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OBJETIVO: Presentar la metodología de elaboración del Plan para la Implementación y Monitoreo de la Política Nacional de Recursos Humanos en Salud (PNRHS) del Ministerio de Salud Pública y Bienestar Social (MSPBS) del Paraguay y los resultados de su aplicación. Material y métodos. La PNRHS abarca seis estrategias y 25 líneas de acción cuya ejecución es preciso monitorear y evaluar. La metodología, dividida en siete fases y cuatro instrumentos, implicó un principio de co-construcción que involucra, a través de la Dirección Nacional Estratégica de Recursos Humanos en Salud (DNERHS) del MSPBS, a los actores relacionados con los recursos humanos en salud (RHS). Se realizó un análisis de los factores facilitadores y obstaculizadores que se podrían potenciar o mitigar. RESULTADOS: Para cada estrategia se definieron indicadores, actividades, metas y medios de verificación y se ordenaron las líneas de acción para programar la ejecución. Se creó un Comité Nacional para la implementación y monitoreo de la PNRHS, entre cuyas funciones se incluyen la integración en mesas intersectoriales temáticas y procesos de validación. Conclusión. Los desafíos principales radican en la capacidad de aminorar los obstáculos y en la continuidad de las acciones, lo que requiere la permanencia de un respaldo político en cada institución representada en el Comité y una fuerte capacidad de convocatoria y coordinación por parte del MSPBS.

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OBJECTIVES: Within the tertiary-case database, the authors tested for differences in long-term continence rates (≥ 12 months) between prostate cancer patients with extraprostatic vs. organ-confined disease who underwent Robotic-Assisted Radical Prostatectomy (RARP). METHOD: In the institutional tertiary-care database the authors identified prostate cancer patients who underwent RARP between 01/2014 and 01/2021. The cohort was divided into two groups based on tumor extension in the final RARP specimen: patients with extraprostatic (pT3/4) vs. organ-confined (pT2) disease. Additionally, the authors conducted subgroup analyses within both the extraprostatic and organ-confined disease groups to compare continence rates before and after the implementation of the new surgical technique, which included Full Functional-Length Urethra preservation (FFLU) and Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE). Multivariable logistic regression models addressing long-term continence were used. RESULTS: Overall, the authors identified 201 study patients of whom 75 (37 %) exhibited extraprostatic and 126 (63 %) organ-confined disease. There was no significant difference in long-term continence rates between patients with extraprostatic and organ-confined disease (77 vs. 83 %; p = 0.3). Following the implementation of FFLU+ NeuroSAFE, there was an overall improvement in continence from 67 % to 89 % (Δ = 22 %; p < 0.001). No difference in the magnitude of improved continence rates between extraprostatic vs. organ-confined disease was observed (Δ = 22 % vs. Δ = 20 %). In multivariable logistic regression models, no difference between extraprostatic vs. organ-confined disease in long-term continence was observed (Odds Ratio: 0.91; p = 0.85). CONCLUSION: In this tertiary-based institutional study, patients with extraprostatic and organ-confined prostate cancer exhibited comparable long-term continence rates.

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Despite that more than one hundred vaccines against SARS-CoV-2 have been developed and that some of them were evaluated in clinical trials, the latest results revealed that these vaccines still face great challenges. Among the components of the virus, the N-protein constitutes an attractive target for a subunit vaccine because it is the most abundant, highly conserved and immunogenic protein. In the present work, a chimeric protein (N-CD protein) was constructed by the fusion of the N-protein to the extracellular domain of human CD154 as the molecular adjuvant. HEK-293 cells were transduced with lentiviral vector bearing the N-CD gene and polyclonal cell populations were obtained. The N-CD protein was purified from cell culture supernatant and further characterized by several techniques. Immunogenicity studies in mice and non-human primates showed the N-CD protein induced high IgG titers in both models after two doses. Moreover, overall health monitoring of non-human primates demonstrated that animals were healthy during 228 days after first immunization. Data obtained support further investigation in order to develop this chimeric protein as vaccine candidate against COVID-19 and other coronavirus diseases.

