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Dementia care scholarship focuses on care challenges and less on positive aspects of care, especially among culturally and linguistically diverse (CALD) carers outside the United States. This article investigates positive aspects of dementia care across eight CALD groups in Australia.We analyzed interviews of 112 family carers using a four-domain framework covering: a sense of personal growth, feelings of mutuality, increases in family cohesion, and a sense of personal accomplishment.Positive associations with care are derived from past relationships, feelings of mutual obligation, valuing changed relationships and enjoying spending time with the person with dementia. Positive aspects of care were not associated with increased family cohesion except in Vietnamese and Arab families; neither was use of ethno-specific residential aged care, except for Greek and Italian families. Religion and spirituality as a coping and comforting mechanism was inconsistently expressed.The study reveals the multi-dimensional nature of care, what resonates, and diverges across CALD populations. Knowing which parts of the framework apply and which do not is useful for interventions seeking to enhance positive aspects of care.Migrant populations are varied and dynamic, and practitioners should be mindful of differences within and between ethnic minority groups.

40% of dementia cases can be prevented by addressing 12 lifestyle factors. These risk factors have increased presence in ethnic minorities, yet dementia prevention messages have not reached these communities. This article investigates the experience of co-designing a dementia prevention animated film with 9 ethnic groups in Australia.Evidence-based recommendations were adapted through an iterative process involving workshops with a stakeholder advisory committee and nine focus groups with 104 participants from the Arabic-, Hindi-, Tamil-, Cantonese-, Mandarin-, Greek-, Italian-, Spanish-, and Vietnamese-speaking communities. Data were analyzed using the Normalization Process Theory.Cultural adaptation involves consideration of the mode of delivery, imagery and tone of the resource being developed; ensuring cultural adequacy; anticipating the need of the end-users; and managing linguistic challenges associated with working across multiple languages.Learnings from this co-design process offer valuable insights for researchers and program developers who work with ethnic minority groups.• Adaptation across cultures and languages is a negotiation not a consensus building exercise• Linguistic adaptation requires consideration of the education levels, and linguistic and intergenerational preferences of community members• Co-designing across multiple languages and cultures risks "flattening out" key aspects of cultural specificity.

Antecedentes: el pioderma gangrenoso es una enfermedad cutánea crónica inflamatoria que pertenece a las dermatosis neutrofílicas, es poco frecuente y su patogenia es desconocida. Se caracteriza por presentar clásicamente nódulos o pústulas de aparición más común en miembros inferiores que en poco tiempo progresan a ulceración dolorosa con bordes sobreelevados, de color eritematovioláceo y fondo sucio de aspecto necrótico. El 70 % de los casos se asocia con otros trastornos sistémicos, siendo la enfermedad inflamatoria intestinal una de las más frecuentes. Caso clínico: se describe el caso de una paciente de 64 años que cursó con lesiones papulo-eritematosas en axila y glúteo con progresión a úlceras dolorosas de características típicas de pioderma gangrenoso, asociado a deposiciones sanguinolentas. Se estableció diagnóstico de colitis ulcerosa mediante histopatología de colon y de pioderma por la presencia de lesiones cutáneas típicas, con histopatología que no fue sugestiva de otra entidad. Recibió tratamiento con ciclosporina, mesalazina y prednisolona, con múltiples recaídas; finalmente, se indicó manejo con terapia biológica logrando control de la enfermedad. Conclusión: se presentó el caso de una paciente con diagnóstico de pioderma gangrenoso, con la intención de describir su evolución y características clínicas típicas, exponiendo imágenes clínicas representativas de lesiones activas y en su fase de cicatriz.

El objetivo fue valorar el capital intelectual incluyendo su ámbito jurídico en el sector hotelero en Cuba. Se desarrolló un estudio de caso, aplicando una investigación analítica, con diseño longitudinal. Se utilizó el modelo y procedimiento Vega-Rivero para la medición del capital intelectual. Además, se aplicó el método de expertos para ponderar los cálculos realizados, procesándose la información con el apoyo de Microsoft Excel 2019 y el software SPSS versión 26. Como resultado se indica que la medición del capital intelectual evidenció un aumento en 299.28 USD en el hotel objeto de estudio al compararse los dos meses estudiados. Así mismo, se rectifica la adaptación del ámbito jurídico cubano a las exigencias del entorno. Se concluye, que la medición del capital intelectual ratificó la validez modelo y procedimiento Vega-Rivero; los resultados sirven de soporte para futuros estudios enfocados a medir el capital intelectual en entidades hoteleras.

