudio con el control químico clásico, mediante el uso de herbicidas, valorando la salud de las plantas de cultivo, la calidad de los productos agrícolas, y la calidad y salud del suelo. Asimismo, el impacto ambiental, los costes económicos y sociales y los beneficios de las estrategias agroecológicas combinadas para el control de malas hierbas se evaluarán a corto, medio y largo plazo en los distintos campos de ensayo.

ABSTRACT Objective: To evaluate autoinflammatory diseases (AID) according to age at diagnosis and sex, and response to therapy in a large population. Methods: This is a cross-sectional observational study of a Latin American registry using a designed web system for data storage, collected between 2015 and 2018. Any altered findings during follow-up were recorded. The forms were translated into Portuguese and Spanish, including demographic, clinical, laboratory, genetic and treatment characteristics. Results: We included 152 patients, 51.3% male and 75% Caucasian. The median age at disease onset was 2.1 years (0–15.6 years) and median age at diagnosis 6.9 years (0–21.9 years); 111 (73%) were children (0–9 years old), and 41 (27%) were adolescents and young adults (AYA) (10–21 years old). Periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome (PFAPA) occurred in 46/152 (30%), chronic non-bacterial osteomyelitis (CNO) in 32/152 (21%), and familial Mediterranean fever (FMF) in 24/152 (15.7%). PFAPA was significantly higher in young children than in AYA (38.7% vs. 7.3%, p<0.001), while CNO were lower (13.5% vs. 41.5%, p<0.001). The frequency of females was significantly higher in CNO (28.4% vs. 14.1%, p=0.031) and lower in FMF (8.1% vs. 23.1%, p=0.011). The most used drugs were glucocorticoids, non-steroidal anti-inflammatory drugs (NSAID), and colchicine. Glucocorticoids and colchicine treatment were used in all AID with good to moderate response. However, cryopyrin-associated periodic syndromes (CAPS) seemed unresponsive to glucocorticoids. NSAIDs and methotrexate were the main medications used to treat CNO. Conclusions: Differences among AID patients were observed in the LA population regarding sex and age at disease diagnosis. Objective (AID Methods crosssectional cross sectional storage 201 2018 followup follow up recorded Spanish demographic clinical laboratory characteristics Results 15 513 51 3 51.3 75 Caucasian 21 2 1 2. 0–15.6 0156 0 6 (0–15. 69 9 6. 0–21.9 0219 (0–21. 11 73% 73 (73% 0–9 09 (0– old, old , old) 4 27% 27 (27% (AYA 10–21 1021 10 (10–2 old. . stomatitis pharyngitis (PFAPA 46152 46 46/15 30%, 30 30% (30%) nonbacterial non bacterial (CNO 32152 32 32/15 21%, 21% (21%) (FMF 24152 24 24/15 15.7%. 157 15.7% 7 (15.7%) 38.7% 387 38 (38.7 vs 7.3% p<0.001, p0001 p p<0.001 001 p<0.001) 13.5% 135 13 5 (13.5 415 41.5% p<0.001. 28.4% 284 28 (28.4 141 14 14.1% p=0.031 p0031 031 8.1% 81 8 (8.1 231 23 23.1% p=0.011. p0011 p=0.011 011 p=0.011) glucocorticoids nonsteroidal steroidal antiinflammatory anti inflammatory NSAID, NSAID (NSAID) However cryopyrinassociated cryopyrin associated CAPS (CAPS Conclusions 20 51. 0–15. 015 (0–15 0–21. 021 (0–21 (73 0– (0 (27 10–2 102 (10– 4615 46/1 (30% 3215 32/1 (21% 2415 24/1 15.7 (15.7% 38.7 (38. 7.3 p000 p<0.00 00 13.5 (13. 41.5 28.4 (28. 14.1 p=0.03 p003 03 8.1 (8. 23.1 p001 p=0.01 01 (NSAID 0–15 (0–1 0–21 02 (0–2 (7 ( (2 10– (10 461 46/ (30 321 32/ (21 241 24/ 15. (15.7 38. (38 7. p00 p<0.0 13. (13 41. 28. (28 14. p=0.0 8. (8 23. 0–1 0–2 (1 (3 (15. p0 p<0. p=0. (15 p<0 p=0 p< p=

