RESUMEN Introducción: los estudiantes de medicina son propensos a recibir maltratos de sus colegas, personal administrativo y pacientes. Objetivo: determinar las características del maltrato a estudiantes de medicina del Paraguay en 2022. Metodología: se aplicó un diseño observacional, de corte transversal. Se incluyó a estudiantes de medicina, de ambos sexos, que aceptaban participar de la encuesta telemática. El muestreo fue por conveniencia. Se midieron variables demográficas. La percepción del maltrato fue evaluada según cuatro componentes (psicológico, físico, académico y sexual) utilizando el cuestionario de Munayco-Guillén F et al, previamente validado. El estudio contó con la aprobación del Comité de ética de la Universidad Privada del Este, Paraguay. Resultados: el cuestionario fue contestado por 214 estudiantes, siendo 146 mujeres (edad media 24 ± 3 años) y 68 varones (edad media 25 ± 5 años). La mayoría reside en Asunción (29,4%) y asiste a universidades privadas (92%). La media ± DE del maltrato psicológico fue 1,89 ± 1,02, la del físico fue 1,64 ± 0,89, la del académico fue 2,01 ± 1,11 y la del sexual fue 1,4 ± 0,83. Aplicando puntos de corte en los percentiles 60 y 70, el maltrato fue leve en 126 estudiantes (58,9%), moderado en 24 (11,2%) y grave en 64 (29,9%). El motivo principal para no denunciarlo fue el miedo a ser señalado por los demás o recibir represalias (17,3%). Discusión: se detectó maltrato leve en 58,9%, moderado en 11,2% y grave en 29,9% de los estudiantes de medicina. Se requiere aplicar medidas de prevención y contención de los maltratos.

ABSTRACT Introduction: medical students are prone to mistreatment from their colleagues, administrative staff, and patients. Objective: to determine the characteristics of the mistreatment of medical students in Paraguay in 2022. Method: an observational, cross-sectional design was applied. Medical students of both sexes who agreed to participate in the online survey were included. Sampling was for convenience. Demographic variables were measured. The perception of abuse was evaluated according to four components (psychological, physical, academic, and sexual) using the previously validated questionnaire by Munayco-Guillén F et al. The study was approved by the Ethics Committee of the Universidad Privada del Este, Paraguay. Results: the questionnaire was answered by 214 students, 146 being women (mean age 24 ± 3 years) and 68 men (mean age 25 ± 5 years). The majority reside in Asunción (29.4%) and attend private universities (92%). The mean ± SD of psychological abuse was 1.89 ± 1.02, physical abuse was 1.64 ± 0.89, academic abuse was 2.01 ± 1.11, and sexual abuse was 1.4 ± 0. 83. Applying cut-off points at the 60th and 70th percentiles, the abuse was mild in 126 students (58.9%), moderate in 24 (11.2%), and severe in 64 (29.9%). The main reason for not reporting it was fear of being singled out by others or receiving reprisals (17.3%). Discussion: mild abuse was detected in 58.9%, moderate in 11.2%, and severe in 29.9% of medical students. It is necessary to apply measures to prevent and contain abuse.

Abstract Urban centers have been under a new concept of city. Smart Cities are, in a nutshell, organized communities that feature high communication technology and conscious investments in sustainability, providing dynamic and safe environments. This paper presents a methodology to assess and rank Smart Cities based on a multi-criteria decision-making process. Methodologies that do not consider a pondered approach and filter for specific goals are commonly found in the literature, once there is a great number of criteria involved in these analyses. This work proposes filtering the criteria, considering each specific evaluation and its objectives. Our methodology is based on a multi-criteria analysis and uses AHP (Analytic Hierarchy Process) to support the process of weights definition and MACBAC (Multi-Attributive Border Approximation Area Comparison) in an application with compensatory characteristics. Through this study, it is possible to conduct the assessment of Smart Cities according to its multiple contexts, viz. its location, decision-makers and the objectives of the analysis. All in all, this research presents novelty related to the organization of the evaluation in accord to the expected resolution and a pondered approach with reduced number of criteria, making the analysis very straightforward.

RESUMO Objetivo: validar o protocolo de avaliação neurofuncional para Comunicação Alternativa e Ampliada. Métodos: o estudo foi realizado em quatro fases: construção do instrumento, revisão de literatura e validação clínica e avaliação do protocolo por especialistas na área a partir de um questionário interativo que circulou repetidas vezes por um grupo de especialistas até que a resposta da última rodada foi considerada de nível satisfatório de concordância, além disso, foram realizadas avaliações clínicas mediante aplicação do protocolo em crianças e adolescentes com deficiência motora em um ensaio clínico. Resultados: a análise estatística da aplicação do protocolo no setting terapêutico tem os índices Kappa para cada observador com média geral de 0,436 (concordância moderada), além do consenso entre especialistas na avaliação de conteúdo. Conclusão: a concordância entre os aplicadores e especialistas e a aplicação clínica seguindo o protocolo desenvolvido permitiu a escolha e implementação de um recurso de comunicação alternativa mais apropriado às características neuromusculares do paciente, proporcionando acesso de baixo custo, bem como permitiu identificar rapidamente as habilidades motoras que possibilitaram a intervenção fonoaudiológica.

