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Progress in palliative care (PC) necessarily involves scientific development. However, research conducted in South America (SA) needs to be improved.To develop a set of recommendations to advance PC research in SA.Eighteen international PC experts participated in a Delphi study. In round one, items were developed (open-ended questions); in round two, each expert scored the importance of each item (from 0 to 10); in round three, they selected the 20 most relevant items. Throughout the rounds, the five main priority themes for research in SA were defined. In Round three, consensus was defined as an agreement of ≥75%.60 potential suggestions for overcoming research barriers in PC were developed in round one. Also in Round one, 88.2% (15 of 17) of the experts agreed to define a priority research agenda. In Round two, the 36 most relevant suggestions were defined and a new one added. Potential research priorities were investigated (open-ended). In Round three, from the 37 items, 10 were considered the most important. Regarding research priorities, symptom control, PC in primary care, public policies, education and prognosis were defined as the most relevant.Potential strategies to improve scientific research on PC in SA were defined, including stimulating the formation of collaborative research networks, offering courses and workshops on research, structuring centers with infrastructure resources and trained researchers, and lobbying governmental organizations to convince about the importance of palliative care. In addition, priority research topics were identified in the region.

El objetivo del estudio fue analizar las directrices de la Responsabilidad Social Universitaria y su ejecución en las Instituciones de Educación Superior (IES) mediante la aplicación de una revisión sistemática para la referenciación de varias perspectivas y habilidades prácticas de desarrollo que mejoren su competitividad. El método PRISMA fue aplicado para la reconstrucción teórica de las fuentes bibliográficas alternas. Se ejecutaron bajo parámetros sistemáticos que reunieron evidencias para la presentación de informes en un corte histórico de 10 años. Los resultados demostraron una tendencia a los enfoques humanista (experiencias reales), pedagógico (guías sistemáticas en enseñanza), ético y socio-curricular (orientan la praxis y exigencias ético-morales del trabajo en la vida diaria), con diversidad de estrategias para múltiples actores. Se concluyó que, el entorno de responsabilidad social es un campo que posee limitaciones de desarrollo conceptual, puesto que, los artículos analizados poseen sesgos empíricos y se limitan a sustentar el eje conceptual.

There is limited knowledge about inequalities regarding palliative care access among patients with intellectual disability. The present scoping review aimed to identify the existing barriers that limit access to palliative care (PC) in patients with intellectual disability.We conducted a literature review on publications since 2014 from three databases (MEDLINE, Biomed Central, and Elsevier Scopus), along with hand searches in scientific journals. The review included peer-reviewed studies written in English and Spanish language with quantitative and qualitative study designs. The participants were patients with intellectual disability and health professionals who had worked with them or had experience in palliative care.22 studies met the selection criteria. The barriers identified were under referral to palliative care, reduced access, communication, and limited knowledge and experience by health professionals.Patients with intellectual disability do not get referred to PC frequently. Health professionals and caregivers do not recognize when it is necessary to make a referral, and they need to improve their communication abilities. Also, health care workers need more training in PC, pain management, anticipation of death, and use of opioids. More research and education on the palliative care needs and care for patients with intellectual disabilities is needed.

Promoting healthy lifestyles is one way to be and keep healthy. When the individual itself recognizes strengths in its self-management, this can be identified as an approach to change or improve eating behaviors and physical activity in adolescents. The objective of this research is to determine the effect of a multi-component intervention, “Promoting health in Adolescents”, in the BMI and the cognitions related to specific conducts: perception of barriers, benefits and self-efficacy, related to nutrition and physical activity in enrolled adolescents with overweight / obesity in Colombia. This is a quasi-experimental study with an intervention (n= 48) and a control group (n=50), pre-trial, post-trial and follow-up (at 2 and 4 months) measurements. The intervention “Promoting health in Adolescents” was offered to the intervention group. The control group received the annual education activity. The study has the endorsement of the ethics committee of the Universidad Nacional de Colombia and the school rectors, and consent and informed assent forms were signed. When comparing the groups after the intervention, there is a difference in the variables Body Mass Index (p=0,000), physical activity (p=0,042) and nutrition (p=0,010). After the intervention, the BMI decreased in the intervention group: 43,8% passed from overweight to normal and obesity decreased from 10,4% to 8,3%. The size of the effect was moderate with a value of 0,571 and were not sustained over time. These results support the approach of the healthy habit modification program in schools.

La educación rural ha enfrentado desafíos en los últimos años, relacionados con dificultades de acceso de la población a la escuela y escasa o nula conexión a las redes de información, los cuales se evidenciaron con mayor fuerza en época de pandemia. Este artículo es resultado de la investigación doctoral Rol parental y educación en tiempos de pandemia. Experiencias en una escuela unitaria del medio rural de Pensilvania. Caldas – Colombia. En él se muestran los trabajos investigativos que establecen una relación entre educación rural, tecnología, pandemia, constructivismo y rol parental. Se abordaron 50 estudios de diversas fuentes entre 2017 y 2021. La metodología se basó en el análisis documental descrito por Quintana y Montgomery, y se abordó el estado de arte por niveles, donde se hizo el estudio de las investigaciones internacionales, luego las latinoamericanas y por último las nacionales y regionales. En el análisis de las investigaciones se tuvo como hallazgo que, en muchos países, especialmente en las zonas rurales, la población enfrenta problemas de conexión a internet, dificultades en infraestructura y equipos tecnológicos, lo que ha obstaculizado la continuidad de la vida cotidiana, la cobertura y la calidad de la educación en tiempos de covid-19.