RESUMO Objetivo: Avaliar as doenças autoinflamatórias (DAI) de acordo com sexo e idade no momento do diagnóstico e a resposta terapêutica em uma grande população. Métodos: Este é um estudo observacional transversal de um registro latino-americano que usou um sistema de dados coletados entre 2015 e 2018. Quaisquer achados alterados ao longo do acompanhamento foram registrados. Os formulários foram traduzidos para os idiomas português e espanhol, incluindo características demográficas, clínicas, laboratoriais, genéticas e de tratamento. Resultados: Incluímos 152 pacientes, sendo 51,3% do sexo masculino e 75% da raça branca. A média de idade de início da doença foi de 2,1 anos (0–15,6 anos) e a média de idade de diagnóstico 6,9 anos (0–21,9 anos); 111 (73%) eram crianças (0–9 anos) e 41 (27%) adolescentes/adultos jovens (10–21 anos). A síndrome de febre periódica, estomatite aftosa, faringite e adenite (PFAPA) ocorreu em 46/152 (30%), osteomielite não bacteriana crônica (CNO) em 32/152 (21%) e febre familiar do Mediterrâneo (FMF) em 24/152 (15,7%). A PFAPA foi significativamente maior em crianças pequenas (38,7 vs. 7,3%, p<0,001), e a CNO, em adolescentes/adultos jovens (13,5 vs. 41,5%, p<0,001). A frequência do sexo feminino foi significativamente maior na CNO (28,4 vs. 14,1%, p=0,031) e menor na FMF (8,1 vs. 23,1%, p=0,011). Os medicamentos mais utilizados foram glicocorticoides, anti-inflamatórios não esteroidais (AINE) e colchicina. O tratamento com glicocorticoides e colchicina foi usado em todas as DAI com resposta boa a moderada. No entanto, as síndromes periódicas associadas à criopirina (CAPS) pareciam não responder aos glicocorticoides. AINE e metotrexato foram os principais medicamentos utilizados no tratamento da CNO. Conclusões: Diferenças de pacientes com DAI foram observadas na população latino-americana em pacientes agrupados por sexo e idade ao diagnóstico da doença. Objetivo (DAI Métodos latinoamericano latino americano 201 2018 registrados espanhol demográficas clínicas laboratoriais Resultados 15 513 51 3 51,3 75 branca 21 2 1 2, 0–15,6 0156 0 6 (0–15, 69 9 6, 0–21,9 0219 (0–21, 11 73% 73 (73% 0–9 09 (0– 4 27% 27 (27% adolescentesadultos adolescentes adultos 10–21 1021 10 (10–2 anos. . periódica aftosa (PFAPA 46152 46 46/15 30%, 30 30% , (30%) (CNO 32152 32 32/15 21% (21% (FMF 24152 24 24/15 15,7%. 157 15,7% 7 (15,7%) 38,7 387 38 (38, vs 7,3% p<0,001, p0001 p p<0,001 001 p<0,001) 13,5 135 13 5 (13, 415 41,5% p<0,001. 28,4 284 28 (28, 141 14 14,1% p=0,031 p0031 031 8,1 81 8 (8, 231 23 23,1% p=0,011. p0011 p=0,011 011 p=0,011) antiinflamatórios anti inflamatórios (AINE moderada entanto CAPS (CAPS Conclusões latinoamericana americana 20 51, 0–15, 015 (0–15 0–21, 021 (0–21 (73 0– (0 (27 10–2 102 (10– 4615 46/1 (30% 3215 32/1 (21 2415 24/1 15,7 (15,7% 38, (38 7,3 p000 p<0,00 00 13, (13 41,5 28, (28 14,1 p=0,03 p003 03 8, (8 23,1 p001 p=0,01 01 0–15 (0–1 0–21 02 (0–2 (7 ( (2 10– (10 461 46/ (30 321 32/ 241 24/ 15, (15,7 (3 7, p00 p<0,0 (1 41, 14, p=0,0 23, 0–1 0–2 (15, p0 p<0, p=0, (15 p<0 p=0 p< p=