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Introducción. Los pequeños para la edad gestacional (PEG) suelen tener una talla final 1 DE bajo la media. Se diferencian tres grupos según antropometría al nacimiento: de peso reducido (PRN), de longitud reducida (LRN) o ambos. Objetivos. Describir las características de los pacientes PEG atendidos en el Servicio de Endocrinología Pediátrica de un hospital de tercer nivel, y analizar la evolución de niños PEG sin crecimiento recuperador a los 4 años de edad, en tratamiento con hormona del crecimiento (GH), según su diagnóstico. Métodos. Estudio retrospectivo de pacientes PEG atendidos desde 2004 hasta 2021. Resultados. Se estudiaron 89 PEG; 44/89 iniciaron tratamiento con GH (11/44 PRN, 8/44 LRN y 25/44 ambos). La edad media al diagnóstico fue de 3,87 años; la talla media al inicio del tratamiento fue de -2,99 DE en los PEG diagnosticados por PRN, -2,85 DE en aquellos diagnosticados por LRN y -3,17 DE en los diagnosticados por bajo PRN y LRN. La talla final fue de -1,77, -1,52 y -1,23 DE, respectivamente, lo que supone una ganancia total de 1,22, 1,33 y 1,93 DE, respectivamente, alcanzando así su talla diana con una diferencia de 0,36 ± 0,08 DE. Conclusión. Menos de la mitad de los PEG derivados a la consulta precisaron tratamiento con GH, por no tener la edad de 4 años aún, o haber completado el crecimiento recuperador. Aquellos pacientes PEG según peso y longitud al nacimiento presentaron percentiles peores al diagnóstico y una mayor respuesta a GH.

Introduction. Small for gestational age (SGA) children usually have a final height of 1 SD below the mean. Three groups are established based on anthropometric characteristics at birth: low birth weight (LBW), short birth length (SBL), or both. Objectives. To describe the characteristics of SGA patients seen at the Department of Pediatric Endocrinology of a tertiary care hospital and to analyze the course of SGA children without catch-up growth at 4 years of age who were receiving treatment with growth hormone (GH), according to their diagnosis. Methods. Retrospective study of SGA patients seen between 2004 and 2021. Results. A total of 89 SGA children were studied; 44/89 started treatment with GH (11/44 LBW, 8/44 SBL, and 25/44 both). Their mean age at diagnosis was 3.87 years; their mean height at treatment initiation was -2.99 SD in SGA children diagnosed by LBW, -2.85 SD in those with SBL, and -3.17 SD in those with both LBW and SBL. Their final height was -1.77, -1.52, and -1.23 SD, respectively, with a total gain of 1.22, 1.33, and 1.93 SD, respectively, thus reaching their target height with a difference of 0.36 ± 0.08 SD. Conclusion. Less than half of SGA children referred to the clinic required treatment with GH because they were not yet 4 years old or had not completed their catch-up growth. SGA patients according to birth weight and length had worse percentiles at diagnosis and a greater response to GH.

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Hurricane Maria was a disastrous weather event that devastated Puerto Rico (PR) in September 2017. Yet, little is known about people's perceptions of this event. In this investigation, we offer insight about Hurricane Maria's impact on PR's inhabitants. More specifically, we study a sample (n = 542 responses) of individuals' worry levels through four time points during the aftermath of Hurricane Maria: their variation through time, their relationship to decision making, and if and how certain demographic variables may influence them. For these purposes, we designed and implemented the Individual Emergency Response and Recovery Questionnaire, a web-based survey that measured several aspects of the objective and subjective experiences of individuals who underwent Hurricane Maria in PR. Results of a statistical analysis using nonparametric tests show that some of the demographic variables selected as factors of interest influence the worry levels reported by respondents. Most significant results coincide with conclusions drawn by literature: that time, age group, and the level of information influence worry levels. Another key finding is that the worry level may influence individual decision-making frequency. Understanding principal factors in people's behavior and perceptions during hurricanes is crucial to help us learn how to better prepare for and respond to natural disasters in the future.

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Objetivo: Evaluar el efecto de un programa de educación física adaptado utilizando la lengua de señas mexicana en niños con discapacidad auditiva sobre el desarrollo coordinativo motor. Materiales y métodos: El diseño del estudio fue cuasi experimental, con muestreo por conveniencia; participando 22 estudiantes (edad 10 ± 1.8 años), diagnosticados con discapacidad auditiva, de dos escuelas de la ciudad de Mexicali, Baja California (México). Los participantes fueron divididos aleatoriamente en un grupo experimental (n=11) y un grupo control (n=11), a los cuales se les evaluó el desarrollo coordinativo motor mediante el test de coordinación corporal para niños KTK. El programa de educación física tuvo una duración de 5 meses, adaptando una programación de clases 2 veces a la semana, con una duración de 50 minutos por sesión, comunicándose con los alumnos mediante la lengua de señas mexicana y una serie de tareas para resaltar la coordinación motora. Resultados: Para comparar las variables de estudio se utilizó el test de análisis de varianza (ANOVA) mixta 2 x 2, y se observó una interacción significativa entre grupo experimental y control, lo cual demostró una significancia positiva en el desarrollo coordinativo motor (p=0.01). Conclusión: La aplicación de un programa de educación física adaptado durante cinco meses puede influenciar una mejora en la coordinación motora en niños con discapacidad auditiva.