Objetivo: esta revisión describió el desarrollo de los cuidados paliativos en Latinoamérica basado en la educación, disponibilidad de opioides, investigación, políticas públicas e implementación de servicios. Metodología: se realizó una búsqueda de los artículos publicados en las bases de datos PubMed, Scopus, Ovid Medline, Lilacs, Google Scholar, y se aplicó un límite temporal de 10 años. Se seleccionaron 33 referencias bibliográficas. Resultados: el número de publicaciones que se identificaron dedicadas al desarrollo de cuidados paliativos en Latinoamérica fue escaso. Pese a que los resultados evidenciaron un crecimiento de los cuidados paliativos, reflejado en las políticas de salud pública, educación, disponibilidad de opioides e implementación de los servicios en todos los niveles de atención, además de la investigación y creación de asociaciones regionales, persistió la inequidad entre los países. No existen políticas de salud en cuidados paliativos, en algunos casos, o no se pusieron en marcha. La disponibilidad de servicios para brindar la atención a la población fue insuficiente y persistió la dificultad del acceso a opioides para el alivio de síntomas. No se logró el compromiso de la academia para masificar la educación de pregrado y posgrado, y la investigación no contó con apoyo y financiamiento. Conclusiones: el desarrollo de los cuidados paliativos en Latinoamérica es aún escaso e irregular, por lo que es necesario seguir sensibilizando a los tomadores de decisiones de políticas públicas a nivel nacional, personal sanitario, organismos internacionales, ONG nacionales e internacionales y comunidad para lograr el crecimiento deseado.

El presente artículo producto de investigación, aborda la evaluación desde la perspectiva de los docentes que perdieron la Evaluación con Carácter Diagnóstica Formativa y que realizaron el curso Evaluación con Carácter Diagnostica Formativa ECDF en la Universidad Católica de Pereira en el año 2017, con el propósito de analizar las concepciones en dos momentos; antes de iniciar el curso y al finalizar el mismo. Metodología: El estudio que se implementó fue de tipo Mixto; la unidad de análisis la componen 109 docentes matriculados en la Universidad Católica de Pereira para el Curso Evaluación con Carácter Diagnostica Formativa ECDF de los cuales se identificaron 72 relatos. Resultados: Al realizar el análisis se evidencia como existe una transformación en las concepciones de los docentes, en los que se tiene en cuenta las concepciones antes de iniciar el curso y perder la ECDF, y después de finalizar este proceso de formación y aprobar el curso ECDF teniendo en cuenta las teorías explícitas e implícitas.

Spiritual care is an essential part of quality palliative care. However, the literature regarding spiritual care competencies in Latin America is limited. Herein we propose the basic quality standards for spiritual care in palliative care according to best professional practices and provide a common vocabulary and required competencies for quality clinical spiritual care. Both elements, quality standards and a common vocabulary, are part of an essential step implementing continuous educational initiatives among interdisciplinary palliative care teams in Latin America. Members of the Spirituality Commission of the Latin American Association for Palliative Care and three members of independent professional palliative care organizations identified and reviewed our proposed spiritual care competencies and created a consensus document describing the competencies for general spiritual care. In the context of palliative care in Latin America, general spiritual care is provided by members of interdisciplinary teams. We proposed six competencies for high-quality general spiritual care and their observable behaviors that every member of an interdisciplinary palliative care team should have to provide quality clinical spiritual care in their daily practice: (I) personal, spiritual, and professional development; (II) ethics of spiritual care; (III) assessment of spiritual needs and spiritual care interventions; (IV) empathic and compassionate communication; (V) supportive and collaborative relationships among the interdisciplinary team; and (VI) inclusivity and diversity.

