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This article describes a proposed protocol for the histologic diagnosis of cutaneous melanoma developed for the National Cutaneous Melanoma Registry managed by the Spanish Academy of Dermatology and Venereology (AEDV). Following a review of the literature, 36 variables relating to primary tumors, sentinel lymph nodes, and lymph node dissection were evaluated using the modified Delphi method by a panel of 8 specialists (including 7 pathologists). Consensus was reached on the 30 variables that should be included in all pathology reports for cutaneous melanoma and submitted to the Melanoma Registry. This list can also serve as a model to guide routine reporting in pathology departments.

Resumen Introducción: La FPI es la neumonía intersticial idiopática más común, con cifras de incidencia y prevalencia que varían en el mundo por la poco uniforme manera de recolectar casos en los diferentes estudios. No hay cifras publicadas sobre la epidemiología de la FPI en Chile ni Latinoamérica. Se hace relevante conocerlas por la carga sanitaria que representan los pacientes con FPI y por la aprobación reciente de drogas antifibróticas de alto costo. El objetivo de este estudio fue realizar un registro de pacientes con FPI atendidos por neumólogos chilenos de diversos regiones del país, con los medios diagnósticos que habitualmente utilizan en la vida real. Pacientes y Métodos: Se utilizó una encuesta electrónica en línea diseñada por el grupo de enfermedades pulmonares difusas del Instituto Nacional del Tórax para registro de pacientes con diagnóstico de FPI según criterios ATS/ERS/JRS/ALAT desde junio de 2015 a junio de 2017. Resultados: 40 de los 200 neumólogos invitados enviaron casos de FPI de las 13 regiones del país, completando un total de 700 pacientes. 2/3 eran casos antiguos, un número similar de hombres y mujeres, 73% tienen patrón definitivo de UIP (Usual Interstitial Pneumonia) en tomografía axial computarizada, la mayoría eran pacientes sobre 60 años y en solo 16% se solicitó biopsia para diagnóstico. Conclusiones: Un registro de 700 casos representa un número muy importante de pacientes con FPI en Chile que nos permite acercarnos a la caracterización de la cohorte y a fortalecer una red de especialistas dedicados al cuidado de estos pacientes y sus familias.

Resumen {0>El debut de la psoriasis en la edad pediatrica, aunque generalmente leve, puede requerir tratamiento sistemico en las formas moderadas o graves de la enfermedad. Childhood-onset psoriasis generally follows an indolent course but patients with moderate or severe disease may require systemic treatment. El objetivo de este trabajo es analizar la frecuencia relativa, las caracteristicas de los pacientes, el tratamiento empleado y los eventos adversos (EA) observados a partir del registro BIOBADADERM en ninos y jovenes con psoriasis moderada-grave. The aim of this study was to determine the relative proportion of children and young people aged up to 21 years with moderate to severe psoriasis in the BIOBADADERM registry and to analyze the characteristics of these patients, treatments used, and adverse events. Del total de 3946 pacientes del registro, se incluyen 24 pacientes menores de 21 anos, con una edad media al inicio del tratamiento en BIOBADADERM de 16,1 anos y un PASI medio de 9,4. Of the 3946 patients in the registry, 24 were aged 21 years or younger.They had mean age of 16.1 years on starting treatment. When the registry was started, they had a Psoriasis Area and Severity Index of 9.4 El 67% de los pacientes estaba en tratamiento sistemico clasico al inicio del registro. and 67% were being treated with a conventional systemic drug. Treatment was discontinued in 14 patients ({0>14 pacientes (58%) suspendieron el tratamiento por perdida o falta de eficacia o por EA. 58%) due to adverse events or a loss or lack of effectiveness. En conclusion, los datos del registro BIOBADADERM muestran que los menores representan un grupo muy pequeno dentro de los pacientes con psoriasis que reciben tratamiento sistemico y son manejados mas frecuentemente con tratamientos clasicos. In conclusion, the BIOBADADERM registry shows that young people account for a small proportion of psoriasis patients receiving systemic treatment, and they are more likely to be treated using conventional systemic drugs.

Resumen Los registros de cáncer de base poblacional (RCBP) son los responsables del reporte de incidencia, mortalidad y supervivencia de los pacientes con cáncer para sus respectivas poblaciones. Los RCBP del país son definidos por la legislación colombiana como fuentes de información de los registros nacionales de cáncer para adultos y niños, pero carecen de un soporte jurídico que permita el acceso a las fuentes oficiales de información nacional y enfrentan restricciones dadas por la ley para el tratamiento de datos personales que impide la transferencia de información de los registros nacionales de cáncer y todas sus fuentes hacia los RCBP. Se analizarán los problemas de acceso a la información de estadísticas vitales del país, así como las consecuencias de estas barreras de acceso para los RCBP, y se presentarán argumentos que sustenten la necesidad de que los RCBP puedan acceder a la información necesaria para poder cumplir su objetivo. Abstract Population-based cancer registries (PBCR) are responsible for reporting incidence, mortality and survival for cancer patients in their respective populations. Colombian legislation assigned the PBCR as sources of information for the national observatory on cancer. However, the PBCR lack legal support that officially assures access to official sources of national vital statistics and information on healthcare consumption; they face restrictions provided by law for the processing of personal data that prevents the transfer of information from national cancer databases and all their sources to the PBCR. We provide analysis of the problems of access to information on vital statistics of the country and the consequences of these access barriers for the PBCR, the presented arguments illustrate the need for the PBCR to have a smooth access to such information to be able to comply with their objectives.

Background We aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures. Methods Scores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared. Results Mean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, p Conclusion Procedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.

Spain is the European country where more assisted reproduction techniques (ART) are performed, reaching 9% of newborns. The objective of this article is to introduce the legal framework and to analyze some ethical questions, not without controversy, in relation to the anonymity of gamete donors and the concealment of origin by ART from their children. Spanish legislation establishes the relative anonymity of donors: both gamete recipients and born children have the right to obtain general information about them as long as their identity is not included, but in situations of risk to the life and health of the children allows your bankruptcy. Likewise, an unequivocal right to privacy and confidentiality of submission to the TRA is established. The movement aimed at introducing in our country a legislative amendment that ends the anonymity of gamete donors is based on the right of those children to know their biological origin. Along with legal changes, the attitude of parents and professionals must gradually change towards more transparent and responsible communication, based on the experiences of adults conceived by these techniques, and those adopted. Building values such as trust and truth in the family relationships from responsibility requires placing the children, largely forgotten and the most vulnerable part, at the center of the debate. Resumen: España es el país europeo donde se realizan más técnicas de reproducción asistida (TRA), alcanzando el 9% de los nacidos. El objetivo de este artículo es introducir el marco legal y analizar algunos aspectos éticos, no exentos de controversia, en relación con el anonimato de los donantes de gametos y la ocultación del origen mediante TRA a los hijos. La legislación española establece el anonimato relativo de los donantes: tanto las receptoras de gametos como los hijos nacidos tienen derecho a obtener información general de los mismos siempre que no incluya su identidad, pero ante situaciones de riesgo para la vida y la salud de los hijos permite su quiebra. Asimismo, se determina un inequívoco derecho a la intimidad y confidencialidad del sometimiento a las TRA. El movimiento tendente a introducir en nuestro país una modificación legislativa que acabe con el anonimato de los donantes de gametos, se basa en el derecho de los nacidos a conocer su filiación biológica. Junto a los cambios jurídicos, la actitud de padres y profesionales debe ir modificándose hacia una comunicación más transparente y responsable, en función de las experiencias de los adultos concebidos por estas técnicas, y de los adoptados. Construir valores como la confianza y la verdad en el ámbito de las relaciones familiares desde la responsabilidad, requiere colocar a los hijos, grandes olvidados y parte más vulnerable, en el centro del debate.