ABSTRACT This study aimed to assess an alkaline protease supplemented in diets with and without crude protein (CP) reduction on performance, apparent total tract digestibility (ATTD), blood parameters, and carcass and meat traits in growing-finishing pigs. Forty male pigs (26.2±1.2 kg) were randomly allocated into one of five treatments: negative control (NC, 2% and 1% reduction of CP in grower and finisher phases, respectively, no protease); NC150: NC + 150 mg protease kg−1 diet; NC300: NC + 300 mg protease kg−1 diet; PC: positive control (no CP reduction and protease); and PC300: PC + 300 mg protease kg−1 diet, with eight replicates of one pig/pen. Pigs fed NC showed greater average daily feed intake (ADFI) than pigs fed NC300 or PC and lower ADFI compared to pigs fed NC150. Pigs fed PC had lower ADFI than those fed PC300. Greater average daily gain and gain to feed ratio (G:F) were observed in pigs on NC compared with those on NC300 or NC150 and NC300, respectively. Pigs fed PC showed better G:F than pigs fed PC300. Lower coefficients of ATTD (CTTAD) of dry and organic matter (OM), digestible dry matter (DDM), digestible organic matter (DOM), and digestible protein were observed in growing II pigs fed NC compared with pigs fed NC150 or NC300. Pigs fed NC showed a lower DP compared with PC or NC150. Positive control group showed increased digestible protein compared with NC. Finishing II pigs fed NC showed lower DDM, DOM, CTTAD of OM, and gross energy than pigs fed NC150 or NC300. Pigs fed PC showed greater albumin concentration compared with pigs fed PC300 in finishing II. Pigs fed NC and PC300 showed greater luminosity in the l. thoracis muscle than pigs fed PC. A greater color score was evidenced in the l. thoracis in pigs fed PC compared with pigs fed PC300. The dietary supplementation of isolated alkaline protease and CP-reduced diets improves ATTD without supporting pig performance. (CP performance ATTD, , (ATTD) parameters growingfinishing 26.2±1.2 26212 26 2 1 (26.2±1. kg treatments NC, (NC phases respectively protease) 15 kg1 kg− diet 30 pigpen pen pig/pen (ADFI NC30 GF G F (G:F NC15 (CTTAD OM (OM) DDM (DDM) DOM (DOM) PC30 l CPreduced reduced (ATTD 26.2±1. 2621 (26.2±1 3 NC3 NC1 (OM (DDM (DOM PC3 26.2±1 262 (26.2± 26.2± (26.2 26.2 (26. 26. (26 (2 (

Abstract There are countless proven benefits of breastfeeding, and the demand for such a right in health for transfeminine people is rarely addressed in the literature, reinforcing inequities in health. The article aims to conduct a scoping review of lactation induction for transfeminine people in the health care context. Systematic literature review in six selected databases, looking for articles with terms related to lactation and transfeminine people. Data were extracted and analyzed, summarizing the main results in tables. Three hundred ninety articles were found. After the exclusion of the duplicates there was a selection by title/abstract and a following selection by the full reading of the remaining articles, considering the pre-determined exclusion and inclusion criteria. Twenty-one articles were included, published between 2018 and 2023. Among them, six are case reports with unprecedented information on the topic, and the others are publications in various formats. Lactation induction was achieved in all the case reports. There is a fragile and recent body of evidence affirming the success of lactation induction in transgender women. There is a necessity to support this demand by health professionals and robust studies to optimize necessary interventions.

Resumo São inúmeros os benefícios comprovados do aleitamento materno, e a demanda por tal direito em saúde para as pessoas transfemininas é pouco abordada na literatura, reforçando as iniquidades em saúde. O artigo objetiva realizar uma revisão de escopo sobre a indução da lactação para pessoas transfemininas no contexto de assistência à saúde. Revisão sistemática da literatura em seis bases de dados selecionadas, buscando artigos com termos relacionados à lactação e pessoas transfemininas. Os dados foram extraídos e analisados, resumindo os principais resultados em tabelas. Foram encontrados 390 artigos. Após a exclusão dos duplicados, procedeu-se à seleção por título/resumo e posterior seleção pela leitura na íntegra, considerando os critérios de exclusão e inclusão. Foram incluídos 21 artigos, publicados entre 2018 e 2023. Entre eles, seis são relatos de casos com informações inéditas sobre o tema, e os demais são publicações em diversos formatos. A indução da lactação foi alcançada em todos os relatos de casos. Existe um corpo de evidências frágil e recente que afirma o sucesso da indução da lactação em mulheres trans. Há necessidade de respaldar essa demanda por parte dos profissionais e estudos robustos para otimizar as intervenções necessárias.

Abstract There are countless proven benefits of breastfeeding, and the demand for such a right in health for transfeminine people is rarely addressed in the literature, reinforcing inequities in health. The article aims to conduct a scoping review of lactation induction for transfeminine people in the health care context. Systematic literature review in six selected databases, looking for articles with terms related to lactation and transfeminine people. Data were extracted and analyzed, summarizing the main results in tables. Three hundred ninety articles were found. After the exclusion of the duplicates there was a selection by title/abstract and a following selection by the full reading of the remaining articles, considering the pre-determined exclusion and inclusion criteria. Twenty-one articles were included, published between 2018 and 2023. Among them, six are case reports with unprecedented information on the topic, and the others are publications in various formats. Lactation induction was achieved in all the case reports. There is a fragile and recent body of evidence affirming the success of lactation induction in transgender women. There is a necessity to support this demand by health professionals and robust studies to optimize necessary interventions. breastfeeding context databases analyzed tables found titleabstract title abstract predetermined pre determined criteria Twentyone Twenty one included 201 2023 them topic formats women interventions 20 202 2