Introducción. El cáncer es uno de los problemas de salud pública más graves a nivel mundial. A pesar de los tratamientos y avances tecnológicos, continúan presentándose elevadas cifras de infecciones en los pacientes oncológicos. La enfermería cumple un papel fundamental al prevenir el riesgo de infección que conllevan las diferentes medidas terapéuticas utilizadas. El control de las Infecciones Asociadas a la Atención en Salud (IAAS) es imprescindible, dado que se considera la labor del cuidado permanente de la enfermera. El objetivo del presente artículo es el de realizar una búsqueda de literatura sobre las principales estrategias de control para la prevención de infecciones en pacientes oncológicos. División de los temas tratados. Se realizó una búsqueda en las bases de datos Medline, Pubmed, Ebsco, Scielo y Clinicalkey entre el 2011 y el 2018 con el propósito de encontrar información sobre la prevención de infecciones en pacientes oncológicos. Se expone la definición, epidemiología y las diferentes formas de control en la prevención de infecciones en pacientes oncológicos, clasificando tales medidas preventivas en generales y específicas. Conclusiones. La literatura científica ofrece una gran variedad de recomendaciones para la prevención de infecciones en pacientes oncológicos. Se pueden minimizar los riesgos a través de la implementación de estrategias que demuestren evidencia científica como es la nutrición y las medidas de higiene. Cómo citar: Bonilla-Marciales AP, Chávez-Cañas WO, Hernández-Mogollón RA, Ramón-Jaimes NA. Estrategias de prevención y control de las infecciones en pacientes oncológicos. MedUNAB. 2019;22(3):356-368. doi: 10.29375/01237047.3376 Introduction. Cancer is one of the most serious global public health problems. Despite the treatments and technological advances, cancer patients continue to present high rates of infection. Nursing plays an essential role in preventing the risk of infection brought by the different therapeutic measures used. Control of Health Care-Associated Infections (HAIs) is essential, because it is considered part of the ongoing care work of nurses. The aim of this article is to conduct a literary review of the main control strategies for the prevention of infections in cancer patients. Division of Covered Topics. A search was conducted in the Medline, Pubmed, Ebsco, Scielo and Clinicalkey databases between 2011 and 2018 to find information about the prevention of infections in cancer patients. The definition, epidemiology and different control methods in the prevention of infections in cancer patients are described, classifying these preventive measures as general or specific. Conclusions. The scientific literature offers a great variety of recommendations for the prevention of infections in cancer patients. The risks can be minimized through the implementation of strategies supported by scientific evidence, such as nutrition and hygiene measures. Cómo citar: Bonilla-Marciales AP, Chávez-Cañas WO, Hernández-Mogollón RA, Ramón-Jaimes NA. Estrategias de prevención y control de las infecciones en pacientes oncológicos. MedUNAB. 2019;22(3):356-368. doi: 10.29375/01237047.3376 Introdução. O câncer é um dos mais graves problemas de saúde pública em todo o mundo. Apesar dos tratamentos e avanços tecnológicos, uns grandes números de infecções em pacientes oncológicos continuam a ocorrer. A enfermagem desempenha papel fundamental na prevenção dos riscos de infecção associados às diferentes medidas terapêuticas utilizadas. O controle das Infecções Associadas aos Cuidados de Saúde (IACS) é essencial, uma vez que é considerada a função de cuidado permanente do enfermeiro. O objetivo deste artigo é realizar uma pesquisa bibliográfica sobre as principais estratégias de controle para a prevenção de infecções em pacientes oncológicos. Divisão dos tópicos discutidos. Foram realizadas buscas nas bases de dados Medline, Pubmed, EBSCO, ScIELO e Clinical Key no período de 2011 a 2018 com o objetivo de encontrar informações sobre a prevenção de infecções em pacientes oncológicos. Apresentam-se a definição, epidemiologia e as diferentes formas de controle na prevenção de infecções em pacientes oncológicos, classificando essas medidas preventivas em geral e específica. Conclusão. A literatura científica oferece uma ampla variedade de recomendações para a prevenção de infecções em pacientes oncológicos. Os riscos podem ser minimizados através da implementação de estratégias que demonstram evidencia científica como a nutrição e as medidas de higiene. Cómo citar: Bonilla-Marciales AP, Chávez-Cañas WO, Hernández-Mogollón RA, Ramón-Jaimes NA. Estrategias de prevención y control de las infecciones en pacientes oncológicos. MedUNAB. 2019;22(3):356-368. doi: 10.29375/01237047.3376

Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium, 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.

Introducción: El diario de campo o diario reflexivo, es una herramienta útil en la valoración del aprendizaje de los estudiantes en áreas de la salud, no solamente de los procesos o procedimientos realizados a las personas enfermas, sino de aquellos aspectos integrales para la formación personal y profesional. Métodos: Investigación cualitativa, descriptiva, de análisis de contenido realizado entre 2018 y 2019 con 54 estudiantes de VII semestre del programa de enfermería en el servicio de cirugía de un Hospital de tercer nivel en la ciudad de Ibagué, a los cuales se les entrego un formato de diario de campo para diligenciar cada día de acuerdo a la asignación diaria. La información se analizó en software ATLAS Ti versión 6. Resultados: Los resultados se presentan en una red semántica que comprende 5 categorías emergentes así: adquisición de habilidades y reforzamiento de conceptos, concepto del campo de práctica, autocorrección, reflexiones del cuidado, actitudes del docente y personal de salud. Conclusiones: Los estudiantes consideran que el diario reflexivo es una herramienta importante para valorar la práctica diaria y sugieren se utilice en otros espacios de aprendizaje, pueden identificar y describir los aspectos relacionados no solo con los procedimientos sino con aspectos relacionados con el campo de práctica, el acompañamiento docente, el apoyo del personal del servicio, entre otros.

Background: The current mental health state of healthcare professionals and students during the COVID-19 pandemic in Ecuador remains understudied and how to improve their mental health is a challenge.Objective: This study aimed to explore the anxiety and depressive symptomatology among healthcare students and professionals in Ecuador and to examine the role of psychological inflexibility, loneliness, and psychological stress as predictors of anxiety and depression symptoms.Methods: A total of 191 undergraduate and graduate healthcare students in clinical practice (early-career healthcare professionals) in Ecuador were surveyed between January and March 2021 using standardized measures of psychological stress (PSS), psychological inflexibility (AAQ), loneliness (UCLA), alcohol consumption (AUDIT-C), and anxiety and depressive symptomatology (PHQ). Macro Process for SPSS (models 4 and 7) were used to test mediation effects.Results: Alcohol consumption varied between men and women and anxiety and depression symptomatology was generally low among the sample. Psychological inflexibility and loneliness mediated the impact of stress on anxiety and depressive mood in participants, regardless of gender and previous personal history of COVID-19.Discussion: Implications of psychological inflexibility and the prevention and coping with stress in healthcare professionals during COVID-19 are further discussed.