O curso de pós-graduação lato sensu em Educação Ambiental do Instituto Federal de Educação, Ciência e Tecnologia Fluminense (IF Fluminense) completa em 2019 quinze anos de criação. Nesse período o IF Fluminense vem integrando as ações no tema nas três premissas definidas para a Universidade Federal pela Constituição Federal de 1988: ensino, pesquisa e extensão. Visando contribuir com a educação ambiental produzida neste recorte lato sensu são apresentados três produtos pelas abordagens: “Ações”, “Registro” e “Perspectivas”. Nesse sentido foram desenvolvidos respectivamente os eventos Seminário de Educação Ambiental Fluminense (SEA Fluminense) e II Mostra de Educação Ambiental do IF Fluminense campus Campos Centro (8 a 11 de julho de 2019); a produção do livro “A educação ambiental lato sensu no Instituto Federal Fluminense: quinze anos de produção acadêmica - Série Artigos – Volume 1”; e a “Carta de Educação Ambiental Fluminense – 2019”, documento final do SEA Fluminense. Considerando as diversas marcas comemorativas pelo IF Fluminense em 2019, celebrar e propor sobre a educação ambiental fortalece a relação do instituto com a sociedade pela construção de uma melhor condição socioambiental de vida.

A pesquisa teve como finalidade identificar nas publicações os registros da Caderneta de Saúde da Criança e analisar suas evidências no âmbito da atenção básica. Foi realizado um estudo de revisão integrativa de literatura, com busca realizada nas bases de dados da BVS, SCIELO, MEDLINE, LILACS e BDENF. Foram utilizados os descritores “Criança”, “Registros de Saúde Pessoal” e “Desenvolvimento Infantil”. Totalizaram-se, de todas as bases, 2.668 artigos encontrados, com a aplicação dos critérios de inclusão e exclusão, concluiu-se 698 artigos para a leitura. Logo após a leitura, finalizou-se 10 artigos para a estruturação do trabalho. Apesar da relevância da CSC, os resultados do presente estudo demonstram baixo índice no seu preenchimento, pois todos os artigos apresentaram déficit quanto a qualidade dos registros. Portanto, a educação em saúde torna-se fundamental, no intuito de orientar responsáveis e profissionais de saúde, visando maior conhecimento sobre sua importância, incentivo quanto ao seu uso adequado e treinamento para melhoria da assistência prestada à criança.

Introduction: The objective of this article was to estimate the type 1 diabetes mellitus (T1DM) incidence in the child population of the Community of Madrid (CM) and its evolution between 1997 and 2016, using the medical-administrative data of the regional registry of T1DM. Methods: T1DM cases of children under 15 years of age, reported to the regional registry or collected from secondary sources were included: Spanish Diabetics Association (1997−2013), and from 2014 on the Basic Minimum Data Set (BMDS). Annual incidence rates were estimated per 100 000 person-years. The comparison of the rates was analysed using Poisson regression models using incidence ratios (IR). Results: A total of 2658 cases were identified as new diagnoses of T1DM. The mean incidence rate for 1997−2013 was 13.7 cases per 100 000 person-years. In the 2014−2016 period, 20 cases per 100 000 persons-years were registered using the BMDS. The age group with the highest incidence was 10−14 years in the two periods (16.6 vs. 25.5). In boys, the age with the highest incidence was 10–14 years in both periods (17.9 vs 30.4), and in girls, the age of 5–9 years (17.0 vs 25.1). Incidence rates decreased slightly in both genders until 2013 (from 15.0 to 11.6). In 2014−2016, the annual incidence rate varied between 18.4 and 21.1 cases (IR: 1.77). The incidence remained stable in children under 5 years old and increased from 5 to 14 years old. Conclusions: The CM is among the regions with a high incidence of T1DM. In its first phase, the regional registry underestimated the incidence of T1DM, and with the incorporation of the MBDS as a source of information, the estimates for the second period (2014−2016) are possibly closer to the actual incidence of T1DM. The data presented suggests the need to know the real evolution of the incidence of the disease by incorporating computerised health records. Resumen: Introducción: El objetivo fue estimar la incidencia de diabetes mellitus tipo 1 (DM1) en la población infantil de la Comunidad de Madrid (CM) y su evolución entre 1997 y 2016, a partir de los datos médicos-administrativos del registro regional de DM1. Métodos: Fueron incluidos los casos de DM1 de menores de 15 años, notificados al registro regional o captados de fuentes secundarias: Asociación Diabéticos Españoles (1997−2013) y a partir de 2014 del Conjunto Mínimo Básico de Datos hospitalario (CMBDS). Se estimaron tasas de incidencia anual por 100.000 personas-año. La comparación de las tasas se analizó mediante modelos de regresión de Poisson a través de razones de incidencia (RI). Resultados: Un total de 2658 casos fueron identificados como nuevos diagnósticos de DM1. La tasa de incidencia media de 1997−2013 fue de 13,7 casos por 100.000 personas-año. En el periodo 2014−2016, utilizando el CMBDS se registraron 20,0 casos por 100.000. El grupo de edad con mayor incidencia fue el de 10−14 años en los dos periodos (16,6 vs 25,5). En los niños, la edad de mayor incidencia fue de 10 a 14 años en ambos periodos (17,9 vs 30,4) y en las niñas el de 5 a 9 años (17,0 vs 25,1). Las tasas de incidencia descendieron ligeramente en ambos sexos hasta 2013 (de 15,0 a 11,6); en 2014–2016 la tasa de incidencia anual varió entre 18,4 y 21,1 casos (RI: 1,77). La incidencia permaneció estable en menores de 5 años y aumentó de 5 a 14 años. Conclusiones: La CM se sitúa entre las regiones de alta incidencia de DM1. En su primera fase, el registro regional infraestimaba la incidencia de DM1. Con la incorporación del CMBDS como fuente de información, las estimaciones del segundo periodo (2014−2016) son posiblemente más próximas a la incidencia real de DM1. Los datos que presentamos sugieren la necesidad de conocer la evolución real de la incidencia de la enfermedad incorporando los registros digitales sanitarios.

The study of gender differences may lead into improvement in patient care. We have aimed to identify the gender differences in heart transplantation (HT) of adult HT recipients in Spain and their evolution in a study covering the years 1993–2017 in which 6740 HT (20.6% in women) were performed. HT indication rate per million inhabitants was lower in women, remaining basically unchanged during the 25‐year study period. HT rate was higher in men, although this decreased over the 25‐year study period. Type of heart disease differed in men versus women (p < .001): ischemic heart disease 47.6% versus 22.5%, dilated cardiomyopathy 41.3% versus 34.6%, or other 36% versus 17.8%, respectively. Men were more frequently diabetics (18% vs. 13.1% p < .001), hypertensives (33.1% vs. 24% p < .001), and smokers (21.7% vs. 12.9% p < .001), respectively. Women had more pre‐HT malignancies (7.1% vs. 2.8% p < .001), and their clinical status was worse at HT due to renal function and mechanical ventilation. Adjusted survival (p = .198) and most of the mortality‐related variables were similar in men and women. Death occurred more frequently in women due to rejection (7.9% vs. 5.1% p < .001) and primary failure (18.2% vs. 12.5% p < .001) and in men due to malignancies (15.1% vs. 6.6% p < .001). Sin financiación 2.863 JCR (2020) Q2, 80/211 Surgery 0.918 SJR (2020) Q2, 15/42 Transplantation No data IDR 2020 UEM

Resumen El oxígeno (O2) es una de las drogas más utilizadas en clínica, su uso no está exento de riesgos. Existen guias internacionales para su uso, pero en nuestro medio no sabemos si se aplican. Nuestro objetivo fue describir la forma en que se utiliza y controla la oxígenoterapia en los 3 hospitales de la red del Servicio de Salud Talcahuano. Aplicamos una encuesta un día de agosto de 2016 a los pacientes hospitalizados en las instituciones de la red que recibían O2 en ese momento. Se recolectaron datos sobre la prescripción, administración y seguimiento de la terapia de O2. De los 381 pacientes auditados, un 13,7% recibía oxígenoterapia. Los diagnósticos más frecuentes fueron de causa respiratoria (46,15%) y cardiológica (25%). La indicación la dio un médico en 88,5% de los casos y en un 3,8% no había registro. En un 17,3% de los pacientes no había fundamento para la indicación. Se indicó una dosis fija en el 75% con una meta de SaO2 en el 50%, siendo naricera y máscara de Venturi los métodos de administración más frecuentes monitorizándose con oximetría de pulso en los hospitales menos complejos y gasometría arterial en el hospital terciario. La duración media de la oxígenoterapia fue de 7,8 días. Habiendo un buen fundamento y control de la oxígenoterapia aún no se indican metas a obtener. No hay un buen registro de la indicación ni de los cambios realizados. Creemos útil la realización periódica de este tipo de control para optimizar su uso evitando los potenciales efectos adversos en los pacientes.