Introduction: Multiple technologies help the development of reconstructive surgical procedures in craniofacial surgery, Surgeon's perception of this type of diagnostic and treatment aids has not been widely studied. Methods and Materials: A workflow is proposed for the management of craniofacial bone defects, then the results are showed to the staff in charge for the treatment of these patients. A survey was subsequently applied, evaluating the degree of satisfaction and perception the perception of the staff regarding applicability, usefulness, impact on different process factors of treatment. Descriptive analysis was performed. Results: 30 people were interviewed: specialists, residents of surgical specialties, general practitioners, medical students. The majority did not have experience with CAD / CAM technology (77%), but considered useful (67%), the considered disadvantages were: technical difficulty, administrative procedures to access, costs, lack of information, need for specific training. The benefits were: Improvement in diagnosis and treatment accuracy, specificity, help in planning, innovation, and versatility. Discussion: Tools such as 3D printing, CAD / CAM technology, facilitate the process of anatomical understanding, planning of the surgical procedure and execution of surgery, implementing the Survey in our service we could show that the perception of the majority of the participants agrees with these data, where the impact and utility of the application of this technology in the treatment of patients is evident, both for graduate surgeons and those in training. Conclusions: The application of technologies in the practice of medicine is useful, facilitates the technical execution of the procedure precision, reduces surgical time and costs. Information and studies that evaluate the surgeon's perception regarding the applicability of CAD / CAM technology in the treatment of craniofacial bone defects are not enough, which represents a novelty of our study.

Previous research has identified numerous barriers to reporting hate crimes. However, high variability exists in the outcome measures considered across multiple studies, including whether hate crimes encompass non-criminal behaviours, whether victims’ perceptions are considered bias indicators, and whether the incident is reported to police or to other organisations. These inconsistencies prevent an understanding of whether different barriers relate to different types of hate crimes. This article presents the results of an exploratory empirical study with a convenience sample of members of minorities facing hate crime victimisation in Victoria, Australia (N = 260). Our study participants experienced different types of barriers regarding incidents with different levels of perceived severity. Internalisation and lack of knowledge were more relevant to the underreporting of incidents perceived as less serious—verbal assault. Fear of consequences, lack of trust in statutory agencies, and accessibility were more relevant to the underreporting of incidents perceived as more serious—physical violence and property destruction.

ObjectiveTo examine the patterns of care for octogenarian head and neck cancer patients.MethodsAll newly diagnosed patients aged 80 years or older, who presented at our centre between June 2018 and October 2020, were included.ResultsThe total number of patients was 42. The median Charlson Comorbidity Index was 5 (range, 4–9). The larynx was the most common subsite (n = 12). Twenty-nine patients (66 per cent) were diagnosed at disease stage IV. Squamous cell carcinoma was the most common histology (86 per cent). Twenty-six patients (62 per cent) had radical treatment and 16 (38 per cent) had palliative treatment. The estimated six-month and one-year overall survival rates for the radical and palliative treatment cohorts were 92.3 per cent and 42.9 per cent (p = 0.001) and 65.4 per cent and 15.4 per cent (p = 0.003), respectively.ConclusionThis study provides useful information on octogenarian patients with head and neck cancer. This information may help in conducting prospective studies, especially those focusing on older patients with head and neck cancer, in order to define the ideal care of this patient population.

This study presents a comprehensive bibliometric analysis of the paper published by John Aitchison in the Journal of the Royal Statistical Society. Series B (Methodological) in 1982. Having recently reached the milestone of 35 years since its publication, this pioneering paper was the first to illustrate the use of the methodology "Compositional Data Analysis" or "CoDA". By October 2019, this paper had received over 780 citations, making it the most widely cited and influential article among those using said methodology. The bibliometric approach used in this study encompasses a wide range of techniques, including a specific analysis of the main authors and institutions to have cited Aitchison' paper. The VOSviewer software was also used for the purpose of developing network maps for said publication. Specifically, the techniques used were co-citations and bibliographic coupling. The results clearly show the significant impact the paper has had on scientific research, having been cited by authors and institutions that publish all around the world The article was supported by the Spanish Ministry of Science, Innovation and Universities (grant RTI2018-095518-B-C21)

RESUMEN Diversas agencias internacionales han considerado que la acrilamida puede producir efectos dañinos en la salud de la población debido a una serie de estudios toxicológicos realizados en modelos animales, en los cuales se observan efectos cancerígenos, genotóxicos, neurotóxicos, inmunológicos y en la salud reproductiva. A pesar de la creciente preocupación en diversos países sobre los potenciales efectos en salud humana, los organismos encargados de determinar límites toxicológicos no han definido aún los límites máximos de acrilamida que pueden estar presente en los diferentes tipos de alimentos para que sean inocuos para la población. El objetivo de esta actualización es revisar las regulaciones existentes sobre la acrilamida y enfatizar la necesidad de establecer límites que la industria alimentaria pueda aplicar efectivamente, además de la necesidad de contar con valores máximos diarios tolerables para prevenir los efectos nocivos para la salud de la población.