Resumo São inúmeros os benefícios comprovados do aleitamento materno, e a demanda por tal direito em saúde para as pessoas transfemininas é pouco abordada na literatura, reforçando as iniquidades em saúde. O artigo objetiva realizar uma revisão de escopo sobre a indução da lactação para pessoas transfemininas no contexto de assistência à saúde. Revisão sistemática da literatura em seis bases de dados selecionadas, buscando artigos com termos relacionados à lactação e pessoas transfemininas. Os dados foram extraídos e analisados, resumindo os principais resultados em tabelas. Foram encontrados 390 artigos. Após a exclusão dos duplicados, procedeu-se à seleção por título/resumo e posterior seleção pela leitura na íntegra, considerando os critérios de exclusão e inclusão. Foram incluídos 21 artigos, publicados entre 2018 e 2023. Entre eles, seis são relatos de casos com informações inéditas sobre o tema, e os demais são publicações em diversos formatos. A indução da lactação foi alcançada em todos os relatos de casos. Existe um corpo de evidências frágil e recente que afirma o sucesso da indução da lactação em mulheres trans. Há necessidade de respaldar essa demanda por parte dos profissionais e estudos robustos para otimizar as intervenções necessárias. materno selecionadas analisados tabelas 39 duplicados procedeuse procedeu se títuloresumo título resumo íntegra inclusão 2 201 2023 eles tema formatos trans necessárias 3 20 202

RESUMEN Objetivo: Analizar la práctica del enfermero en consultas de enfermería en salud infantil y la presencia de habilidades de gestión del cuidado propuestas para el Enfermero de Práctica Avanzada (EPA). Método: Estudio multicéntrico, método mixto secuencial exploratorio, realizado en 17 Unidades Básicas de Salud de cuatro ciudades brasileñas. La recolección se realizó de mayo a julio de 2022 mediante filmación de la consulta y análisis de historias clínicas. Se analizaron las consultas con cumplimiento ≥50% del Proceso de Enfermería para identificar las competencias propuestas para EPA. Resultados: Se filmaron 24 consultas infantiles realizadas por 12 enfermeras. En el análisis cuantitativo, 11 consultas de enfermería, realizadas por siete enfermeros, alcanzaron ≥50% de cumplimiento del Proceso de Enfermería. En el análisis cualitativo de estas consultas se identificaron algunas competencias del EPA en la gestión del cuidado, pero incompletas. Conclusión: Las consultas de enfermería en salud infantil presentan debilidades en la realización del Proceso de Enfermería, y los enfermeros demostraron una aplicación parcial y superficial de las habilidades de gestión del cuidado propuestas para el EPA. Objetivo . (EPA) Método multicéntrico exploratorio 1 brasileñas 202 clínicas 50 ≥50 Resultados 2 enfermeras cuantitativo incompletas Conclusión (EPA 20 5 ≥5 ≥

ABSTRACT Objective: To analyze nurses’ practice in child health nursing consultations and the presence of care management competencies proposed for Advanced Practice Nurses (APN). Method: Multicenter, exploratory sequential mixed methods research, carried out in 17 Basic Health Units in four Brazilian cities. Collection was carried out from May to July 2022 through filming of consultation and analysis of medical records. Consultations with compliance with the Nursing Process ≥50% were analyzed to identify the competencies proposed for APN. Results: 24 child consultations carried out by 12 nurses were filmed. In the quantitative analysis, 11 nursing consultations, carried out by seven nurses, achieved ≥50% Nursing Process compliance. In the qualitative analysis of these consultations, some APN competencies in care management were identified, but incomplete. Conclusion: child health nursing consultations present weaknesses in carrying out the Nursing Process, and nurses demonstrated a partial and superficial application of the care management competencies proposed for APN. Objective . (APN) Method Multicenter research 1 cities 202 records 50 ≥50 Results 2 filmed identified incomplete Conclusion (APN 20 5 ≥5 ≥