While the value of national arthroplasty registries (NAR) for quality improvement in total hip arthroplasty (THA) has already been widely reported, some methodological limitations associated with observational epidemiological studies that may interfere with the assessment of safety and efficacy of prosthetic implants have recently been described in the literature. Among the main limitations of NAR, the need for at least 80% compliance of all health institutions covered by the registry is emphasized; completeness equal or greater than 90% of all THA performed; restricted data collection; use of revision surgery as the sole criterion for outcome; and the inability of establishing a definite causal link with prosthetic dysfunction. The present article evaluates the advantages and limitations of NAR, in the light of current knowledge, which point to the need for a broader data collection and the use of more structured criteria for defining outcomes. In this scenario, the authors describe of idealization, conceptual and operational structure, and the project of implantation and implementation of a multicenter registry model, called Rempro-SBQ, which includes healthcare institutions already linked to the Brazilian Hip Society (Sociedade Brasileira de Quadril [SBQ]). This partnership enables the collection of more reliable and comprehensive data at a higher hierarchical level, with a significant reduction in maintenance and financing costs. The quality improvement actions supported by SBQ may enhance its effectiveness and stimulate greater adherence for collecting, storing, interpreting, and disseminating information (feedback). Resumo Ainda que os registros nacionais de artroplastias (RNAs) sejam um importante instrumento de controle e melhoria da qualidade da artroplastia total de quadril (ATQ), algumas limitações metodológicas associadas aos estudos epidemiológicos observacionais, que podem interferir na avaliação da segurança e eficácia dos implantes protéticos, têm sido recentemente descritas na literatura.Dentre as principais limitações destacam-se a necessidade de cobertura mínima de 80% das instituições hospitalares da região objeto do registro; integralidade mínima de 90% de todas as ATQs feitas; coleta de informações mais restritas; uso da cirurgia de revisão como critério único de desfecho e a dificuldade de se estabelecer um nexo causal com a disfunção protética.No presente artigo avaliamos as vantagens e limitações dos RNAs, à luz dos conhecimentos atuais, que apontam para a necessidade da coleta de informações mais amplas e de uso de critérios mais estruturados na definição de desfechos.Nesse cenário, descrevemos os processos de idealização, a estrutura conceitual e operacional e o projeto de implantação e implementação de um modelo de registro multicêntrico, denominado Rempro-SBQ, que inclui os centros hospitalares de treinamento em cirurgia de quadril já ligados institucionalmente à Sociedade Brasileira de Quadril (SBQ). Essa parceria possibilita, simultaneamente, a coleta de informações mais abrangentes e de elevado nível hierárquico, de forma confiável, com redução bastante significativa dos custos de manutenção e financiamento. As ações de melhoria da qualidade, amparadas pela SBQ, podem protagonizar uma condição de maior efetividade e maior adesão aos procedimentos de coleta, armazenamento, interpretação e divulgação das informações.

To compare the Latin American and European assisted reproductive technology (ART) registries regarding data accessibility and quality, treatment utilization, effectiveness, safety, and quality of services. We performed an ecological study using data from scientific publications of Latin American and European registries that report cycles initiated during 2013 (the most recent registries available until December of 2017). The summarized data are presented as frequencies, percentages, minimum-maximum values, and absolute numbers. Reporting clinics and cycle treatments were unevenly distributed between the participating countries for both registries, although access to ART is 15 times greater in Europe. In Latin America, individual services participate voluntarily reporting started cycles until cancellation, birth or miscarriage, while in Europe it varied among countries. It makes the data available from Latin America more uniform, although lesser representative when compared with European ones, given that reporting is compulsory for most countries. The cumulative live birth rate was better in Latin America. Female age, use of intracytoplasmic sperm injection (ICSI), cycles with transfer of ≥ 3 embryos, as well as multiple pregnancy rates were greater in the Latin American Register of Assisted Reproduction (RLA, in the Portuguese acronym). Assisted reproductive technology complications, such as ovarian hyperstimulation syndrome, hemorrhage, and infections were also higher in Latin America, although they are extremely uncommon in both regions. Both regions have points to improve in the quality of their reports. Latin America has produced a more uniform reporting, their clinical results are generally comparable and sometimes higher than the European ones. In contrast, the safety of the treatment was higher in Europe, with lower rates of complications, especially multiple pregnancies. Comparar os registros das técnicas de reprodução assistida da América Latina e da Europa em relação à qualidade dos dados e acesso, utilização do tratamento, efetividade, segurança e qualidade dos serviços. MéTODOS: Estudo ecológico usando os dados das publicações científicas dos registros da América Latina e da Europa com os ciclos iniciados durante o ano de 2013 (que são os dados mais recentes disponíveis até dezembro de 2017). Os dados são apresentados como porcentagens, valores mínimos e máximos e números absolutos. Em comum, vemos que o número de clínicas e de ciclos de tratamento varia bastante entre os países dentro de cada região em ambos os registros, embora o acesso às técnicas de reprodução assistida seja 15 vezes maior na Europa. Na América Latina, os serviços reportam voluntariamente os ciclos iniciados até o cancelamento, o nascimento ou aborto, enquanto que na Europa o que é reportado varia entre os países. Isso faz o registro da América Latina mais uniforme, apesar de ser menos representativo quando comparado ao Europeu, dado o caráter compulsório na maioria dos países deste último. A taxa de gravidez cumulativa, idade feminina, uso de injeção intracitoplasmática de espermatozoides (ICSI), ciclos com transferência ≥ 3 embriões e taxa de gestação múltipla foram mais elevados na América Latina. Complicações da reprodução assistida, como síndrome de hiperestimulação ovariana, hemorragia, e infecções também foram mais comuns na América Latina, embora sejam incomuns em ambas as regiões. CONCLUSãO: Ambas as regiões têm pontos a melhorar na qualidade dos registros. A América Latina tem produzido um registro mais uniforme, e seus resultados clínicos são comparáveis e, algumas vezes, superiores aos Europeus. Por outro lado, a segurança do tratamento foi maior na Europa, com menores taxas de complicações, especialmente gestações múltiplas.

Resumen Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) de los años 2016 y 2017 del Grupo NADYA-SENPE. Material y métodos: se recopilaron los pacientes introducidos en el registro del 1 de enero al 31 de diciembre de 2016 y la mismas fechas de 2017 para proceder al análisis descriptivo y analítico de los datos. Resultados: en el año 2016 se obtuvieron 4.578 pacientes activos (prevalencia = 98,33 pacientes/millón de habitantes) y en 2017 fueron 4.777 (prevalencia = 102,57). Por sexos, hubo un 50,8% de varones en 2016 y un 50,5% en 2017. En el periodo 2016-17, la edad mediana fue de 71,5 años (IIQ 57-83); asimismo, finalizaron 1.558 episodios de NED y la causa principal fue el fallecimiento (793 pacientes, 50,89%). Los varones adultos fueron más jóvenes que las mujeres (65,3 vs. 73,3 años, p-valor < 0,001) y el diagnóstico más frecuente fue la enfermedad neurológica que cursa con afagia o disfagia severa (59%). La sonda nasogástrica (SNG) fue la vía de acceso más utilizada (48,3%) y se observa, además, que esta es la vía que se utiliza en los pacientes más ancianos (p < 0,001). Se registraron 126 pacientes pediátricos (57,1% niñas). La edad mediana de inicio de la NED fue de cuatro meses. Otras patologías fue el grupo diagnóstico más registrado (41,3%), seguido por la enfermedad neurológica que cursa con afagia o disfagia severa. Se alimentaban a través de gastrostomía en el 57,6% de los casos. Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p-valor 0,001). Conclusiones: el número de pacientes del registro, así como el número de centros participantes, se va incrementando progresivamente. Las principales características de los pacientes no han variado. A pesar del aumento de posibilidades diagnósticas en la población pediátrica, llama la atención la clasificación dentro del grupo de Otras patologías.