Whether hate crime against minority groups increases or decreases over time underpins important theoretical and policy questions. However, the ability to capture trends is limited due to a dearth of data and measurement problems, especially in countries where there is no official register of hate crime. Using Chile as a case study, we compare longitudinal data from victimization surveys, registers of community organizations and mainstream media reports. The results allow us to discuss opportunities and limitations of triangulating different data sources to capture trends of hate crime. Our study results show a general increase in trends of hate crimes in Chile between 2015 and 2019, but important differences between data sources and victim groups (we consider LGBTI, migrant and Indigenous victims). We propose that the qualitative difference in the size of variation across different sources is explained by different biases of the data, which we review. This article illustrates the importance of disaggregating hate crimes because trends, correlates and key predictors often differ depending on the type of hate crime and the source of data.

In this report, we present a rare case of solid silicone implant displacement to the contralateral side after aesthetic gluteal augmentation, a phenomenon that has never been reported before in the literature. A 29-year-old woman with a history of gluteal augmentation 9 months previously and soft tissue infection presented for a consultation due to 3 days of sudden progressive pain in the right gluteus with erythema and edema, without a history of trauma. Displacement of the left gluteal implant to the right gluteal pocket was shown by magnetic resonance imaging. Because the patient refused implant removal, the decision was made to perform capsulotomy, to reconstruct the gluteal pockets, and to preserve the implants. The patient showed a satisfactory early and late postoperative course. Possible causes of this complication include poor surgical technique, with insufficient tissue preservation to keep the pockets apart, and the presence of seroma or hematoma that favored an infectious process, thereby leading to deterioration of the dissected soft tissues with dehiscence of the wound favoring the displacement of the implant.

espanolLa validez de las pruebas proyectivas en la evaluacion de victimas de abuso sexual infantil no ha sido suficientemente establecida, siendo un ambito controversial. A partir de una revision critica de la literatura disponible, el presente articulo argumenta la existencia de deficiencias en la investigacion en este campo. De este analisis se deriva una propuesta metodologica para el diseno de estudios empiricos cuantitativos que busquen establecer la validez de los instrumentos proyectivospara su uso en esta poblacion. Esta propuesta, que consideralos principios de cientificidad, la naturaleza de las tecnicas proyectivas como instrumentos psicodiagnosticos y la complejidad del fenomeno del abuso sexual, provee un modelo metodologico operacional para el desarrollo de una linea de investigacion comparable y de calidad en este campo. Finalmente, se discuten las implicancias y alcances de la propuesta formulada. EnglishThe validity of projective tests for evaluating child sexual abuse victims has not been established and remains controversial. From a critical review of available literature, the present article argues the existence of deficiencies in research in this field. From this analysis derived a methodological proposal for the design of quantitative empirical studies that seek to establish the validity of projective tests for their use with this population. This proposal, which considers the principles of scientificity, the nature of projective techniques as psychodiagnostic instruments and the complexity of the phenomenon of sexual abuse, provides an operational methodological model for the development of a comparable line of research in this field. Finally, the implications and scope of the proposal formulated are discussed.

Purpose: To Evaluate the inter-observer reproducibility of a mobile pediatric auto refractor in an infant Colombian population. Methodology: Quantitative longitudinal prospective study. Variables of age, sex, ocular history and refractive defect were measured. The sample size was estimated assuming as values of the intraclass correlation coefficient (ICC). The descriptive statistical analysis of the variables was performed and the ICC was calculated to evaluate the reproducibility of the data taken independently by two examiners. Results: 138 participants were included, median age was 42 months. 51% of the sample were females and hypermetropic astigmatism was the prevalent refractive defect with a 67.39% occurrence. The ICC for sphere, cylinder and axis, showed an almost perfect degree of agreement. Conclusions: A mobile pediatric auto refractor brings reliable data when evaluating the refractive status without cycloplegia in children aged 24-67 months. Although it is suggested to classify the refractive error as the average of three consecutive measurements and correlate the result with the clinical history of optometry to define the final formula. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/reproducibility-of-mobile-auto-refractor-measurements-in-a-columbian-children-population) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Multi-drug resistant Pseudomonas aeruginosa is a gram-negative bacillus responsible for nosocomial infections. Immunoglobulin Y (IgY) is a chicken immunoglobulin used for research, immunodiagnosis, and immunotherapy. IgY presents antimicrobial properties and it is under investigation for use as an adjunct to prophylactic therapies. The current study aimed to assess the synergistic action between anti-P aeruginosa IgY and the beta-lactams ceftazidime, imipenem, and meropenem. IgY antibodies were obtained from laying hens immunized with SPM-1 producing P. aeruginosa (Pa48