Objective: To evaluate the effect of an adapted physical education program using mexican sign language in children with hearing impairment on motor coordination. Materials and methods: The design of the study was quasi-experimental, with convenience sampling, involving twenty-two children with an average age of 10 ± 1.8 years, diagnosed with hearing impairment, from two schools of the city of Mexicali, Baja California. Mexico. The participants were randomly divided into an experimental group (n = 11) and a control group (n = 11). The motor coordination was evaluated using the KTK test (Kiphard Körperkoordinationstest für Kindergarten and Schiling, as per the German acronym), through the tests, balancing movements of backs, jumps on one foot, lateral jumps and transposition on a platform. This physical education program was achieved during 5 months, 2 times a week, 50 minutes per session and Mexican Sign Language was utilized and a series of tasks to emphasize motor coordination. Results: Analysis of Variance was applied in order to compare the study variable (ANOVA), mixed 2 x 2. A significant interaction between the two groups (experimental and control) was observed; showing a positive measuring significance in motor coordination (p=0.01). Conclusion: An adapted physical education program using the mexican sign language applied during 5 months can influence an improvement on motor coordination on hearing impaired children.

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Introduction. Small for gestational age (SGA) children usually have a final height of 1 SD below the mean. Three groups are established based on anthropometric characteristics at birth: low birth weight (LBW), short birth length (SBL), or both. Objectives. To describe the characteristics of SGA patients seen at the Department of Pediatric Endocrinology of a tertiary care hospital and to analyze the course of SGA children without catch-up growth at 4 years of age who were receiving treatment with growth hormone (GH), according to their diagnosis. Methods. Retrospective study of SGA patients seen between 2004 and 2021. Results. A total of 89 SGA children were studied; 44/89 started treatment with GH (11/44 LBW, 8/44 SBL, and 25/44 both). Their mean age at diagnosis was 3.87 years; their mean height at treatment initiation was -2.99 SD in SGA children diagnosed by LBW, -2.85 SD in those with SBL, and -3.17 SD in those with both LBW and SBL. Their final height was -1.77, -1.52, and -1.23 SD, respectively, with a total gain of 1.22, 1.33, and 1.93 SD, respectively, thus reaching their target height with a difference of 0.36 ± 0.08 SD. Conclusion. Less than half of SGA children referred to the clinic required treatment with GH because they were not yet 4 years old or had not completed their catch-up growth. SGA patients according to birth weight and length had worse percentiles at diagnosis and a greater response to GH.

Introducción. Los pequeños para la edad gestacional (PEG) suelen tener una talla final 1 DE bajo la media. Se diferencian tres grupos según antropometría al nacimiento: de peso reducido (PRN), de longitud reducida (LRN) o ambos. Objetivos. Describir las características de los pacientes PEG atendidos en el Servicio de Endocrinología Pediátrica de un hospital de tercer nivel, y analizar la evolución de niños PEG sin crecimiento recuperador a los 4 años de edad, en tratamiento con hormona del crecimiento (GH), según su diagnóstico. Métodos. Estudio retrospectivo de pacientes PEG atendidos desde 2004 hasta 2021. Resultados. Se estudiaron 89 PEG; 44/89 iniciaron tratamiento con GH (11/44 PRN, 8/44 LRN y 25/44 ambos). La edad media al diagnóstico fue de 3,87 años; la talla media al inicio del tratamiento fue de -2,99 DE en los PEG diagnosticados por PRN, -2,85 DE en aquellos diagnosticados por LRN y -3,17 DE en los diagnosticados por bajo PRN y LRN. La talla final fue de -1,77, -1,52 y -1,23 DE, respectivamente, lo que supone una ganancia total de 1,22, 1,33 y 1,93 DE, respectivamente, alcanzando así su talla diana con una diferencia de 0,36 ± 0,08 DE. Conclusión. Menos de la mitad de los PEG derivados a la consulta precisaron tratamiento con GH, por no tener la edad de 4 años aún, o haber completado el crecimiento recuperador. Aquellos pacientes PEG según peso y longitud al nacimiento presentaron percentiles peores al diagnóstico y una mayor respuesta a GH.