Over the last thirty years, there have been various and increasing efforts made to establish effective and consistent public service interpreting and translation. Good progress has been made but there are impasses. This paper attempts to stand back and look objectively at where, and more importantly how, we might proceed from here. This could be said to be a turning point for legal interpreting for two reasons. Firstly, enough time has elapsed for us to copy our scientific colleagues, who view the process of exploring and eliminating unsatisfactory approaches overtly, so that what does not work is recognised and discarded. Secondly, this process of exploration has enabled us to clarify and define what does work in order to focus our energies and take matters forward., A lo largo de estos últimos treinta años se han producido diversos y crecientes esfuerzos para establecer unos servicios de traducción e interpretación en los servicios públicos que fuesen eficaces y coherentes. Aunque se han realizado importantes progresos, existe cierto estancamiento. Este artículo pretende alzar la vista y proporcionar una visión objetiva sobre hacia dónde, pero sobre todo cómo se puede proceder a partir de este momento. Cabría decir que la interpretación judicial se encuentra en un punto de inflexión por dos razones. En primer lugar, ha transcurrido tiempo suficiente para ser capaces de imitar a nuestros colegas científicos, que abordan de manera abierta el proceso de evaluación y eliminación de planteamientos insatisfactorios, identificando y descartando lo que no funciona. En segundo lugar, este proceso de exploración nos ha permitido aclarar y definir lo que sí funciona con el fin de centrar bien nuestras energías y avanzar.

Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) del año 2014 y 2015 del Grupo NADYA-SENPE. Métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2014 y la mismas fechas de 2015, y se procedió al análisis descriptivo y analítico de los datos. Resultados: en el año 2014, se registraron 3.749 pacientes y en 2015, 4.202; la prevalencia fue de 80,58 pacientes/millón de habitantes en el año 2014 y de 90,51 en 2015. Por sexos, hubo un 49,9% de mujeres en 2014 y un 50,3% en 2015. La edad media fue de 73 años (IIQ 59-83) en ambos años. Finalizaron 684 episodios de NED en 2014 y 631 en 2015, la causa principal fue el fallecimiento en el 54,9% y 50,4% de los casos, respectivamente. Los portadores de sonda nasogástrica presentan una edad media superior a los pacientes con cualquier otra vía (p < 0,001). Se registraron 67 pacientes pediátricos en 2014 (56,7% niñas) y 77 en 2015 (55,8% niñas). La vía principal de administración fue la gastrostomía en el 52,0% de los casos de 2014 y sonda nasogástrica en el 50,8% de los casos de 2015. La causa principal de fi nalización de la nutrición fue el fallecimiento (57,1% en 2014 y 38,5% en 2015). Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p 0,004 vs. 0,002).Tanto en pacientes pediátricos como en adultos el diagnóstico principal que motivó la necesidad de NED fue la enfermedad neurológica que cursa con afagia o disfagia severa. Conclusiones: se ha incrementado el número de pacientes del registro, así como el número de centros participantes y el número medio de pacientes comunicados por cada centro respecto a años anteriores, sin que se hayan modificado sustancialmente las características de los pacientes, salvo mayor duración de los episodios, Objective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015. Methods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes fi nished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sisty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes fi nished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia. Conclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any signifi cant change in the characteristics of the patients other than longer duration of the episodes

Objetivo: Algunos estudios observacionales han comunicado una paradójica menor utilización de la estrategia invasiva precoz (EIP) en los pacientes con síndrome coronario agudo sin elevación de ST (SCASEST) de alto riesgo. Los objetivos del estudio son: 1) Examinar la asociación entre el riesgo basal de los pacientes con SCASEST y el uso de una EIP en la práctica clínica actual, y 2) identificar algunos de los factores asociados de forma independiente con el uso de EIP. Diseño: Estudio de cohortes retrospectivo. Ámbito: Unidades de cuidados intensivos participantes en el registro ARIAM-SEMICYUC. Pacientes: Pacientes consecutivos ingresados con diagnóstico de SCASEST de menos de 48 horas de evolución entre los meses de abril-julio de 2010. Intervenciones: Ninguna. Variables principales: Realización de coronariografía con o sin angioplastia en las primeras 72 horas, estratificación del riesgo mediante la escala GRACE. Resultados: Se analizaron 543 pacientes con SCASEST, de los cuales 194 eran de bajo riesgo, 170 de riesgo intermedio y 179 de riesgo alto. La EIP se utilizó en el 62,4% de los pacientes de bajo riesgo, el 60,2% de los de riesgo intermedio y el 49,7% de los de riesgo alto (valor de p para la tendencia 0,0144). La EIP se utilizó de forma preferente en pacientes con baja gravedad y comorbilidad. En el modelo de regresión logística, la EIP se asoció de forma directa con la disponibilidad de laboratorio de hemodinámica (OR 2,22, [intervalo de confianza (IC) del 95% 1,55 a 3,19], la presencia de cambios de ST en el ECG (OR 1,80 [1,23 a 2,64]) y la existencia de un bajo riesgo hemorrágico (OR 0,76 [0,66 a 0,88]). Por el contrario, la EIP se asoció de forma negativa con la presencia de diabetes (OR 0,60 [0,41 a 0,88]) o de taquicardia al ingreso (OR 0,54 [0,36 a 0,82]). Conclusiones: En el año 2010, persiste una menor utilización relativa de la EIP en los pacientes de alto riesgo, debido en parte al mayor riesgo hemorrágico de estos pacientes. Objective: Observational studies have reported a paradoxical inverse relationship between the use of an early invasive strategy (EIS) and the risk of events in patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS). The study objectives are: 1) to examine the association between baseline risk in patients with NSTE ACS and the use of EIS; and 2) to identify some of the factors independently associated to the use of EIS. Design: Retrospective cohort study. Setting: Intensive care units participating in the SEMICYUC ARIAM Registry. Patients: Consecutive patients admitted with a diagnosis of NSTE-ACS within 48hours of evolution between the months of April-July 2010. Interventions: None. Main outcomes: Coronary angiography with or without angioplasty within 72hours, risk stratification using the GRACE scale. Results: We analyzed 543 patients with NSTE-ACS, of which 194 were of low risk, 170 intermediate risk and 179 high risk. The EIS was used in 62.4% of the patients at low risk, in 60.2% of those with intermediate risk, and in 49.7% of those at high risk (p for tendency 0.0144). The EIS was used preferentially in patients with low severity and comorbidity. In the logistic regression model, EIS was independently associated to the availability of a catheterization laboratory (OR 2.22 [CI 95% 1.55 to 3.19]), the presence of ST changes on ECG (OR 1.80 [1.23 to 2.64]), or the existence of a low risk of bleeding (OR 0.76 [0.66 to 0.88)]. Conversely, EIS was less prevalent in patients with diabetes (OR 0.60 [0.41 to 0.88]) or tachycardia upon admission (OR 0.54 [0 36 to 0.82]). Conclusions: In 2010 there remained a lesser relative use of EIS in patients at high risk, due in part to an increased risk of bleeding in these patients.

Resumen Objetivo Algunos estudios observacionales han comunicado una paradojica menor utilizacion de la estrategia invasiva precoz (EIP) en los pacientes con sindrome coronario agudo sin elevacion de ST (SCASEST) de alto riesgo. Los objetivos del estudio son: 1) Examinar la asociacion entre el riesgo basal de los pacientes con SCASEST y el uso de una EIP en la practica clinica actual, y 2) identificar algunos de los factores asociados de forma independiente con el uso de EIP. Diseno Estudio de cohortes retrospectivo. Ambito Unidades de cuidados intensivos participantes en el registro ARIAM-SEMICYUC. Pacientes Pacientes consecutivos ingresados con diagnostico de SCASEST de menos de 48 horas de evolucion entre los meses de abril-julio de 2010. Intervenciones Ninguna. Variables principales Realizacion de coronariografia con o sin angioplastia en las primeras 72 horas, estratificacion del riesgo mediante la escala GRACE. Resultados Se analizaron 543 pacientes con SCASEST, de los cuales 194 eran de bajo riesgo, 170 de riesgo intermedio y 179 de riesgo alto. La EIP se utilizo en el 62,4% de los pacientes de bajo riesgo, el 60,2% de los de riesgo intermedio y el 49,7% de los de riesgo alto (valor de p para la tendencia 0,0144). La EIP se utilizo de forma preferente en pacientes con baja gravedad y comorbilidad. En el modelo de regresion logistica, la EIP se asocio de forma directa con la disponibilidad de laboratorio de hemodinamica (OR 2,22, [intervalo de confianza (IC) del 95% 1,55 a 3,19], la presencia de cambios de ST en el ECG (OR 1,80 [1,23 a 2,64]) y la existencia de un bajo riesgo hemorragico (OR 0,76 [0,66 a 0,88]). Por el contrario, la EIP se asocio de forma negativa con la presencia de diabetes (OR 0,60 [0,41 a 0,88]) o de taquicardia al ingreso (OR 0,54 [0,36 a 0,82]). Conclusiones En el ano 2010, persiste una menor utilizacion relativa de la EIP en los pacientes de alto riesgo, debido en parte al mayor riesgo hemorragico de estos pacientes.