RESUMO Objetivo: Analisar a prática de enfermeiros nas consultas de enfermagem em saúde da criança e a presença das competências de gestão do cuidado propostas para o Enfermeiro de Prática Avançada (EPA). Método: Estudo multicêntrico, método misto sequencial exploratório, realizado em 17 Unidades Básicas de Saúde em quatro cidades brasileiras. A coleta foi realizada de maio a julho de 2022 através de filmagem da consulta e análise dos registros em prontuário. As consultas com cumprimento do Processo de Enfermagem ≥50% foram analisadas para identificar as competências propostas para EPA. Resultados: Foram filmadas 24 consultas de crianças realizadas por 12 enfermeiros. Na análise quantitativa, 11 consultas de enfermagem, realizadas por sete enfermeiros, alcançaram cumprimento ≥50% Processo de Enfermagem. Na análise qualitativa dessas consultas, algumas competências do EPA em gestão do cuidado foram identificadas, porém incompletas. Conclusão: As consultas de enfermagem em saúde da criança apresentam fragilidades na realização do Processo de Enfermagem, e os enfermeiros demonstraram uma aplicação parcial e superficial das competências de gestão do cuidado propostas para o EPA. Objetivo . (EPA) Método multicêntrico exploratório 1 brasileiras 202 prontuário 50 ≥50 Resultados 2 quantitativa identificadas incompletas Conclusão (EPA 20 5 ≥5 ≥

El uso de herramientas de la salud digital se ha intensificado en la Atención Primaria de la Salud (APS) y en las prácticas de Agentes Comunitarias de Salud (ACS). El objetivo de este artículo es analizar los desafíos impuestos por las condiciones de trabajo de las ACS en el contexto de la salud digital. Se trata de una investigación cualitativa, con triangulación de métodos, envolviendo liderazgos sindicales, gestores y profesionales de la salud. Los resultados señalan una reedición de viejos desafíos alrededor del trabajo de las ACS, tales como mayor burocratización, control, división social y técnica. Sin embargo, surgen nuevos desafíos alrededor del mantenimiento, calidad de los instrumentos y formación profesional. Se concluye demarcando la necesidad de una garantía logística, financiera y política para la implementación de la salud digital en el trabajo de las ACS.

The use of digital health tools has grown in intensity in Primary Health Care (PHC) and in the practices of Community Health Workers (CHWs). This article aims to analyze the challenges imposed by the working conditions of CHWs in the context of digital health. It is a qualitative study, with triangulation of methods involving union leaders, managers and health professionals. The results indicate the re-emergence of old challenges surrounding the work of CHWs, such as greater bureaucratization, control, social and technical division of work. However, new challenges emerge around maintenance, quality of tools and professional training. In conclusion, there is a need for logistical, financial and political safeguards for the implementation of digital health in the work of CHWs.

O uso de ferramentas da saúde digital tem sido intensificado na Atenção Primária à Saúde (APS) e nas práticas de agentes comunitários de saúde (ACS). Este artigo tem como objetivo analisar os desafios impostos pelas condições de trabalho dos ACS no contexto da saúde digital. Trata-se de uma pesquisa qualitativa com triangulação de métodos envolvendo lideranças sindicais, gestores e profissionais da saúde. Os resultados apontam uma reedição de velhos desafios em torno do trabalho dos ACS, como maior burocratização, controle, divisão social e técnica. Porém, novos desafios emergem em torno da manutenção, da qualidade dos instrumentos e da formação profissional. Conclui-se demarcando a necessidade de uma garantia logística, financeira e política para a implementação da saúde digital no trabalho dos ACS.

El uso de herramientas de la salud digital se ha intensificado en la Atención Primaria de la Salud (APS) y en las prácticas de Agentes Comunitarias de Salud (ACS). El objetivo de este artículo es analizar los desafíos impuestos por las condiciones de trabajo de las ACS en el contexto de la salud digital. Se trata de una investigación cualitativa, con triangulación de métodos, envolviendo liderazgos sindicales, gestores y profesionales de la salud. Los resultados señalan una reedición de viejos desafíos alrededor del trabajo de las ACS, tales como mayor burocratización, control, división social y técnica. Sin embargo, surgen nuevos desafíos alrededor del mantenimiento, calidad de los instrumentos y formación profesional. Se concluye demarcando la necesidad de una garantía logística, financiera y política para la implementación de la salud digital en el trabajo de las ACS. APS (APS . (ACS) cualitativa métodos sindicales burocratización control técnica embargo mantenimiento profesional logística (ACS

The use of digital health tools has grown in intensity in Primary Health Care (PHC) and in the practices of Community Health Workers (CHWs). This article aims to analyze the challenges imposed by the working conditions of CHWs in the context of digital health. It is a qualitative study, with triangulation of methods involving union leaders, managers and health professionals. The results indicate the re-emergence of old challenges surrounding the work of CHWs, such as greater bureaucratization, control, social and technical division of work. However, new challenges emerge around maintenance, quality of tools and professional training. In conclusion, there is a need for logistical, financial and political safeguards for the implementation of digital health in the work of CHWs. PHC (PHC . (CHWs) study leaders professionals reemergence re emergence bureaucratization control However maintenance training conclusion logistical (CHWs