Advanced Chronic Kidney Disease (ACKD) supposes a public health problem in Ecuador that requires a comprehensive approach. In view of the scarcity of studies on the subject in this country, the objective of this research was to determine the signs and symptoms associated with the patients’ physical, social and psychological spheres that allow properly developing palliative care. A longitudinal, prospective and observational study was conducted with ACKD patients. In order to assess the symptomatic burden and suffering of these patients, the Edmonton Symptom Assessment System Revised: renal (ESAS-r) for renal patients and the Distress Thermometer (DT) were used. The sample consisted of a total of 246 patients. The most common symptoms that affect them, causing them suffering in their daily lives, are those related to well-being, difficulty falling asleep and itching. It is necessary that health professionals adapt care measures and help patients undergoing renal treatment, especially those who have suffered the disease for a longer period of time, in order to alleviate the patients’ suffering and therefore improve their daily lives. To such an end, a care plan could be designed that includes early palliative care.

Un deseo intenso de rescate por la cultura y costumbres debería imperar en el siglo XXI. La tecnificación e insensibilidad con la que luchamos debe ser contrarrestada por las sendas antiguas en cuanto al rescate de principios, valores, fundamentos para vivir en armonía con todos los seres vivos del entorno. Una vida sencilla que nos haga ver lo realmente importante, que es mirar a los ojos y reconocer la sabiduría de los ancianos, sentir los olores de la cocina tradicional, prevenir la desarmonía o enfermedad o curarnos con la fe y usar recetas ancestrales, escuchar el consejo y las tradiciones de los abuelos y cocer alrededor del fuego historias inacabadas que deben seguir siendo escritas por nuestros niños y jóvenes [Fragmento de texto].

El texto, una cumbre de historias, es un producto intelectual que complementa el ejercicio de hacer investigación educativa, en el que se cualifica el trabajo etnográfico, con rasgos de análisis categorial. Así, se reconstruye el saber pedagógico significativo desde el descubrimiento de la narrativa como un ejercicio dentro del quehacer de enseñar y aprender

Members of the genus Naegleria are free-living amoebae that are widely distributed in water and soil environments. Moreover, Naegleria fowleri is a pathogenic amoeba species that causes a fatal disease in the central nervous system known as primary amoebic meningoencephalitis (PAM) in humans. Since most reported infections due to N. fowleri are reported in recreational waters worldwide, this study was aimed to describe the presence of these amoebic genus in Mexicali Valley irrigation channels of recreational use. A total of nine water samples were collected and processed by triplicate, in nine different sites of the Valley. After filtering and culturing the samples, plates were examined, and the observed amoebae were morphologically identified at the genus level. In addition, the pathogenicity of these amoebic isolates was checked, and molecular characterization was performed by PCR/sequencing. The results revealed the presence of Naegleria spp. in all the channels sampled. Finally, molecular identification confirmed the presence of five different species of Naegleria: N. fowleri, N. australiensis, N. gruberi, N. clarki and N. pagei. The presence of these protists, particularly N. fowleri, should be considered as a potential human health risk in the region.

Objective: This study aimed at exploring the compassion attitudes and needs for awareness and training related to a compassionate approach for Medicine, Nursing, and Psychology students, as well as for the academic and administration personnel from the Universidad T&eacute, cnica Particular de Loja (UTPL, Ecuador) Health Sciences area. Methods: A cross-sectional observational study, based on a self-administered questionnaire through a sample of 788 UPTL students. STROBE guidelines were followed and applied. Results: A positive correlation was found between life engagement and compassion for others, from others, and self-compassion. The Nursing students were those who reported having previous experiences of contact with people with an advanced disease or in an end-of-life situation and having received some type of training compared to Medicine and Psychology students and lecturers (faculty members). Differences were found on the &ldquo, self-compassion&rdquo, and &ldquo, compassion for others&rdquo, subscales, noting a higher level of compassion among Psychology students. Conclusions: To implement the philosophy of compassionate universities it is necessary to design trainings that include the students, the faculty members, and the administrative staff, centered on sensitization and training about assistance, care, and accompaniment at the end of life, as well as cultivating compassion in the workplace.