O estudo tem como objetivos identificar o fluxo de preenchimento das Declarações de Nascidos Vivos (DNs) e analisar a consistência das informações contidas nas mesmas. Para a coleta de dados utilizou-se uma DN-Controle, preenchida com base nas informações contidas nos prontuários do recém-nascido e da mãe, as quais foram comparadas com os dados contidos na DN-Oficial, disponível no Departamento de Informática da Secretaria Municipal da Saúde de Ribeirão Preto. A amostragem constitui-se de 911 DNs dos nascimentos ocorridos no mês de julho de 1996. Da análise dos dados verificou-se que o fluxo de preenchimento da DN é heterogêneo entre os hospitais, envolvendo desde o pediatra até a escriturária, e às vezes, funcionários administrativos. Em relação à consistência das informações, identificou-se uma concordância elevada, acima de 90% em 13 das 18 variáveis comparadas nas DNs e em metade dos hospitais investigados; a discordância ocorreu, principalmente, naquelas informações referentes ao número de filhos tidos, número de consultas pré-natal, grau de instrução da mãe e nome do pai.

INTRODUÇÃO: A evolução tecnológica tem permitido ampliar a indicação da intervenção coronária percutânea (ICP) para cenários clínicos e angiográficos mais desafiadores. Nosso objetivo foi avaliar os resultados da ICP em dois diferentes períodos, nos últimos 6 anos. MÉTODOS: Registro multicêntrico no qual 6.288 pacientes consecutivos tratados por ICP foram divididos por períodos de tratamento: 2006 a 2008 (P1; n = 1.779) e 2009 a 2012 (P2; n = 4.509). Buscamos comparar as taxas de eventos cardíacos e cerebrovasculares adversos maiores (ECCAM) hospitalares e identificar seus preditores. RESULTADOS: Pacientes do Grupo P2 mostraram ser mais jovens, com maior prevalência de tabagismo e diabetes. Esses pacientes mostraram maior acometimento de múltiplos vasos, maior número de lesões trombóticas e lesões em bifurcações. A relação de vasos tratados/paciente foi maior no Grupo P2, assim como a relação stent/paciente e a utilização de stents farmacológicos. ECCAM foi mais frequente no Grupo P2 (2,5% vs. 3,5%; P = 0,04), às custas do infarto periprocedimento (1,7% vs. 2,6%; P = 0,05), não havendo diferenças quanto a óbito (1,0% vs. 1,0%; P = 0,87), acidente vascular cerebral (0,2% vs. 0,1%; P = 0,47) ou cirurgia de revascularização de emergência (0,1% vs. 0; P = 0,68). Idade (odds ratio - OR - de 1,02; intervalo de confiança de 95% - IC 95% - de 1,00-1,05; P = 0,04) e Killip III/IV (OR = 6,03, IC 95%; 3,39-10,90; P < 0,01) foram as variáveis que melhor explicaram a presença de ECCAM. CONCLUSÕES: Nessa grande coorte, mudanças substanciais ocorreram nas características de pacientes tratados por ICP nos últimos 6 anos. O cenário mais complexo associou-se a discreto aumento de infartos periprocedimento, mas não a outros eventos adversos clínicos hospitalares. BACKGROUND: Technological developments have enabled the expansion of percutaneous coronary intervention (PCI) indications for more challenging clinical and angiographic scenarios. Our objective was to evaluate the results of PCI in two different periods in the past 6 years. METHODS: This was a multicenter registry including 6,288 consecutive patients treated by PCI, who were divided according to different treatment periods: 2006 to 2008 (P1; n = 1,779) and 2009 to 2012 (P2; n = 4,509). We intended to compare the rates of in-hospital major adverse cardiac and cerebrovascular events (MACCE) and identify their predictors. RESULTS: P2 patients were younger and had a higher prevalence of smoking and diabetes. These patients had a greater rate of multivessel, thrombotic and bifurcation lesions. The number of diseased vessels per patient was higher in the P2 Group, as well as the number of stents per patient, and the use of drug-eluting stents. MACCE was more frequent in P2 patients (2.5% vs. 3.5%; P = 0.04), due to periprocedural myocardial infarction (1.7% vs. 2.6%; P = 0.05), and there were no differences in terms of death (1.0% vs. 1.0%; P = 0.87), stroke (0.2% vs. 0.1%; P = 0.47) or emergency coronary artery bypass grafting (0.1% vs. 0; P = 0.68). Age (odds ratio - OR - 1.02; 95% confidence interval - CI 95% - 1.00-1.05; P = 0.04) and Killip III/IV (OR = 6.0, 95% CI; 3.3-10.9; P < 0.01) were the variables that best explained the presence of MACCE. CONCLUSIONS: In this large cohort, substancial changes occurred in the characteristics of patients treated by PCI in the last 6 years. This more complex scenario was associated to a slight increase of periprocedural myocardial infarctions, but not to other in-hospital clinical adverse events.

Resumen Objetivos Conocer la capacidad informativa del registro, calcular, en personal sanitario y poblacion general, las tasas de incidencia de accidente con exposicion a fluidos biologicos, conocer la tasa postaccidental de seroconversion al virus de la inmunodeficiencia humana (VIH) e identificar grupos de riesgo. Metodos Se realizo un estudio descriptivo del fichero VIH del Registro de Contactos Accidentales con Fluidos Biologicos del Hospital Clinico de Zaragoza, entre enero de 1987 y septiembre de 1993. En el se registran las declaraciones de trabajadores sanitarios y de la poblacion general del Area III de Salud de Aragon, exceptuando el Hospital de Calatayud. Se calcularon tasas de incidencia, razones de tasas (RT) y sus intervalos de confianza al 95%. Resultados Se declararon 595 accidentes, en ninguno de los cuales aparecio posteriormente infeccion por VIH. La tasa de incidencia en personal sanitario fue de 1,7 declaraciones por 100 trabajadores al ano y en la poblacion general de 8,1 por 100.000. El grupo con mayor incidencia fue el personal de limpieza (RT= 6,7; IC 95%: 3-14,8) y el tipo de accidente mas declarado fue la herida percutanea con aguja. Conclusiones La incidencia de accidentes declarados ha aumentado, tanto en la poblacion general como en el personal sanitario, lo cual puede deberse a un incremento en las declaraciones. La magnitud de la incidencia en personal sanitario, en 1993 se encuentra en el rango de las obtenidas en otros paises. La percepcion de riesgo es universal ante accidentes con fluidos biologicos desconocidos. La accion preventiva mas importante debe ser la eliminacion correcta del material contaminado con fluidos biologicos.