Background: The current spread of carbapenemase-producing Enterobacterales (CPE) is a great concern. Methods: We recovered 198 CPE from 162 patients admitted in our Hospital (March 2014-March 2016) during the R-GNOSIS European Project. Microbiological features and plasmid characteristics of CPE recovered from patients co-colonized with multiple CPE were studied. Findings: Thirty patients (18.5%; CI 95%= 12.5%–24.5%) presented co-colonization with multiple CPE producing the same (CPE-SC) (15.4%) or a different carbapenemase (CPE-DC) (4.3%). OXA-48 (83.3%) was the most frequent carbapenemase, followed by VIM-1 (26.7%), NDM-1 (10%) and KPC-3 (3.3%). CPE-DC-patients had longer admissions [63 days (20–107)] than the other patients. Moreover, hospital stay until CPE detection was lower [9 days (5–14)] (p = 0.0052) in CPE-SC-patients than in those with a single colonization; 56% showed co-colonization in the first positive sample, although most of them had previous admissions and had received multiple antibiotic treatments. CPE were more frequently recovered in clinical samples from co-colonized [CPE-DC (28.6%), CPE-SC (24%)] patients than from patients with a single CPE (15.2%). Among CPE-SCOXA-48 [80% (p = 0.11)], K. pneumoniae [88% (p = 0.006)] and E. coli [84% (p

Here we describe an outbreak due to NDM-1+CTX-M-15+DHA-1-producing Klebsiella pneumoniae (NDM-1-Kp) in Spain related to a patient previously admitted to a healthcare centre in an endemic area (Pakistan). Nine colonised patients were detected in the Neurosurgery ward between September 2015 and February 2016 during the R-GNOSIS European Project. NDM-1-Kp isolates from clinical samples were also recovered in three of these patients. Surveillance culture at admission was negative in the index case, but NDM-1-Kp colonisation was detected 27 days later after receiving antibiotic treatment. Co-colonisation with a second NDM-1-Kp isolate was identified in this patient 61 days post-admission. Overall length of stay (LOS = 75 days) (P0.01) and LOS until carbapenemase detection (LOS-1 = 36 days) was longer in NDM-1-Kp carriers than in patients with other carbapenemase-producing Enterobacterales. Intervention strategies were implemented after the outbreak declaration and NDM-1-Kp transmission was contained. Among the NDM-1-Kp isolates, two clones [ST437 (index case and Patient 2) and ST101 (index case and Patients 3-9)] with different IncFIB NDM-1-containing plasmids were identified. Whole-genome sequencing revealed a high content of antimicrobial resistance genes in both isolates in addition to a large number of virulence factors. Colonisation with other epidemic (OXA-48-ST11-K. pneumoniae and VIM-1-ST54-K. pneumoniae) and non-epidemic (VIM-1-ST908-K. pneumoniae and VIM-ST431-Escherichia coli) clones was also detected in two NDM-1 carriers. Implementation of adequate infection control measures and uninterrupted active surveillance programmes for detecting patients with a low colonisation status are crucial to prevent the introduction and dissemination of NDM-type enzymes in our region.

Lipase immobilization using adsorption on magnetic nanoparticles, cross-linked enzyme aggregates (CLEA), and a combination of both techniques was investigated. Experimental designs were used for the optimization of the immobilization observing that the pH and ionic strength play a principal role during the lipase immobilization and its activity. For adsorption on magnetic nanoparticles and CLEA synthesis the optimal condition was pH and 100 mM. Besides, during the CLEA synthesis, glutaraldehyde concentration showed to be a significant effect on the enzyme activity. A comparison between a magnetic CLEA prepared with (Lip@mCLEA) and without (mCLEA) biological functionalized magnetic nanoparticles was made observing that the use of functionalized support showed the best performance activity. All biocatalytic systems developed gives to the enzyme thermal stability between 45 and 70 °C, being Lip@mCLEA the more stable biocatalyst. Similar behavior was observed at different pH, where both Lip@mCLEA and mCLEA showed stability at a range of pH 5 to 8. The immobilized biocatalysts showed the same affinity of the subtract that the free enzyme suggested that the enzyme structure not modified the active site. The combination of both types of immobilization show evidenced the importance of the biological functionalization of the support when magnetic CLEA is produced.