Objetivo: identificar las características psicométricas de las escalas de barreras y beneficios para la realización de ejercicio en adolescentes basada en el modelo de promoción de la salud de Nola Pender. Metodología: Las escalas de percepción de barreras y beneficios para el ejercicio, fueron sometidas a los procedimientos según Pender 2011 y Muñiz 2013; permisos, traducción, retro-traducción y pruebas de validez facial, de contenido y de constructo. Resultados: las escalas de Percepción de Barreras para el ejercicio tienen un índice de Lawshe modificado de 0,83 y kappa de Fleiss de 0,59 para relevancia y pertinencia 0,53 la escala de percepción de beneficios para el ejercicio así mismo presenta un índice de Lawshe modificado de 0,93 y Kappa de Fleiss para relevancia 0,70 y para pertinencia 0,91. El análisis factorial identifico en cada una de las escalas 2 factores y la confiabilidad se encontró en 0,82 y 0,83 para la percepción de barreras y beneficios respectivamente Conclusiones: En razón a las mediciones obtenidas y los datos que reporta la literatura como válidos para instrumentos podemos concluir que las escalas son válidas, confiables y consideradas apropiadas para evaluar y diseñar estrategias que contribuyan a mejorar la realización de actividad física en los adolescentes. PALABRAS CLAVE: adolescente, actividad física, ejercicio, validez, (Fuente: DeCS, BIREME) Objective: To validate the instruments for perceiving barriers and benefits of exercising for Colombian adolescents based on the health promotion model of Nola Pender. Methodology: The instruments for perceiving barriers and benefits of exercising were subject to the following procedures: permits, translation, back translation, and validity tests: facial, content, and construction. Results: The instruments for perceiving barriers and benefits of exercising have a modified Lawshe index of 0.83 and Fleiss Kappa of 0.59 for relevance and pertinence of 0.53. The instruments for perceiving barriers and benefits of exercising also present a modified Lawshe index of 0.93 and Fleiss Kappa for relevance 0.70 and for pertinence 0.91. The factor analysis identified in each of the instruments 2 factors: barriers to physical and affective or emotional health; in terms of benefits, they were related to environmental conditions and the time available to perform the exercise, and reliability was found in 0.82 and 0.83 for the barrier and benefits perceptions, respectively. Conclusions: The instruments for perceiving barriers and benefits of exercising adapted to the Colombian context are valid and reliable. Therefore, they are considered appropriate for evaluating and designing strategies that contribute to improving the performance of physical activity in adolescents.

El programa de enfermería de la Universidad Autónoma de Bucaramanga busca innovar con un currículo globalizado que responda a las necesidades tanto del país como del mundo, para ello se ha vinculado con el proyecto internacional International Best Practice Spotlight Organization, para la implementación a nivel curricular de la guía de buenas prácticas clínicas de valoración y manejo del dolor basadas en la evidencia científica de la Registered Nurses' Association of Ontario. Objetivo: Reflexionar sobre la experiencia de la implementación de la guía de buenas prácticas clínicas para la valoración y manejo del dolor de la Registered Nurses' Association of Ontario en el programa de Enfermería de la Universidad Autónoma de Bucaramanga. Discusión: Para la metodología de la implementación se consideró como marco de referencia el Proyecto Educativo Institucional, proyecto educativo del programa de la Universidad Autónoma de Bucaramanga, la herramienta de Implementación de buenas prácticas propuesta por la Registered Nurses' Association of Ontario y el levantamiento de información que permitiera identificar los vacíos y las acciones de implementación en los contenidos curriculares respecto al uso de recomendaciones de práctica clínica, para la valoración y manejo del dolor en el currículo del programa de enfermería. Conclusiones: Realizar el levantamiento de información de los contenidos curriculares según las recomendaciones permitió identificar los mínimos curriculares a garantizar tales como: mecanismos del dolor, clasificación, intervenciones farmacológicas, no farmacológicas, implicaciones éticas, gestión y fortalecimiento de la actitud profesional que permita brindar un plan de atención integral del ser humano en cada una de las etapas del ciclo vital. La implementación de la guía de buenas prácticas clínicas de valoración y manejo del dolor permitirá tener un impacto académico en la formación de los futuros profesionales del programa de enfermería, una vez se incluyan transversalmente los contenidos relacionados con las buenas prácticas en las diferentes asignaturas del componente básico, profesional y específico del nuevo plan curricular. [Bonilla-Marciales AP, Jaimes-Valencia ML, Serrano-Gomez SE, Arenas-Luna GI, Padilla-García CI, Criado-Morales ML. Implementación de la guía de valoración y manejo del dolor, de la Registered Nurses' Association of Ontario (RNAO) en el programa de Enfermería de la Universidad Autónoma de Bucaramanga. MedUNAB 2017; 20(2): 148-164]. The nursing program of the Autonomous University of Bucaramanga seeks to innovate with a globalized curriculum that responds to the needs of both the country and the world, to that end, it has been linked to the international project International Best Practice Spotlight Organization, for the implementation at the curricular level of good clinical practices for the assessment and pain management guidelines based on the scientific evidence of the Registered Nurses' Association of Ontario. Objective: To reflect on the experience of the implementation of good clinical practices for the assessment and management of pain guidelines of the Registered Nurses' Association of Ontario in the Nursing program of the Autonomous University of Bucaramanga. Discussion: For the methodology of its implementation, the Institutional Educational Project was considered as a reference framework, educational project of the program of the Autonomous University of Bucaramanga, the implementation tool of good practices proposed by the Registered Nurses' Association of Ontario and the gathering of information that would allow to identify the gaps and the implementation actions in the curricular contents regarding the use of clinical practice recommendations, for the assessment and management of pain in the curriculum of the nursing program. Conclusions: Carrying out the information gathering of the curricular contents according to the recommendations allowed identifying the minimum curricula to be guaranteed such as mechanisms of pain, classification, pharmacological and non-pharmacological interventions, ethical implications, management and strengthening of the professional attitude that allows providing an integral attention program for the human being in each stage of the life cycle. The implementation of good clinical practices of assessment and pain management guidelines will allow an academic impact in the training of future professionals at the nursing program, once the contents related to good practices in the different subjects of the basic, professional and specific component of the new curricular plan are included transversally. [Bonilla-Marciales AP, Jaimes-Valencia ML, Serrano-Gomez SE, Arenas-Luna GI, Padilla-García CI, Criado-Morales ML. Implementation of the Assessment and Pain Management Guidelines of the Registered Nurses' Association of Ontario (RNAO) in the Nursing Program of the Autonomous University of Bucaramanga. MedUNAB 2017; 20(2): 148-164].