El registro de la valoración de una herida es la documentación escrita y fotográfica de su evolución y conlleva un proceso de observación, recolección de datos y evaluación. Con el avance de la informática, se han implementado diversos sistemas de registro electrónico en el área del cuidado de las heridas. La presente revisión de literatura tiene por objetivo describir la utilidad de los registros electrónicos como herramienta de apoyo en el área de la valoración de las heridas. Se realizó una exhaustiva revisión de literatura, de las bases de datos COCHRANE LIBRARY MEDLINE, PUBMED, PROQUEST NURSING & ALLIED HEALTH SOURCE. Se incluyeron artículos publicados desde el año 1998 hasta el 2010. Dentro de los principales resultados se desprende que el contar con una óptima documentación de valoración de las heridas es fundamental debido a razones clínicas, legales, de investigación, de docencia, de administración de recursos materiales y humanos y de comunicación con los diferentes miembros del equipo de salud. Existen variados beneficios en la utilización del uso del sistema de registro electrónico (SRE), sin embargo, no existe consenso si el SRE o el sistema de registro manual es la mejor manera de registrar las actividades de enfermería. Se recomienda la creación de un formato electrónico amigable, contando con la participación de profesionales relacionados al área de la informática, junto a profesionales de enfermería, para definir en forma exacta lo que debe registrarse en la valoración de las heridas. The wound assessment record, is the written and photographic documentation of their development and involves a process of observation, data collection and evaluation. With the advance of computer technology, have implemented various electronic record systems in the area of wound care. This literature review aims to describe the usefulness of electronic records as a support tool in the assessment area of the wounds. We conducted a thorough review of literature, the COCHRANE LIBRARY databases MEDLINE, PUBMED, Proquest NURSING & ALLIED HEALTH SOURCE. Articles published from 1998 to 2010. Among the main results suggest that having an excellent documentation of assessment of injury, is essential due to medical reasons, legal, research, teaching, administration and human resources and communication with different members of health team. There are many benefits in using the use of electronic registration system (ERS), but there is no consensus whether the ERS or the manual registration system is the best way to record the activities of nursing. We recommend creating a user-friendly electronic format, with the participation of professionals working in the area of information technology, along with nursing professionals to define exactly what should be recorded in the assessment of injuries.

O presente estudo caracterizou o perfil dos pacientes com queixas e/ou alterações vocais atendidos de julho de 2003 a dezembro de 2006 no ambulatório de fonoaudiologia do Hospital das Clínicas da Universidade Federal de Minas Gerais de acordo com as variáveis idade, sexo, profissão, escolaridade, procedência, tratamento realizado e fatores interferentes na evolução do atendimento. Trata-se de um estudo retrospectivo baseado na análise dos dados dos prontuários, coletados de acordo com protocolo especialmente elaborado. Os resultados apontaram que os indivíduos estudados eram predominantemente mulheres jovens, encaminhadas para o atendimento fonoaudiológico por um médico especialista, procedentes de Belo Horizonte, sem uma ocupação profissional e com ensino fundamental incompleto. O atendimento fonoaudiológico aconteceu de forma individual e quase metade dos pacientes recebeu alta. Os indivíduos mais idosos, com disfonia funcional ou psicogênica e com voz do tipo neutra ou soprosa apresentaram correlação com alta fonoaudiológica. Os indivíduos mais jovens e com disfonia organofuncional tiveram correlação estatística com o desligamento do serviço. Os sujeitos que evoluíram para abandono não apresentaram correlação com as variáveis cruzadas. This study set out to describe the profile of the patients with voice complaints and/or alterations who were attended between July 2003 and December 2006 at the speech therapy outpatient unit of "Hospital das Clínicas da Universidade Federal de Minas Gerais." This was analyzed according to age, sex, profession, schooling, origin, treatment performed and factors that interfere in medical care evolution. This was a retrospective study based on the analysis of the recorded data of the individuals according to a specifically prepared Protocol. The results showed that the individuals included in this study were predominantly young women, referred by a specialist from Belo Horizonte, who do not work and also have incomplete elementary school education. Attendance of those patients was on an individual basis, and almost half of them were discharged by the speech therapist. The elderly patients, who have functional or psychogenic dysphonia and a neutral or wheezy type of voice, showed a close correlation with the discharge rate by speech therapist. The younger individuals with organo-functional dysphonia bore a statistical correlation with abandoning treatment. The individuals who eventually abandoned treatment did not bear any correlation with the crossed variables.

Nas últimas décadas, a eficácia e a segurança dos stents não-farmacológicos (SNF) e dos stents farmacológicos (SF) têm sido demonstradas em muitos ambientes clínicos diferentes, levando ao seu uso em mais de 75% de procedimentos no mundo todo. Comparados aos SNF, os SF mostraram menores taxas de reestenose angiográfica e revascularização do vaso-alvo. Esse benefício foi inicialmente demonstrado em estudos que excluíram pacientes com lesões mais complexas, tais como aquelas com vasos mais calibrosos ou finos, oclusão crônica, lesões bifurcadas, reestenose de stent, lesões longas e do tronco da coronária esquerda. Essa população do "mundo real" tem sido recentemente avaliada em muitos registros e meta-análises que são aqui revisados. over the last decades the efficacy and safety of bare metal (BMS) and drug eluting stents (DES) have been demonstrated in many different clinical scenarios, leading to their use in more than 75% of the procedures worldwide. Compared to BMS, DES have shown lower rates of angiographic restenosis and target-vessel revascularization. This benefit was initially demonstrated in trials that excluded patients with more complex lesions, such as those with larger or smaller vessels, chronic total occlusions, bifurcation lesions, stent restenosis, long lesions and left main coronary artery disease. This real-world population has been recently evaluated in many registries and meta-analyses that are reviewed herein. En las últimas décadas, la eficacia de la seguridad de los stents no-farmacológicos (SNF) y de los stents farmacológicos (SF) ha sido demostrada en muchos ambientes clínicos diferentes, llevando a su uso en más de 75% de los procedimientos en todo el mundo. Comparados a los SNF, los SF mostraron menores tasas de reestenosis angiográfica y revascularización del vaso a tratar. Ese beneficio fue inicialmente demostrado en estudios que excluyeron a pacientes con lesiones más complejas, tales como aquellas con vasos más dilatados o finos, oclusión crónica, lesiones bifurcadas, reestenosis de stent, lesiones largas y del tronco de la coronaria izquierda. Esa población del "mundo real" ha sido recientemente evaluada en muchos registros y meta-análisis que son aquí revisados.

La investigación se realizó con el objeto de comparar los registros de control y los indicadores de resultados obtenidos en sistemas de producción de ganadería de doble propósito (SPGDP) de la parroquia Libertad del municipio Machiques de Perijá, estado Zulia, Venezuela. Se utilizó una muestra de 64 fincas (32% de la población) seleccionadas por un muestreo aleatorio estratificado con afijación proporcional. Con un cuestionario validado, se tomó información social, técnica y gerencial del sistema, codificada posteriormente en una matriz de datos. La técnica estadística utilizada fue la distribución de frecuencias absolutas, relativas y porcentuales. Los resultados obtenidos permitieron describir las características del SPGDP, así mismo, los registros de control de las actividades ejecutadas y los indicadores reproductivos, técnicos, productivos y económicos de estos sistemas. En el uso de los registros se muestran poco confiable y sistematizado, lo que genera dificultad en la actualización de los mismos y un proceso de control poco satisfactorio; se manifiesta un nivel de improvisación evidente entre el corto plazo de las metas y la evaluación. Dentro de los indicadores de desempeño estudiados se tiene: Intervalo entre parto de 408,2 días; duración de la lactancias de 239,7 días; edad al destete de 249,2 días; edad al primer parto de 35,4 meses; vida útil de reproductores de 5,56 años; carga animal promedio de 0,9 U.A/ha en aquellos sistemas que emplean registros y 0,8 U.A/ha en sistemas que no usan registros. Los indicadores de desempeños están referidos a la producción de leche y carne dependiendo del número de establecimientos y las actividades de cría, levante y ceba. Los resultados indican que los productores que utilizan registros presentan mejores índices técnicos, productivos y económicos que aquellos que no los utilizan. En efecto, aquellos productores observan la importancia al proceso de control a las diferentes actividades ejecutadas en el manejo de estos sistemas. The research was realized in order to compare obtained control registers and results indicators in dual purpose cattle productions systems (SPGDP) at Libertad Parish on Machiques of Perijá Municipality in Zulia State, Venezuela. It was used a sample of 64 farms (32% of population). They were selected through a stratified random sample with proportional fixation. It was taken through a validated questionnaire social, technical and management information which was codified in a data matrix. It was used as statistical technique, absolute, relative and percentage frequency distribution. The obtained results allowed to describe SPGDP characteristics, also, performed activities control registers and reproductive, technical, productive and economical systems indicators. When the registers are used they look with little reliability and systematized, which has generated difficulty to update them and a control process non satisfactory; there is an evident improvisation level between goals and evaluation. 408.2 days in calving interval, 239.7 days in lactation length, 249.2 days in weaning age, 35.4 months in the first calving age, 5.56 years at sire longevity, 0.9 UA / ha at animal average load were performance studied indicators in systems that use registers and 0.8 UA/ ha in systems where registers are not used. Performance indicators are milk and meat production which depends on the number of establishments and raising, growth and fatten calf activities. The results indicate that those producers that use registers have better technical, productive and economic rates than the other ones who don’t use them. In fact those producers observe the importance about control activities in different performanced activities in all these systems operations. 89-100 dioneljsu@hotmail.com mariaelenapena2006@hotmail.com urdanet@hotmail.com Bimestral