Introducción: Analizar y describir las características óseas en pacientes con defectos óseos cráneo-faciales complejos, utilizando un software de reconstrucción tridimensional. Determinar la utilidad y aplicabilidad en el planeamiento y tratamiento quirúrgico de los pacientes. Métodos: Se realizó muestreo poblacional de pacientes con defectos óseos cráneo-faciales complejos tomando datos de historia clínica y tomografías computarizadas, determinando las características físicas y densitométricas de los huesos y realizando el análisis diagnóstico y planeación de tratamiento. Se realizó recolección de datos y posterior análisis usando el software Stata 12.0, cuantitativo y cualitativo, demostrando significancia estadística con prueba de chi2. Resultados: Se recolectó información de 50 pacientes de los cuales el 70% correspondían a hombres, la edad promedio fue de 37 años, la causa más frecuente fue traumática secundaria a accidente de tránsito, el hueso comprometido en la mayoría de los pacientes fue la mandíbula y el tamaño del defecto llego a ser hasta de 234 mm. El análisis de los pacientes con software de reconstrucción tridimensional permitió crear un algoritmo de enfoque diagnóstico y tratamiento. Se muestran algunos casos. Conclusiones: La utilidad de la implementación de tecnología CAD/CAM en el manejo de reconstrucciones óseas cráneo-faciales está demostrada, representan un alto costo para el paciente y el sistema de salud. Es posible mediante la implementación de software gratuitos y el trabajo multidisciplinario con servicios como biomedicina, diseño industrial e ingenierías, aplicar esta tecnología en pacientes, aprovechando sus beneficios en la reconstrucción de defectos complejos así como disminuyendo sus costos

En estos tiempos, la sociedad se enfrenta a una nueva realidad que ha modificado las formas y patrones de comportamientos de las personas y las organizaciones como consecuencia de la pandemia del covid-19. Esta situación ha exigido los sistemas de salud en términos de sus capacidades para responder a las necesidades del contexto. Considerando lo anterior, en este libro se exploran un conjunto de experiencias en los sistemas de salud en el contexto local como la aplicación de la psicología en el contexto clínico hospitalario, los modelos de oportunidad en la asignación de citas en el servicio de reumatología, la adherencia a guías de seguridad del paciente en el servicio de hospitalización, el conocimiento del personal profesional de medicina sobre la ruta de atención a mujeres víctimas de violencia y restablecimiento de derechos, el conocimiento de los médicos sobre el protocolo de atención e intervención en el abuso sexual en niños y adolescentes, las estrategias para asunción de diagnóstico clínico y adherencia al tratamiento médico, la ansiedad y depresión como factores de riesgo en pacientes con larga estancia hospitalaria. A partir de estas experiencias, se analizan desafíos para el mejoramiento del servicio de salud en el territorio.

Housing deprivation is a key determinant of the capacity to prevent infection and to recover from a disease because poor housing prevents adequate sheltering during a quarantine. We analyze the degree of housing deprivation faced by households in European countries when COVID-19 lockdown measures were enacted. To do so, we propose a synthetic measure that includes more dimensions than the official Eurostat indicator of severe housing deprivation. We use a fuzzy set approach to measure housing deprivation so that, unlike traditional deprivation approaches, based on a dichotomous variable, we can identify different degrees of housing deprivation for each household in the population. We find similar orderings of housing deprivation dimensions by country with the highest degree of deprivation in the living space dimension and the lowest one in the standard housing or technology deprivation dimension. Nonetheless, housing deprivation levels differ across countries, with Eastern European households being significantly more housing deprived than the rest when the lockdown began. This result shows that the effects of the lockdown on social well-being have not affected all Europeans equally and emphasizes the need for government measures that promote decent housing.

This report provides important evidence for all stakeholders involved in tackling hate in Victoria, including policy makers, law enforcement agencies and community organisations, to better understand how to address community reporting barriers.

Objective Increase in population's longevity has led to considerable efforts worldwide on physical therapy aging research. The aim of this study is to identify which are the main scientific journals, as well as the most productive authors, institutions and keywords related to the journals, that have published about physical therapy and aging. Methods Original articles published from 1990 to 2014 were retrieved from the bibliographic database Science Citation Index Expanded of Web of Science Core Collection. After standardization of the bibliographic information, a series of bibliometric indicators was obtained regarding authors, institutions, citation and keywords of the core journals using bibliometric software. The PAJEK network analysis program was used for graphic representation. Results A total of 2,237 original articles are included in this analysis. The number of identified journals is 573, with an average growth of publishing journals throughout the studied period of 9.41%. Bradford's distribution shows 12 core journals, out of which 41.67% have published constantly all throughout the 25-year period, being the most productive one Physical Therapy. Fritz, Julie M is the most productive author, and University of Sydney the most productive institution. The keyword exercise is used in an outstanding way. Conclusions The productivity trends provided an indication of the greater scientific interest of physical therapy in aging as a line of research. Collectively, the data indicated that physical therapy-specific journals are being consolidated but non-specific are still a significant research source, and that a fundamental element of their research includes exercise and movement.