Objective. Chronic pain conditions profoundly affect the daily living of a significant number of people and are a major economic and social burden, particularly in developing countries. The Change Pain Latin America (CPLA) advisory panel aimed to identify the most appropriate guidelines for the treatment of neuropathic pain (NP) and chronic low back pain (CLBP) for use across Latin America. Methods. Published systematic reviews or practice guidelines were identified by a systematic search of PubMed, the Guidelines Clearinghouse, and Google. Articles were screened by an independent reviewer, and potential candidate guidelines were selected for more in-depth review. A shortlist of suitable guidelines was selected and critically evaluated by the CPLA advisory panel. Results. Searches identified 674 and 604 guideline articles for NP and CLBP, respectively. Of these, 14 guidelines were shortlisted for consensus consideration, with the following final selections made: • 'Recommendations for the pharmacological management of neuropathic pain from the Neuropathic Pain Special Interest Group in 2015-pharmacotherapy for neuropathic pain in adults: A systematic review and meta-analysis.' • 'Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society' (2007). Conclusions. The selected guidelines were endorsed by all members of the CPLA advisory board as the best fit for use across Latin America. In addition, regional considerations were discussed and recorded. We have included this expert local insight and advice to enhance the implementation of each guideline across all Latin American countries. © 2017 American Academy of Pain Medicine.

Resumo O controle da dor no periodo pos‐operatorio e um problema significativo na pratica clinica na America Latina. O controle insuficiente ou inadequado da dor e devido, em grande parte, a insuficiencia de conhecimento, atitudes e formacao e a comunicacao precaria em varios niveis. Alem disso, a falta de conscientizacao da disponibilidade e importância de politicas e diretrizes inequivocas para avaliar a intensidade da dor, o uso de analgesicos especificos e a abordagem adequada para instruir o paciente levaram ao subtratamento consistente da dor na regiao. Contudo, esses problemas nao sao insuperaveis e podem ser abordados no âmbito tanto do provedor quanto do paciente. Politicas e diretrizes substanciais podem ajudar a garantir a continuidade dos cuidados e reduzir as variacoes desnecessarias na pratica. O objetivo deste artigo e chamar a atencao para os problemas associados a dor aguda no pos‐operatorio (DAPO) e sugerir recomendacoes para soluciona‐los na America Latina. Um grupo de especialistas em anestesiologia, cirurgia e dor desenvolveu recomendacoes que levarao a um controle mais eficiente e eficaz da dor. Sera preciso mudar o conhecimento e o comportamento dos profissionais de saude e pacientes e obter um compromisso por parte de legisladores. O sucesso dependera de uma atitude positiva e do compromisso de cada parte atraves do desenvolvimento de politicas e programas e da promocao de um sistema mais eficiente e eficaz para a prestacao de servicos para a DAPO, como recomendado pelos autores deste trabalho. O grupo que as redigiu acredita que a aplicacao dessas recomendacoes deve melhorar de modo significativo a eficiencia e eficacia do controle da dor no periodo pos‐operatorio na America Latina.

Cancer is a major public health issue. Poor pain management has devastating consequences that seriously affect quality of life, diminish functionality and place a huge emotional burden on patients and their relatives. A group of Latin American opinion leaders were invited to participate in a meeting to discuss areas associated with cancer pain. The expert panel reviewed the latest literature to draft region-specific guidelines for effective pain management. The guidelines make recommendations on tailoring treatment to the specific type of pain and provide local physicians with the state-of-the art findings in the field. Management should be with pharmacological approaches (nonopioid, adjuvant and opioid analgesics, as well as oncologic therapies and interventional procedures) and nonpharmacological approaches.

Post-operative pain management is a significant problem in clinical practice in Latin America. Insufficient or inappropriate pain management is in large part due to insufficient knowledge, attitudes and education, and poor communications at various levels. In addition, the lack of awareness of the availability and importance of clear policies and guidelines for recording pain intensity, the use of specific analgesics and the proper approach to patient education have led to the consistent under-treatment of pain management in the region. However, these problems are not insurmountable and can be addressed at both the provider and patient level. Robust policies and guidelines can help insure continuity of care and reduce unnecessary variations in practice. The objective of this paper is to call attention to the problems associated with Acute Post-Operative Pain (APOP) and to suggest recommendations for their solutions in Latin America. A group of experts on anesthesiology, surgery and pain developed recommendations that will lead to more efficient and effective pain management. It will be necessary to change the knowledge and behavior of health professionals and patients, and to obtain a commitment of policy makers. Success will depend on a positive attitude and the commitment of each party through the development of policies, programs and the promotion of a more efficient and effective system for the delivery of APOP services as recommended by the authors of this paper. The writing group believes that implementation of these recommendations should significantly enhance efficient and effective post-operative pain management in Latin America. Resumo: O controle da dor no período pós-operatório é um problema significativo na prática clínica na América Latina. O controle insuficiente ou inadequado da dor é devido, em grande parte, à insuficiência de conhecimento, atitudes e formação e à comunicação precária em vários níveis. Além disso, a falta de conscientização da disponibilidade e importância de políticas e diretrizes inequívocas para avaliar a intensidade da dor, o uso de analgésicos específicos e a abordagem adequada para instruir o paciente levaram ao subtratamento consistente da dor na região. Contudo, esses problemas não são insuperáveis e podem ser abordados no âmbito tanto do provedor quanto do paciente. Políticas e diretrizes robustas podem ajudar a garantir a continuidade dos cuidados e reduzir as variações desnecessárias na prática. O objetivo deste artigo é chamar a atenção para os problemas associados à dor aguda no pós-operatório (DAPO) e sugerir recomendações para solucioná-los na América Latina. Um grupo de especialistas em anestesiologia, cirurgia e dor desenvolveu recomendações que levarão a um controle mais eficiente e eficaz da dor. Será preciso mudar o conhecimento e o comportamento dos profissionais de saúde e pacientes e obter um compromisso por parte de legisladores. O sucesso dependerá de uma atitude positiva e do compromisso de cada parte através do desenvolvimento de políticas e programas e da promoção de um sistema mais eficiente e eficaz para a prestação de serviços para a DAPO, como recomendado pelos autores deste trabalho. O grupo que as redigiu acredita que a aplicação dessas recomendações deve melhorar de modo significativo a eficiência e eficácia do controle da dor no período pós-operatório na América Latina. Keywords: Acute post-operative pain, Pain management, Latin America, Chronic pain, Palavras chave: Dor aguda no pós-operatório, Controle da dor, América Latina, Dor crônica