O uso de ferramentas da saúde digital tem sido intensificado na Atenção Primária à Saúde (APS) e nas práticas de agentes comunitários de saúde (ACS). Este artigo tem como objetivo analisar os desafios impostos pelas condições de trabalho dos ACS no contexto da saúde digital. Trata-se de uma pesquisa qualitativa com triangulação de métodos envolvendo lideranças sindicais, gestores e profissionais da saúde. Os resultados apontam uma reedição de velhos desafios em torno do trabalho dos ACS, como maior burocratização, controle, divisão social e técnica. Porém, novos desafios emergem em torno da manutenção, da qualidade dos instrumentos e da formação profissional. Conclui-se demarcando a necessidade de uma garantia logística, financeira e política para a implementação da saúde digital no trabalho dos ACS. APS (APS . (ACS) Tratase Trata se sindicais burocratização controle técnica Porém manutenção profissional Concluise Conclui logística (ACS

Resumen Introducción. El sistema de producción de cacao forma parte de la agricultura colombiana en las subregiones de Montes de María y La Mojana en el departamento de Sucre. En la literatura no hay evidencia de un estudio de caracterización y tipificación del sistema de producción. Objetivo. Analizar los aspectos socioeconómicos y tecnológicos del cultivo del cacao para la subregión de los Montes de María y La Mojana, y definir grupos homogéneos de productores que compartan las mismas características que sirvan de dominio de recomendación. Materiales y métodos. Se diseñaron y aplicaron encuestas a los agricultores de la región de Montes de María y La Mojana durante el año 2019. Se seleccionaron, por muestreo determinístico, veintidós agricultores. El análisis consistió en la tipificación de los agricultores por el método de distancias y agrupamiento jerárquico de Ward. Resultados. Se obtuvieron tres grupos de agricultores. El grupo GI con nivel tecnológico bajo, la escolaridad de los agricultores fue primaria incompleta, la producción presentó bajos rendimientos (420 kg ha-1). El Grupo GII agricultores con secundaria incompleta, rendimientos más altos que los del GI (491 kg ha-1), incorporaban prácticas como podas de formación y mantenimiento. El grupo GIII con mayor nivel de escolaridad, uso de opciones tecnológicas como mejores materiales de siembra y técnicas de manejo del cultivo, obtuvieron los rendimientos más altos entre todos los agricultores (550 kg ha-1). Conclusión. Las fincas tipificadas mostraron diferencias entre los grupos y se llegó a concluir que el grupo G3 fue el que obtuvo mayor rendimiento por hectárea, lo cual se atribuyó a la incorporación de nuevas tecnologías.

Abstract Introduction. The cocoa production system is an integral part of Colombian agriculture in the subregions of Montes de María and La Mojana in the department of Sucre. There is currently no evidence in the literature regarding a characterization and typification of the study of this production system. Objective. To analyze the socio-economic and technological aspects of cocoa cultivation in the Montes de María and La Mojana subregions and define homogeneous groups of producers sharing similar characteristics that serve as recommendation domains. Materials and methods. Surveys were designed and conducted among farmers in the Montes de María and La Mojana region during 2019. Twenty-two farmers were selected through deterministic sampling. The analysis involved the typification of farmers using the distance method and Ward's hierarchical clustering. Results. Three groups of farmers were identified. Group GI exhibited a low technological level, with farmers having incomplete primary education and low yields (420 kg ha-1). Group GII consisted of farmers with incomplete secondary education, achieving higher yields than GI (491 kg ha-1) and incorporating practices like formation and maintenance pruning. Group GIII had a higher level of education, used technological options such as improved planting materials and crop management techniques, and obtained the highest yields among all farmers (550 kg ha-1). Conclusion. The typified farms displayed differences among the groups, concluding that group G3 achieved the highest yields per hectare, attributed to the adoption of new technologies.

Abstract Introduction: In the pre-hospital, nurses experience health/illness transitions in victims who present signs and symptoms of Stroke, using several instruments to perform their assessment. Subsequently, they activate the Via Verde promoting health gains for the victims. Objective: To map the instruments used to assess signs and symptoms in adult stroke victims in the pre-hospital setting. Methods: A scoping review was conducted following the method proposed by the Joanna Briggs Institute, with the following research question: Which instruments for assessing signs and symptoms in stroke victims are used by nurses in the pre-hospital setting? The selection of studies, extraction, and synthesis of data was performed by two independent reviewers. Results: The following assessment instruments are highlighted: Face Arm Speech Test (FAST), Los Angeles Prehospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Screen (MASS), Rapid Arterial Occlusion Evaluation (RACE), Los Angels Motor Score (LAMS), Cincinnati Prehospital Stroke Severity Score (CPSSS), Field Assessment Stroke Triage for Emergency Destination (FAST- ED), National Institute of Health Stroke Scale (NIHSS) and Postural Assessment Scale for Stroke Patients (PASS). Conclusion: All scales have advantages and disadvantages, translating into their specificity and sensitivity. However, primary studies in the area should be conducted to compare the existing scales, define the “most” recommended one, and explore the application of the assessment tools in different pre-hospital settings.