ABSTRACT Objective: to validate the neurofunctional evaluation for Alternative and Augmented Communication protocol. Methods: the study was carried out in four steps: instrument construction, literature review, clinical validation and evaluation of the protocol by field experts, through an interactive questionnaire which was repeatedly applied, until the last set of responses was regarded as satisfactory. In addition, clinical evaluations were performed by applying the protocol in children and adolescents with motor impairment in a clinical trial. Results: statistical analysis of the protocol application in the therapeutic setting showed the Kappa indices for each observer with an overall mean of 0.436 (moderate agreement), besides the agreement among experts in content evaluation. Conclusion: agreement between the evaluators, specialists and the protocol clinical application results allowed choosing and implementing an alternative communication resource appropriate to the neuromuscular characteristics of the patient, providing a low cost access, as well as the quick identification of the motor skills that enabled the speech-language therapy.

Segundo as evidências, há uma necessidade mais profunda de avaliação e quantificação da dimensão e da forma corporal e o risco de câncer de mama (CM). Utilizando a metodologia do somatotipo, realizamos uma pesquisa original com o objetivo de explorar possíveis associações entre a forma corporal e o risco de CM nas mulheres uruguaias. Com essa finalidade, 254 casos recentes de CM e 1.000 controles emparelhados por freqüência foram entrevistadas sobre história menstrual e reprodutiva, e uma série de dobras cutâneas, circunferências e diâmetros foram medidas especificamente para se fazer o cálculo do somatotipo. Foi encontrada uma associação positiva com CM para forte endomorfismo (OR = 2.82, p < 0.001), especialmente nas mulheres premenopáusicas (OR = 4.98, p < 0.001) e com normopeso (OR = 5.12, p = 0.002); entretanto, não foram observadas diferenças para mesomorfismo e ectomorfismo. As análises apresentaram um elevado padrão meso-endomórfico na população estudada. São necessários novos estudos para confirmar os resultados presentes, obtidos em um país com elevada incidência da enfermidade.

According to the evidence, there is a need for more thorough assessment and quantification of body size and shape and the risk of breast cancer. Using the somatotype methodology, we carried out an original research in order to explore possible associations between body shape and the risk of breast cancer in Uruguayan women. With this objective, 254 recent breast cancer cases and 1,000 frequency-matched healthy controls were interviewed on menstrual and reproductive story, and a series of skinfolds, circumferences and diameters were measured specifically to calculate somatotype. A positive association with breast cancer was found for high endomorphy (Odds Ratio [OR] = 2.82, p < 0.001), mainly among pre-menopausal women (OR = 4.98, p <0.001) and normoweight women (OR = 5.12, p = 0.002), whereas almost no differences were observed for mesomorphic and ectomorphic women. Analysis showed a high meso-endomorphic pattern in the study population. Further studies are needed to confirm the present results obtained in a country with high incidence of the disease.

Segundo as evidências, há uma necessidade mais profunda de avaliação e quantificação da dimensão e da forma corporal e o risco de câncer de mama (CM). Utilizando a metodologia do somatotipo, realizamos uma pesquisa original com o objetivo de explorar possíveis associações entre a forma corporal e o risco de CM nas mulheres uruguaias. Com essa finalidade, 254 casos recentes de CM e 1.000 controles emparelhados por freqüência foram entrevistadas sobre história menstrual e reprodutiva, e uma série de dobras cutâneas, circunferências e diâmetros foram medidas especificamente para se fazer o cálculo do somatotipo. Foi encontrada uma associação positiva com CM para forte endomorfismo (OR = 2.82, p < 0.001), especialmente nas mulheres premenopáusicas (OR = 4.98, p < 0.001) e com normopeso (OR = 5.12, p = 0.002); entretanto, não foram observadas diferenças para mesomorfismo e ectomorfismo. As análises apresentaram um elevado padrão meso-endomórfico na população estudada. São necessários novos estudos para confirmar os resultados presentes, obtidos em um país com elevada incidência da enfermidade.

According to the evidence, there is a need for more thorough assessment and quantification of body size and shape and the risk of breast cancer. Using the somatotype methodology, we carried out an original research in order to explore possible associations between body shape and the risk of breast cancer in Uruguayan women. With this objective, 254 recent breast cancer cases and 1,000 frequency-matched healthy controls were interviewed on menstrual and reproductive story, and a series of skinfolds, circumferences and diameters were measured specifically to calculate somatotype. A positive association with breast cancer was found for high endomorphy (Odds Ratio [OR] = 2.82, p < 0.001), mainly among pre-menopausal women (OR = 4.98, p <0.001) and normoweight women (OR = 5.12, p = 0.002), whereas almost no differences were observed for mesomorphic and ectomorphic women. Analysis showed a high meso-endomorphic pattern in the study population. Further studies are needed to confirm the present results obtained in a country with high incidence of the disease.