El consumo de sustancias psicoactivas en los universitarios es un problema que va e n aumento, por tal motivo es un tema necesario pensar y analizar entre los diversos actores, docentes, empleados, estudiantes y de una manera más profunda por aquellos que somos los llamados a acompañar a los estudiantes en la vivencia académica de los claustros universitarios. Objetivo: Caracterizar los conocimientos, actitudes y prácticas del consumo de sustancias psicoactivas en los estudiantes de los programas de medicina y enfermería de la Facultad de Ciencias de la Salud, con el propósito de implementar estrategias de prevención y manejo de forma integral, del problema, año 2015. Método: Estudio descriptivo, transversal, realizado entre Marzo y Di,dembre del 2015, utilizando el instrumento "Factores de riesgo y de protección para el consumo de drogas en Jóvenes. Resultados: Los jóvenes inician el consumo de sustancias psicoactivas a los 17 años, el alcohol es la primera sustancia consumida por los estudiantes de medicina con un 92, 85%, enfermería un 91,12% y el tabaco es la segunda con un 24,80% por enfermería y un 37,03% por medicina; la marihuana es la tercera sustancia consumida con mayor frecuencia con 26,31 por enfermería y 19, 51 en Medicina. Conclusión: E l presente estudio evidencia que el consumo de sustancias psicoactivas en los estudiantes de la universidad del Tolima, va en ascenso, si comparamos cifras con estudios anteriores, lo cual amerita l a adopción de una política clara y precisa en consumo de las sustancias psicoactivas dentro del campus universitario.

Aim: Latin-American experts in the use of opioids in patients with chronic nononcologic pain (CNOP) have updated existing recommendations to current Latin-American reality. Methods: Several key opinion leaders from Latin America participated in a face-to-face meeting in Guatemala (April 2015) to discuss the use of opioids in CNOP. Subgroups of experts worked on specific topics, reviewed the literature and shaped the final manuscript. Results: The expert panel developed guidelines taking into consideration the utility of both opioid and nonopioid analgesics and factors pertaining to their efficacy, safety, adherence, administration and risks for abuse/addiction. Conclusion: Latin-American guidelines for the use of opioids in CNOP should improve pain relief and patients’ quality of life by increasing access to these effective agents.