Human talent in the tourism sector necessarily incorporates a global vision for quality improvement and sustainable development. Increased competition and the need to improve quality in tourism are closely linked. The objective of this work was to analyse the role of human talent. To analyse its impact on customer care and service quality in the tourism sector. An analysis and theoretical perspectives on the subject were established. Quality management was analysed as a key axis in the development of the tourism sector. Adequate management and the process that identifies the importance of the professional in the area were determined. A qualitative approach methodology was developed. The design was documentary interpretative. Bibliographic information was collected with theoretical and scientific positions. The material and content approached was based on the theories of tourism service quality. The information collected was collected globally on the web. The information was analysed using the triangulation technique. It is concluded that it is necessary to generate suitable mechanisms for tourism service quality. In addition, the work of the professional in the area must be highlighted to obtain significant achievements. These achievements are the satisfaction of the client who demands a tourist service.

Objetivo: Presentar un caso de una patología poco frecuente que puede ser causa de hipoacusia conductiva y/o neurosensorial en el adulto. Introducción: Paciente, masculino de 85 años de edad con compromiso de ambos huesos temporales con el tipo benigno del adulto de la osteopetrosis. Se presenta con hipoacusia neurosensorial bilateral de varios años de evolución, con múltiples lesiones de consistencia ósea que obstruyen la luz de los conductos auditivos externos. La tomografía computarizada simple de oídos evidencia extensos cambios hiperostósicos en los huesos temporales. Durante el seguimiento el paciente presenta aumento de la hipoacusia y disminución en la discriminación. Método: Se realiza una canaloplastia y timpanoplastia del oído derecho sin complicaciones. Resultados: El paciente evoluciona satisfactoriamente, el seguimiento a 3 años muestra un buen diámetro del conducto auditivo externo derecho, sin nuevas infecciones y con una audición estable rehabilitada con un audífono en su oído derecho. Conclusión: Este caso muestra la importancia de la observación del cuadro clínico, el adecuado tratamiento y el seguimiento juicioso para lograr buenos resultados en patologías poco frecuentes.

Objetivo. Realizar una comparación analítica sobre la efectividad, seguridad y duración de los materiales comúnmente utilizados como rellenos faciales en nuestro país. Materiales y métodos. Revisión de la literatura y lectura crítica de los artículos, desde Enero 2004 hasta Diciembre de 2007; se obtuvieron, 16 artículos, 3 series de casos y 13 revisiones de la literatura. Conclusiones No existen estudios clínicos aleatorizados, ni con diseño ciego respecto al tema en la literatura y las series de casos presentan resultados de difícil comparación con evidentes conflictos de intereses. El ácido hialurónico es el material más seguro y versátil para el relleno de labios. La grasa es más efectiva en el tercio medio facial. En el complejo fronto-glabelar los materiales evaluados presentaron resultados similares, quedando el análisis de costo-efectividad, como la variable a considerar para elegir el relleno. Importancia clínica: No existe relleno inyectable ideal para tratar los diferentes pliegues y ritidosis faciales, cada área debe ser analizada en el contexto del paciente y todos los materiales autólogos o aloplásticos demuestran resultados limitados en el tiempo.

Objetivo: Evaluar la respuesta de la inyección intratimpánica (IIT) con Metilprednisolona como manejo primario en la Hipoacusia Neurosensorial Súbita Idiopática (HNSSI). Materiales y métodos: Estudio experimental en 16 pacientes y 17 oídos, con HNSSI sometidos a IIT con Metilprednisolona como terapia primaria. Se realizó una comparación estadística, posterior a la intervención. Se utilizó prueba de rangos de Wilcoxon y análisis de varianza de Kruskal – Wallis entre los valores de PTA y el porcentaje de discriminación con las variables de sexo, edad, tipo de curva y tiempo transcurrido hasta la consulta. Resultados: Mejoría global del 58,80%, cambios significativos para mejoría del PTA (p=0.01) y para porcentaje de discriminación (p=0.03). Influencia significativa en la recuperación del PTA dependiendo de la clasificación del grado de pérdida inicial (p=0.005), y de la clasificación del tipo de curva (p=0.039). En la discriminación, se encontró efecto significativo de la clasificación del grado de pérdida inicial (p = 0,004). Conclusión: Se demuestra utilidad de la IIT con Metilprednisolona en la sordera súbita como terapia primaria.

Reconstructive surgery field is looking for sustainable alternatives on its procedures, specifically on affordable alternatives to manufacturing processes for medical devices. This paper outlines a design process to develop 3D printed medical devices for reconstructive surgery in a specific patient who had congenital, oncological or traumatic fracture cases in the face and/or skull. The implementation of the design process strategy was supported using endogenous capabilities and resources at Universidad Industrial de Santander, which could be applied in developing countries. So, this approach might offer solutions adapted to the South American population. For this reason, the research framework was a specific patient implant method, defined by modeling integration technologies, those supported by 3D virtual biomodels, computer-aided design, and rapid prototyping tools. A deep research has carried out with some surgeons within reconstructive surgery field, identifying needs and requirements for each case through an iterative process. Expected results of this paper were a workflow definition for 3D printed medical device development for a specific patient. Five cases were processed through the proposed workflow. From those cases, main identified outputs were related to devices such as implants, prosthesis surgical cutting guides, and pre-surgical planning to be performed. The proposed workflow showed strong viability implementation in future services among different academics and health facilities located in developing countries.