La investigación se realizó con el objeto de comparar los registros de control y los indicadores de resultados obtenidos en sistemas de producción de ganadería de doble propósito (SPGDP) de la parroquia Libertad del municipio Machiques de Perijá, estado Zulia, Venezuela. Se utilizó una muestra de 64 fincas (32% de la población) seleccionadas por un muestreo aleatorio estratificado con afijación proporcional. Con un cuestionario validado, se tomó información social, técnica y gerencial del sistema, codificada posteriormente en una matriz de datos. La técnica estadística utilizada fue la distribución de frecuencias absolutas, relativas y porcentuales. Los resultados obtenidos permitieron describir las características del SPGDP, así mismo, los registros de control de las actividades ejecutadas y los indicadores reproductivos, técnicos, productivos y económicos de estos sistemas. En el uso de los registros se muestran poco confiable y sistematizado, lo que genera dificultad en la actualización de los mismos y un proceso de control poco satisfactorio; se manifiesta un nivel de improvisación evidente entre el corto plazo de las metas y la evaluación. Dentro de los indicadores de desempeño estudiados se tiene: Intervalo entre parto de 408,2 días; duración de la lactancias de 239,7 días; edad al destete de 249,2 días; edad al primer parto de 35,4 meses; vida útil de reproductores de 5,56 años; carga animal promedio de 0,9 U.A/ha en aquellos sistemas que emplean registros y 0,8 U.A/ha en sistemas que no usan registros. Los indicadores de desempeños están referidos a la producción de leche y carne dependiendo del número de establecimientos y las actividades de cría, levante y ceba. Los resultados indican que los productores que utilizan registros presentan mejores índices técnicos, productivos y económicos que aquellos que no los utilizan. En efecto, aquellos productores observan la importancia al proceso de control a las diferentes actividades ejecutadas en el manejo de estos sistemas. The research was realized in order to compare obtained control registers and results indicators in dual purpose cattle productions systems (SPGDP) at Libertad Parish on Machiques of Perijá Municipality in Zulia State, Venezuela. It was used a sample of 64 farms (32% of population). They were selected through a stratified random sample with proportional fixation. It was taken through a validated questionnaire social, technical and management information which was codified in a data matrix. It was used as statistical technique, absolute, relative and percentage frequency distribution. The obtained results allowed to describe SPGDP characteristics, also, performed activities control registers and reproductive, technical, productive and economical systems indicators. When the registers are used they look with little reliability and systematized, which has generated difficulty to update them and a control process non satisfactory; there is an evident improvisation level between goals and evaluation. 408.2 days in calving interval, 239.7 days in lactation length, 249.2 days in weaning age, 35.4 months in the first calving age, 5.56 years at sire longevity, 0.9 UA / ha at animal average load were performance studied indicators in systems that use registers and 0.8 UA/ ha in systems where registers are not used. Performance indicators are milk and meat production which depends on the number of establishments and raising, growth and fatten calf activities. The results indicate that those producers that use registers have better technical, productive and economic rates than the other ones who don’t use them. In fact those producers observe the importance about control activities in different performanced activities in all these systems operations.

A pesquisa Mortalidade Perinatal na Região Sul do Município de São Paulo: Um Estudo Caso-controle de Base Populacional possibilitou a comparação das informações das declarações de nascido vivo (DN) com as obtidas em entrevistas com as mães e o registro nos prontuários hospitalares, e permitiu avaliar diferenças de registro nos nascimentos que resultaram em óbitos neonatais precoces (casos) e sobreviventes (controles). Para avaliar a confiabilidade e validade das informações das DN foram utilizadas medidas de concordância, sensibilidade, especificidade, prevalências real e estimada. A paridade materna e presença de anomalias congênitas mostraram elevada ausência de registro. O peso ao nascer e o tipo de parto são bem identificadas pela DN, em casos e controles. A DN mostrou alta sensibilidade e especificidade para captar os nascimentos de pré-termo nos casos, contudo, subestima o número de nascimentos de pré-termo: 30,8% nos controles e 2,9% nos casos. O SINASC superestima em cerca de duas vezes a presença de nascimentos de mães de baixa escolaridade. Verificou-se que as DNs dos controles têm informações mais completas, porém a informação registrada para os casos apresenta melhor qualidade. The information recorded on birth certificates was validated with data from a perinatal mortality case-control study, obtained from home interviews of mothers and hospital records for cases (early neonatal deaths) and controls. Sensitivity, specificity, and concordance were calculated for all variables and their estimated and real prevalence. The completeness of birth certificates was lowest for mother's parity and presence of congenital anomalies (records without information range from 23% to 31% for cases and controls). Birth certificates correctly identified low birth weight and type of delivery for cases and controls. Birth certificates showed high sensitivity and specificity to detect preterm births within cases. The number of preterm births was underestimated at 30.8% of the controls and 2.9% of the cases. Low maternal education was two times greater on birth certificates than in the mother's interview, for cases and controls. Completeness of birth certificates was higher in controls, but data quality was better in cases.

Disease surveillance has a century-long tradition in public health, and environmental data have been collected at a national level by the U.S. Environmental Protection Agency for several decades. Recently, the Centers for Disease Control and Prevention announced an initiative to develop a national environmental public health tracking (EPHT) network with "linkage" of existing environmental and chronic disease data as a central goal. On the basis of experience with long-established disease surveillance systems, in this article we suggest how a system capable of linking routinely collected disease and exposure data should be developed, but caution that formal linkage of data is not the only approach required for an effective EPHT program. The primary operational goal of EPHT has to be the "treatment" of the environment to prevent and/or reduce exposures and minimize population risk for developing chronic diseases. Chronic, multifactorial diseases do not lend themselves to data-driven evaluations of intervention strategies, time trends, exposure patterns, or identification of at-risk populations based only on routinely collected surveillance data. Thus, EPHT should be synonymous with a dynamic process requiring regular system updates to a) incorporate new technologies to improve population-level exposure and disease assessment, b) allow public dissemination of new data that become available, c) allow the policy community to address new and emerging exposures and disease "threads," and d) evaluate the effectiveness of EPHT over some appropriate time interval. It will be necessary to weigh the benefits of surveillance against its costs, but the major challenge will be to maintain support for this important new system. Key words: environmental health, evaluation, intervention, registries, surveillance.