Resumo Introdução: No pré-hospitalar, os enfermeiros vivenciam transições de saúde/doença em pessoas vítimas que apresentam sinais e sintomas de Acidentes Vasculares Cerebrais (AVC), recorrendo a vários instrumentos para realizar a sua avaliação. Posteriormente, ativam a Via Verde AVC (VVAVC) promovendo ganhos em saúde das vítimas. Objetivo: Mapear os instrumentos de avaliação de sinais e sintomas em pessoas adultas vítimas de AVC no pré-hospitalar. Métodos: Foi realizada uma revisão scoping seguindo o método proposto pelo Instituto Joanna Briggs, com a seguinte questão de investigação: Quais são os instrumentos de avaliação de sinais e sintomas em pessoas vítimas de AVC utilizados pelos enfermeiros no pré-hospitalar? A seleção dos estudos, extração e síntese dos dados foi realizada por dois revisores independentes. Resultados: Destacam-se os seguintes instrumentos de avaliação: Face Arm Speech Test (FAST), Los Angeles Prehospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Screen (MASS), Rapid Arterial Occlusion Evaluation (RACE), Los Angels Motor Score (LAMS), Cincinnati Pre-hospital Stroke Severity Score (CPSSS), Field Assessment Stroke Triage for Emergency Destination (FAST- ED), National Institute of Health Stroke Scale (NIHSS) e Postural Assessment Scale for Stroke Patients (PASS). Conclusão: Todas as escalas possuem vantagens e desvantagens que se traduz na sua especificidade e sensibilidade. Contudo, sugere-se a realização de estudos primários na área, por forma a comparar as escalas existentes e definir a “mais” recomendada, bem como explorar a aplicação dos instrumentos de avaliação em diferentes cenários pré-hospitalares.

Resumen Introducción: En el área prehospitalaria, los enfermeros experimentan transiciones salud/enfermedad en las víctimas que presentan signos y síntomas de Ictus, utilizando diversos instrumentos para evaluarlas. Posteriormente, activan la Vía Verde, promoviendo beneficios para la salud de las víctimas. Objetivo: Mapear los instrumentos de evaluación de signos y síntomas en víctimas adultas de ictus en el ámbito prehospitalario. Métodos: Se realizó una revisión scoping siguiendo el método propuesto por el Instituto Joanna Briggs, con la siguiente pregunta de investigación: ¿Cuáles son los instrumentos de valoración de signos y síntomas en víctimas de ictus utilizados por el personal de enfermería en el ámbito prehospitalario? La selección de los estudios, la extracción y la síntesis de los datos fueron realizadas por dos revisores independientes. Resultados: Destacan los siguientes instrumentos de evaluación: Face Arm Speech Test (FAST), Los Angeles Prehospital Stroke Screen (LAPSS), Melbourne Ambulance Stroke Screen (MASS), Rapid Arterial Occlusion Evaluation (RACE), Los Angels Motor Score (LAMS), Cincinnati Pre-hospital Stroke Severity Score (CPSSS), Field Assessment Stroke Triage for Emergency Destination (FAST- ED), National Institute of Health Stroke Scale (NIHSS) e Postural Assessment Scale for Stroke Patients (PASS). Conclusión: Todas las escalas tienen ventajas e inconvenientes que se traducen en su especificidad y sensibilidad. No obstante, deberían realizarse estudios primarios en la materia para comparar las escalas existentes y definir la “más” recomendable, así como explorar la aplicación de las escalas en diferentes escenarios prehospitalarios.

Abstract This bibliographic essay seeks to explore the experiences of transgender and/or gender non-conforming (TGNC) people on the use of psychotherapy services. We begin by reviewing the state of the art of existing guidelines for psychotherapeutic intervention with this population. Followed by a bibliographic review aimed at accessing narratives of TGNC people about their psychotherapeutic processes, selecting four articles that explore a total of 70 narratives of TGNC people. We present an integrative exploration of the main findings of these researches. Finally, from a critical social constructionist positioning, some considerations for a critical psychotherapeutic practice with TGNC people are presented.