Introducción: El Síndrome de Apnea Hipopnea Obstructiva del Sueño es un trastorno respiratorio del sueño mayor ampliamente conocido, con importantes implicaciones para los pacientes y cuya incidencia ha venido en aumento durante los últimos años; comprende diversas manifestaciones clínicas que varían desde el ronquido hasta consecuencias cardiovasculares importantes. Objetivo: Describir la experiencia de los procedimientos quirúrgicos más utilizados para el tratamiento de pacientes con Trastornos Respiratorios del Sueño en la Clínica Rivas. Diseño: Estudio observacional descriptivo. Métodos: Revisión de 366 historias clínicas de pacientes con diagnóstico clínico y Polisomnográfico de SAHOS intervenidos quirúrgicamente debido al Trastorno Respiratorio del Sueño por rechazo de terapia de presión positiva en 3 años de observación. Resultados: Se evaluaron diferencias en medianas de los cambios del IAH, índice de Saturación de oxigeno basal y mínima, y el índice de microdespertares nocturnos tanto prequirúrgica como postquirúrgicamente. Como medida de evaluación secundaria se evaluaron las complicaciones quirúrgicas. Conclusión: En nuestra institución, como centro de referencia en apnea del sueño, la cirugía ha demostrado que disminuye de forma significativa gravedad del SAHOS y disminuye el riesgo de los pacientes con trastornos respiratorios del sueño que han rechazado el dispositivo de presión positiva.

The problem of emissions crosses the boundaries between states and is considered a global issue. In this sense, it is undeniable the responsibility attributed to cities to elaborate strategies for the mitigation of these pollutants. Considering this problem, the aim of this article is to bring a reflection about the conditions for the implementation of Low Emission Zones (LEZ)- considered a regulatory vehicle restriction measure – in order to reduce emissions locally. Therefore, from a descriptive, exploratory research based on literature review, the international experiences bring some relevant reflections for planning a LEZ: define precisely where the LEZ will be implemented; define the type of vehicle to be restricted; develop a mechanism, electronic (license plate control) or manual (vehicle labeling), to control vehicles circulating within zones; set the opening hours; set penalties and fines for drivers who do not meet the requirements for driving in the defined space; and, finally, develop strategies to manage vehicle access from other municipalities. Thus, this local public policy - LEZ - can be considered an inducer to broaden the concept of low emission transport within the cities.

Contribute to improve the coverage of statistics in the higher education and make more youngsters that have the academic merits have access to the Honduras Autonomous National University, UNAH, reason that motivated the municipal authorities of the city halls that make the Valle de Sesecapa in the western part of the country, the living forces in that zone and the Western Regional Universitary Center (CUROC), add efforts to put in functioning the Telecenter UNAH-CUROC Ocotepeque, that is currently benefiting more than 100 youngsters of that sector of the Honduran territory. The telecenter of the UNAH in Ocotepeque, has as origin the request for the creation of a Higher technological institute, that the living forces of the western zone, requested to the CUROC, as the central node of the educational web of the UNAH in the western of the country. To this initiative was added the association of city halls of Valle de Sesecapa (AMVAS). The renovation of the social commitment of the UNAH with the society, the succesful experience of the functioning of the telecenter in Gracias, Lempira, by the CUROC and the responsibility assumed by the city halls of Ocotepeque, Concepcion, Santa Fe and Sinuapa and its citizens, showed that through this experience of the telecenter of Ocotepeque, that the united effort of the academy, the local governments and the civil society assure the answers to the socioeconomic and cultural needs of the communities. In 2014, that effort is traduced in the achievement of 87 graduated youngsters of the different high schools of Ocotepeque, study in the telecenter of the UNAH in Ocotepeque the careers of degree in Pedagogy and the Technical in Microfinances, both in the virtual modality. The process and the achievements of this dream and shared work are exposed in the following article. UNAH INNOV@ No 4 2015 page 11-18

This paper analyses how the economic crisis has modified the relationship between income and material deprivation in Spain, one of the European countries most affected by the crisis. We show that the degree of overlap between low income and material deprivation has increased by around 50% from 2008 to 2012, even despite the offsetting effect of the reduction in the (relative) income poverty threshold. We demonstrate that the Great Recession has produced a significant recomposition of the poverty profile in Spain. Our findings underline the increasing role played by long-term unemployment and by differences in tenure status of households in predicting this overlap, four years after the bursting of the property bubble.