Resumen Introducción Dado que el sobrepeso y la obesidad en la población adolescente van en aumento, es necesario identificar las intervenciones para la prevención y manejo de estas condiciones en el grupo de jóvenes. Objetivo Presentar la evidencia encontrada, en relación con las características de las intervenciones publicadas en revistas científicas indexadas, sobre la prevención y manejo del sobrepeso y de la obesidad, respecto de la nutrición y la actividad física, para ser utilizada en la toma de decisiones, en cuanto a políticas y programas de promoción y prevención de esta condición de salud. Materiales y Métodos Se realizó la revisión sistemática de estudios cualitativos y cuantitativos (desde descriptivos hasta experimentales, que incluyeran tanto revisiones sistemáticas como meta-análisis), publicados en el período comprendido entre 2005 y 2017, a través de las bases de datos PubMed y ScienceDirect, las bibliotecas virtuales Ovid y SciELO, y el compendio de revisiones Cochrane. Resultados Existe gran variedad en diseño e implementación de las intervenciones, en cuanto a componentes, teorías, escenarios, evaluación de los efectos, dosis, tiempo y seguimiento, que tienen efecto en los hábitos nutricionales, en la actividad física, en la autoeficacia y en el índice de masa corporal (IMC) de la población estudiada. Discusión La efectividad de las intervenciones varía, dependiendo de los componentes y de la fidelidad en la aplicación de la misma, lo cual debe revisarse a la luz de los mejores efectos encontrados. Conclusiones 47 estudios cumplieron los requisitos de inclusión. Las intervenciones se robustecen con el uso de una teoría que direccione y fundamente los hallazgos que permitan dar mayores y mejores resultados. Los componentes de las intervenciones incluyen: duración, dosis, intensidad de la intervención, respuesta y seguimiento. Los adolescentes prefieren metodologías participativas e interactivas; sin embargo, aún no existe una intervención concreta y claramente definida que pueda ser estandarizada para enfrentar este problema de salud. Abstract Introduction Overweight and obesity in the adolescent population are on the rise, it is thus necessary to identify interventions to prevent and manage these conditions in the youth group. Objective To show the evidence found about the characteristics of the interventions published in indexed scientific journals on prevention and management of overweight and obesity, nutrition and physical activity, so that they are used in decision-making of policies and programs for the promotion and prevention of this health condition. Materials and Methods A systematic review of qualitative and quantitative studies (ranging from experimental to descriptive, including both systematic reviews and meta-analyzes) published in 2005-2017 was performed by means of the PubMed and ScienceDirect databases, the Ovid and SciELO virtual libraries, and the Cochrane library reviews. Results There is great variety in the design and implementation of interventions concerning components, theories, scenarios, evaluation of the effects, dosage, timing and monitoring that impact nutritional habits, physical activity, self-efficacy and the body mass index (BMI) of the studied population. Discussion The effectiveness of interventions varies depending on the components and accuracy of implementation; consequently, this must be reviewed in the light of the best effects that have been found. Conclusions 47 studies met the inclusion criteria. Interventions will be strengthened with the use of a theory that guides and supports the findings to provide greater and better results. The components of interventions include: duration, dosage, intensity of intervention, response and monitoring. Adolescents prefer participatory and interactive methodologies; however, there is still no specific and clearly defined intervention that could be standardized to address this health issue. Resumo Introdução Uma vez que o sobrepeso e a obesidade na população adolescente estão aumentando, é aconselhável identificar intervenções necessárias para a prevenção e o controle dessas condições no grupo de jovens. Objetivo Apresentar as evidências encontradas em relação às características das intervenções publicadas em periódicos científicos indexados sobre prevenção e controle do sobrepeso e da obesidade, e sobre a nutrição e a atividade física, a serem utilizadas na tomada de decisão no que diz respeito a políticas e programas para promover e prevenir esta condição de saúde. Materiais e Métodos A revisão sistemática de estudos qualitativos e quantitativos (de descritivos a experimentais, incluindo tanto revisões sistemáticas, quanto metanálises), publicados no período entre 2005 y 2017, foi realizada por meio do PubMed e do ScienceDirect, das bibliotecas virtuais Ovid e SciELO e do compêndio de revisão da Cochrane. Resultados Existe uma grande variedade na concepção e na aplicação de intervenções, em termos de componentes, teorias, cenários, avaliação dos efeitos, da dose, do tempo e do acompanhamento, que têm um efeito sobre os hábitos nutricionais, na atividade física, na auto eficácia e no índice de massa corporal (IMC) da população estudada. Discussão A efetividade das intervenções varia, dependendo dos componentes e da fidelização em sua aplicação, portanto deve ser revista à luz dos melhores efeitos encontrados. Conclusões 47 estudos atenderam aos requisitos de inclusão. As intervenções são fortalecidas com o uso de uma teoria que direcione e fundamente os achados que permitam maiores e melhores resultados. Os componentes das intervenções incluem: duração, dose, intensidade da intervenção, resposta e acompanhamento. Os adolescentes preferem metodologias participativas e interativas, no entanto, ainda não existe uma intervenção concreta e claramente definida que possa ser padronizada para fazer frente a esse problema de saúde.

Supplemental Digital Content is Available in the Text., Introduction: Chronic pain (CP) is highly prevalent and generally undertreated health condition. Noninvasive brain stimulation may contribute to decrease pain intensity and influence other aspects related to CP. Objective: To provide consensus-based recommendations for the use of noninvasive brain stimulation in clinical practice. Methods: Systematic review of the literature searching for randomized clinical trials followed by consensus panel. Recommendations also involved a cost-estimation study. Results: The systematic review wielded 24 transcranial direct current stimulation (tDCS) and 22 repetitive transcranial magnetic stimulation (rTMS) studies. The following recommendations were provided: (1) Level A for anodal tDCS over the primary motor cortex (M1) in fibromyalgia, and level B for peripheral neuropathic pain, abdominal pain, and migraine; bifrontal (F3/F4) tDCS and M1 high-definition (HD)-tDCS for fibromyalgia; Oz/Cz tDCS for migraine and for secondary benefits such as improvement in quality of life, decrease in anxiety, and increase in pressure pain threshold; (2) level A recommendation for high-frequency (HF) rTMS over M1 for fibromyalgia and neuropathic pain, and level B for myofascial or musculoskeletal pain, complex regional pain syndrome, and migraine; (3) level A recommendation against the use of anodal M1 tDCS for low back pain; and (4) level B recommendation against the use of HF rTMS over the left dorsolateral prefrontal cortex in the control of pain. Conclusion: Transcranial DCS and rTMS are recommended techniques to be used in the control of CP conditions, with low to moderate analgesic effects, and no severe adverse events. These recommendations are based on a systematic review of the literature and a consensus made by experts in the field. Readers should use it as part of the resources available to decision-making.

El presente libro destaca el papel de la pedagogía y al desarrollo humano; el proceso de enseñanza-aprendizaje como eje de discusión de la investigación en educación; comunicación organizacional: gestión interna, proyección y auditoría y comunicación; y culturas mediáticas: una aproximación a las coordenadas del sentido.