Resumo O presente ensaio bibliográfico procura refletir sobre as experiências e vivências de pessoas transgénero e/ou não-conformes de género (TGNC) em torno da utilização de serviços de psicoterapia. Começamos por enquadrar o estado de arte das linhas orientadoras existentes para a intervenção psicoterapêutica com esta população. Avançamos com uma revisão bibliográfica com objetivo de aceder a narrativas de pessoas TGNC sobre os seus processos psicoterapêuticos, selecionando quatro artigos que exploram um total de 70 narrativas de pessoas TGNC. Apresentamos uma reflexão integrativa das principais conclusões destas investigações. Por fim, são lançadas algumas considerações, baseadas num posicionamento construcionista social crítico, para uma prática psicoterapêutica crítica com pessoas TGNC.

Abstract Gender violence against women in the province of Manabí, and the rest of Ecuador, is increasingly alarming. Since 2014, when the crime of femicide was incorporated into the Comprehensive Organic Penal Code (COIP), investigations in this area have increased. In Manabí, measuring violence against women before culminating in femicide is also a task of recent academic interest. For this reason, the objective of this study is to contextualize gender violence by focusing on the patriarchal system and the socio-legal conditions administered in Ecuador. Within the framework of the figures collected by the Manabí Gender Observatory (OVIGEMA), this is qualitative research whose main findings are centered on the fact that the main types of violence that are generated in Manabí are: psychological violence, which is the type of violence with the highest registration, followed by physical violence and sexual violence, as well as violence against women is the result of the macho culture and the fragile legal system prevailing at the national level.

Resumen La violencia de género contra las mujeres en la provincia de Manabí, y el resto de Ecuador, es cada vez más alarmante. Desde el 2014 que se incorporó en el Código Orgánico Integral Penal (COIP) el delito de femicidio, han aumentado las investigaciones en esta materia. En Manabí, medir las violencias contra las mujeres antes de culminar en femicidio es, también, una tarea de reciente interés académico. Por este motivo, el objetivo del presente estudio fue contextualizar la violencia de género enfocando como causalidad el sistema patriarcal y las condiciones socio legales administradas en el Ecuador. En el marco de las cifras recolectadas por el Observatorio de violencia de género contra las mujeres y demás identidades sexo genéricas (OVIGEMA)1 , esta investigación es de tipo cualitativa cuyos principales hallazgos se centralizan en que los principales tipos de violencia que se generan en Manabí son: violencia psicológica, que es el tipo de violencia con mayor registro, seguido de la violencia física y la violencia sexual, así como también, se puede indicar que la violencia contra las mujeres es el resultado de la cultura machista y el frágil sistema legal imperante a nivel nacional.

Resumen La rápida propagación de la Covid-19 a nivel mundial generó una paralización en todos los sectores siendo el turismo el más fuertemente perjudicado, representando un reto para todos los territorios que dependen en mayor o menor medida del turismo. En este contexto, todos los sistemas turísticos tienen la obligación de incluir aspectos de seguridad por la creciente necesidad de los turistas y prestadores de servicios en percibir confianza sobre el entorno para que se puedan ejecutar las actividades dispuestas para este fin. El objetivo de la presente investigación es evaluar la percepción de seguridad de clientes hospedados en hoteles del polo turístico Pesquero en la etapa post Covid-19. La presente investigación es cuantitativa y de carácter descriptiva. Mediante encuesta que se aplicó a una muestra de 159 clientes se pudo constatar que existe una percepción positiva respecto a la seguridad sanitaria en los hoteles del destino. Los factores limpieza e higiene, asistencia médica y staff del hotel fueron las más valoradas, mientras que prevención y mitigación, tecnología y comunicación alcanzan una menor puntuación. Finalmente, se puede inferir que los hoteles del polo Pesquero del destino turístico Holguín, en la etapa de postpandemia son hoteles seguros.

Abstract The rapid spread of Covid-19 worldwide generated a paralysis in all sectors, with tourism being the most severely affected, representing a challenge for all territories that depend to a greater or lesser extent on tourism. In this context, all tourism systems have the obligation to include security aspects due to the growing need of tourists and service providers to perceive confidence in the environment so that they can carry out the activities arranged for this purpose. The objective of the present research is to evaluate the perception of security of clients staying in hotels in the Pesquero tourist pole in the post Covid-19 stage. This is a quantitative and descriptive research. By means of a survey applied to a sample of 159 clients, it was found that there is a positive perception regarding health safety in the destination's hotels. The factors cleanliness and hygiene, medical assistance and hotel staff were the most highly valued, while prevention and mitigation, technology and communication scored lower. Finally, it can be inferred that the hotels in the Pesquero pole of the Holguín tourist destination, in the post-pandemic stage, are safe hotels.