[Resumen] Introducción y objetivos. Los datos sobre el manejo de los pacientes con infarto agudo de miocardio (IAM) que llegan a un hospital en España no garantizan la exhaustividad en el registro. El objetivo de este trabajo es conocer las características y el manejo de los pacientes con IAM que llegan a todos los hospitales de distintas áreas de 8 comunidades autónomas españolas. Métodos. El estudio IBERICA es un registro poblacional de IAM entre 25 y 74 años de edad realizado en ocho comunidades autónomas españolas. Para este trabajo se incluyeron los casos de IAM que llegaron vivos al hospital durante 1997. Se recogen las características, tratamiento y evolución a los 28 días del episodio. Se realizó un análisis descriptivo y se calculó el coeficiente de variación. Resultados. Se registraron 4.041 casos de IAM: el 79,9% eran varones y la edad media fue de 61,1 años. El 10,9% (IC del 95%: 9,9-11,9%) no ingresaron en una unidad de cuidados intensivos cardiológicos, existiendo una gran variabilidad entre las zonas (coeficiente de variación del 53%). Existe también una gran variabilidad en la realización e indicación de técnicas diagnósticas y terapéuticas invasivas y no invasivas, así como en el tratamiento farmacológico empleado: únicamente la utilización de antiagregantes (91,5%) Y trombólisis (41,8%) presenta un coeficiente de variación < 10%. La letilidad a los 28 días fue del 16,2% (IC del 95%: 15,1-17,4%) con un coeficiente de variación del 20,6%. Conclusión. Las características de los pacientes varían entre las zonas estudiadas. Las diferencias geográficas en el manejo y pronóstico sugieren que puede existir desigualdades en la atención al enfermo con IAM en España. [Abstract] Introduction and objective. Although some in-hospital studies have described the management of acute myocardial infarction (MI) patients in Spain, none has been able to guarantee the exhaustiveness of patient registry. This study sought to determine the clinical characteristics and in-hospital management of patients with MI in eight Spanish population registries. Methods. The IBERICA study is a population-based MI registry carried out in the 25 to 74 year-old population, in eight Spanish regions in 1997. A standardized methology was used to register and investigate all MI arriving alive to a hospital. Clinical characteristics, cardiovascular risk factors prevalence, pharmacological treatment, invasive and non- invasive procedures performed and complications at 28 days of evolution were recorded. A descriptive analysis was performed and the variation coefficient (VC) was calculated. Results. In 1997, 4,041 MI patients were registered, 79.9% were men with a mean age of 61.1 years. Although 10.9% (95% CI: 9.9-11.9%) were not admitted to the coronary care unit, a large variability existed among different areas (VC = 53%). There was a high variability in the utilization and performance of non-invasive and invasive procedures among regions, as well as in the use of pharmacological treatment. Only the use of antiaggregants (91.5%) and thrombolytic theraphy (41.8%) showed a low variability (VC < 10%). Twenty-eight day mortality was 16.2% (95% el: 15.1-17.4%) with a high variability being observed among the different regions (VC = 20.6%). Conclusion. Patient characteristics vary among the different Spanish regions. The differences in management and prognosis suggest a lack of equality in the health care provided to MI patients in the different regions in Spain.

Record linkage is a powerful tool in assembling information from different data sources and has been used by a number of public health researchers. In this review, we provide an overview of the record linkage methodologies, focusing particularly on probabilistic record linkage. We then stress the purposes and research applications of linking records by focusing on studies of infant health outcomes based on large data sets, and provide a critical review of the studies in Brazil.

Os acidentes nas indústrias de processo químico representam um sério problema para a Saúde Pública. Além de afetar os próprios trabalhadores, têm o potencial de afetar populações vizinhas e causar danos ambientais. A partir de uma ação de vigilância em saúde do trabalhador envolvendo diversos órgãos públicos, analisam-se, aqui, as causas de 800 eventos ocorridos em uma refinaria de petróleo no Estado do Rio de Janeiro (Brasil), no ano de 1997, e que resultaram em lesões em trabalhadores diretos e terceirizados, perdas ou parada da produção, danos à equipamentos e materiais e conseqüências sobre o meio ambiente. Na metodologia utilizada, adotaram-se abordagens que privilegiam os aspectos gerenciais e organizacionais na origem dos acidentes, sendo utilizado como referência o sistema de registro de acidentes em indústrias perigosas utilizado pela União Européia. A partir dos resultados, verifica-se que há limites na investigação e registro dos acidentes, bem como uma nítida hierarquização pela empresa, caracterizada por uma menor atenção aos trabalhadores terceirizados e pela realização de melhores registros para os eventos que afetam diretamente a produção. Accidents in the chemical industry can have serious consequences for workers, communities, and the environment and are thus highly relevant to public health. This article is the result of an occupational surveillance project involving several public institutions. We analyze 800 work-related accidents that resulted in injuries, environmental damage, or loss of production in 1997 in an oil refinery located in Rio de Janeiro, Brazil. The methodology was based on managerial and organizational approaches to accident investigation, with the European Union reporting system as the reference. The results highlight various limitations in the process of reporting and investigating accidents, as well as a certain hierarchy of accidents, with more attention given to accidents involving loss of production and less to those resulting in injuries, particularly among outsourced workers.

ObjetivoCuantificar la prevalencia de cáncer y su distribución en adultosDiseñoEstudio descriptivo de prevalencia de punto mediante investigación de Fuentes primarias y secundariasEmplazamientoAtención primaria. Área de Salud Guadalajara (133.539 pacientes mayores de 14 años)ParticipantesPacientes previamente diagnosticados de cáncer con tarjeta sanitaria en junio de 1999 en el área de saludMedicionesDatos demográficos y del diagnóstico (localización según CIE-9, fecha y método diagnóstico). Fuentes de datos: historias clínicas de atención primaria, registros de morbilidad y de cáncer y órdenes de asistencia. Se calcularon las tasas globales, crudas y ajustadas, en función del sexo y grupo de edad, y específicas por localizaciones. Se compararon con datos de otros estudios y los estimados para España basándose en datos de la Organización Mundial de la SaludResultadosSe estudiaron 2.717 tumores (2.595 pacientes). La edad media de los pacientes fue de 68,2 años (IC del 95%, 67,6-68,7), y la edad de diagnóstico, de 62,8 (IC del 95%, 62,1–63,5), ambas superiors en varones (p < 0,01). Los tumores más frecuentes fueron los de próstata, vejiga, colon y pulmón en los varones, y los de mama, colon, endometrio y ovario en las mujeres. La prevalencia cruda fue de 2.303,8/100.000 para los varones y de 1.763,8 para las mujeres; la prevalencia ajustada a la población mundial fue de 1.394,2 y 1.227,4/100.000, respectivamente (razón de prevalencia: 1,14; IC del 95%, 1,03-1,25). La tasa truncada fue mayor en mujeres que en varones (1.638/100.000 frente a 1.308). El quinquenio con mayor prevalencia fue 75-79 años en varones (8.763,5/100.000) y 80-84 en mujeres (4.558,7/100.000)ConclusionesLa prevalencia de cáncer en adultos es ligeramente superior al 2%. Los valores, una vez ajustados por edad, son similares a los de otros estudios y esperables para nuestro país. Los tumors más prevalentes se localizan en el aparato digestivo, mama y genitourinario. La proporción varón/mujer es superior a la descrita en otros estudiosObjectiveTo quantify the prevalence of cancer and its distribution in adultsDesignDescriptive study of point prevalence through research into primary and secondary sourcesSettingPrimary care, Guadalajara Health Region. 133 539 people over 14 years oldParticipantsPatients previously diagnosed with cancer, who had a health card in the health area in June 1999MeasurementsDemographic and diagnostic details (location according to CIE-9, date and diagnostic method). Data sources: primary care clinical records, cancer morbidity records and attendance orders. Overall crude and adjusted rates, in function of sex and age group, and specific to locations, were calculated. They were compared with data from other studies and data calculated for Spain on the basis of WHO informationResults2717 tumours (2595 patients). Mean age, 68.2 (95% CI, 67.6–68.7); diagnostic age, 62.8 (95% CI, 62.1–63.5), in both cases higher in men (P

BackgroundTechnological developments have enabled the expansion of percutaneous coronary intervention (PCI) indications for more challenging clinical and angiographic scenarios. Our objective was to evaluate the results of PCI in two different periods in the past 6 years.MethodsThis was a multicenter registry including 6,288 consecutive patients treated by PCI, who were divided according to different treatment periods: 2006 to 2008 (P1; n=1,779) and 2009 to 2012 (P2; n=4,509). We intended to compare the rates of in-hospital major adverse cardiac and cerebrovascular events (MACCE) and identify their predictors.ResultsP2 patients were younger and had a higher prevalence of smoking and diabetes. These patients had a greater rate of multivessel, thrombotic and bifurcation lesions. The number of diseased vessels per patient was higher in the P2 Group, as well as the number of stents per patient, and the use of drug-eluting stents. MACCE was more frequent in P2 patients (2.5% vs. 3.5%; P=0.04), due to periprocedural myocardial infarction (1.7% vs. 2.6%; P=0.05), and there were no differences in terms of death (1.0% vs. 1.0%; P=0.87), stroke (0.2% vs. 0.1%; P=0.47) or emergency coronary artery bypass grafting (0.1% vs. 0; P=0.68). Age (odds ratio – OR – 1.02; 95% confidence interval – CI 95% – 1.00-1.05; P=0.04) and Killip III/IV (OR=6.0, 95% CI; 3.3-10.9; P