Background: QRS distortion is an electrocardiographic (ECG) sign of severe ongoing ischemia in the setting of ST-segment elevation acute myocardial infarction (STEMI). We sought to evaluate the association between the degree of QRS distortion and myocardium at risk and final infarct size, measured by cardiac magnetic resonance (CMR). Methods: A total of 174 patients with a first anterior STEMI reperfused by primary angioplasty were prospectively recruited. Pre-reperfusion ECG was used to divide the study population into three groups according to the absence of QRS distortion (D0) or its presence in a single lead (D1) or in 2 or more contiguous leads (D2 +). Myocardium at risk and infarct size were determined by CMR one week after STEMI. Multiple regression analysis was used to study the association of QRS distortion with myocardium at risk and infarct size, with adjustment for relevant clinical and ECG variables. Results: 101 patients (58%) were in group D0, 30 (17%) in group D1, and 43 (25%) in group D2 +. Compared with group D0, presence of QRS distortion (groups D2 + and D1) was associated with a significantly adjusted larger extent of myocardium at risk (group D2 +: absolute increase 10.4%, 95% CI 6.1-14.8%, p < 0.001; group D1: absolute increase 3.3%, 95% CI 1.3-7.9%, p = 0.157) and larger infarct size (group D2 +: absolute increase 10.1%, 95% CI 5.5-14.7%, p < 0.001; group D1: absolute increase 4.9%, 95% CI 0.08-9.8%, p = 0.046). Conclusions: Distortion in the terminal portion of the QRS complex on pre-reperfusion ECG in two or more leads is independently associated with larger myocardium at risk and infarct size in the setting of primary angioplasty-reperfused anterior STEMI. QRS distortion in only one lead is independently associated with larger infarct size in this setting. Our findings suggest that QRS distortion analysis could be included in risk-stratification of patients presenting with anterior STEMI.

Dada la importancia del tema relacionado a la realidad de la pandemia, se presenta el siguiente trabajo cuyo objetivo principal de esta investigación es analizar las proyecciones laborales para las trabajadoras domésticas en el contexto del COVID-19, en Ecuador y la vulneración de su trabajo. La investigación se desarrolló desde la perspectiva cuantitativa, de tipo documental, el diseño se circunscribe al bibliográfico. Dicho diseño utiliza procedimientos lógicos y mentales tales como: análisis, síntesis, deducción e inducción, mediante un análisis de contenido de normativas, leyes, informes, datos de organismo mundiales, relacionado al tema de estudio. Se concluye, que existe la necesidad de plantear alternativas con el fin proteger y tutelar los derechos de las trabajadoras domésticas, ya que la realidad que vendrá después de la pandemia seguramente será aún más complicada, por tal motivo, este sector de la sociedad debe contar con las garantías necesarias para continuar con la prestación de sus servicios.

Introduction The utility of CAD/CAM technology in the treatment of mandibular defects has been demonstrated, allowing effective analysis, diagnosis and treatment for bone defects, however the high cost and sometimes the difficult access to this technology limits its use. Materials and methods: observational descriptive cross-sectional study in which craniofacial bone defects were analyzed with emphasis at the mandibular level, with free 3D reconstruction software, determining characteristics of the population and bone defect. A management workflow is proposed and some cases analyzed are presented. Results 50 patients with craniofacial bone defects were collected over a one year period. Mandibular defects account for 44% of the total sample, the majority of cases involving more than one mandibular area; the most affected areas were the body and parasymphysis; the average bone defect size was 36mmx56 mm × 15 mm. The proposed low cost workflow allows multidisciplinary work with industrial design teams to ensure the best treatment for the patient. Conclusions It is possible to implement low-cost management of mandibular defects. The multidisciplinary work between reconstructive surgeons, industrial design and biomedical engineering is useful for the treatment of patients.

OBJECTIVES: To evaluate the moderating effect of feeding styles on the association between satiety responsiveness and child BMI z-scores in children aged 3-to-5 in Santiago, Chile. METHODS: Participants were recruited from childcare centers serving low- and middle-income families in 2017 and 2018. During a face-to-face individual interview, the Caregiver Feedings styles Questionnaire and food responsiveness subscale of the Child Eating Behavior Questionnaire were applied to parents. Weight and height were obtained for children and caregivers. Multiple linear regressions were conducted to test the moderating effect of feeding styles on the relationship between satiety responsiveness and child BMI z-scores. RESULTS: 92.5% of caregivers were mothers, the parent BMI was 29.2 (SD = 5.7). No feeding style moderated the association between satiety responsiveness and BMI z-score Satiety responsiveness had a significant main effect on child BMI z score. None of the feeding styles was significantly associated with child BMI z-score. Only satiety responsiveness was significantly associated with child BMI z score (B = –.32, P