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ABSTRACT Objectives: Within the tertiary-case database, the authors tested for differences in long-term continence rates (≥ 12 months) between prostate cancer patients with extraprostatic vs. organ-confined disease who underwent Robotic-Assisted Radical Prostatectomy (RARP). Method: In the institutional tertiary-care database the authors identified prostate cancer patients who underwent RARP between 01/2014 and 01/2021. The cohort was divided into two groups based on tumor extension in the final RARP specimen: patients with extraprostatic (pT3/4) vs. organ-confined (pT2) disease. Additionally, the authors conducted subgroup analyses within both the extraprostatic and organ-confined disease groups to compare continence rates before and after the implementation of the new surgical technique, which included Full Functional-Length Urethra preservation (FFLU) and Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE). Multivariable logistic regression models addressing long-term continence were used. Results: Overall, the authors identified 201 study patients of whom 75 (37 %) exhibited extraprostatic and 126 (63 %) organ-confined disease. There was no significant difference in long-term continence rates between patients with extraprostatic and organ-confined disease (77 vs. 83 %; p = 0.3). Following the implementation of FFLU+ NeuroSAFE, there was an overall improvement in continence from 67 % to 89 % (Δ = 22 %; p < 0.001). No difference in the magnitude of improved continence rates between extraprostatic vs. organ-confined disease was observed (Δ = 22 % vs. Δ = 20 %). In multivariable logistic regression models, no difference between extraprostatic vs. organ-confined disease in long-term continence was observed (Odds Ratio: 0.91; p = 0.85). Conclusion: In this tertiary-based institutional study, patients with extraprostatic and organ-confined prostate cancer exhibited comparable long-term continence rates.

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INTRODUCTION: Asthma is a growing health problem in children in marginalised urban settings in low-income and middle-income countries. Asthma attacks are an important cause of emergency care attendance and long-term morbidity. We designed a prospective study, the Asthma Attacks study, to identify factors associated with recurrence of asthma attacks (or exacerbations) among children and adolescents attending emergency care in three Ecuadorian cities. METHODS AND ANALYSIS: Prospective cohort study designed to identify risk factors associated with recurrence of asthma attacks in 450 children and adolescents aged 5-17 years attending emergency care in public hospitals in three Ecuadorian cities (Quito, Cuenca and Portoviejo). The primary outcome will be rate of asthma attack recurrence during up to 12 months of follow-up. Data are being collected at baseline and during follow-up by questionnaire: sociodemographic data, asthma history and management (baseline only); recurrence of asthma symptoms and attacks (monthly); economic costs of asthma to family; Asthma Control Test; Pediatric Asthma Quality of life Questionnaire; and Newcastle Asthma Knowledge Questionnaire (baseline only). In addition, the following are being measured at baseline and during follow-up: lung function and reversibility by spirometry before and after salbutamol; fractional exhaled nitric oxide (FeNO); and presence of IgG antibodies to SARS-CoV-2 in blood. Recruitment started in 2019 but because of severe disruption to emergency services caused by the COVID-19 pandemic, eligibility criteria were modified to include asthmatic children with uncontrolled symptoms and registered with collaborating hospitals. Data will be analysed using logistic regression and survival analyses. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Hospital General Docente de Calderon (CEISH-HGDC 2019-001) and Ecuadorian Ministry of Public Health (MSP-CGDES-2021-0041-O N° 096-2021). The study results will be disseminated through presentations at conferences and to key stakeholder groups including policy-makers, postgraduate theses, peer-review publications and a study website. Participants gave informed consent to participate in the study before taking part.

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Resumen Introducción: Cada vez se masifican las tecnologías electrónicas de pantalla entre la población infantil, práctica que ha llevado a un estilo de vida sedentario incrementa los riesgos para la salud de los individuos. Objetivo: Asociar la actividad física y el uso de pantallas, con el índice de masa corporal (IMC) y el género en escolares urbanos de la ciudad de Popayán entre 10 a 12 años. Materiales y métodos: Muestreo aleatorio simple, 440 escolares en edades entre los 10 y 12 años (220 niños/220 niñas). Se realizó la encuesta Physical activity Questionnaire for Older Children-PAQ-C. Estudio prospectivo transversal comparativo, de análisis univariado y bivariado. Resultados: Existe la asociación entre niveles de actividad física moderados y las horas de uso de pantallas (X2=598,6; p=0,00); así como también entre el nivel de actividad física y el sexo de los escolares (X2=13,551; p=0,004). Conclusiones: Los niveles de actividad física y el uso de pantallas demuestran que los escolares que usan con mayor frecuencia la televisión, el computador y los videojuegos, despliegan la actividad física en niveles de moderada a baja.

Abstract Introduction: Use of electronic screen technologies are increasingly widespread among children and their frequent use has led to a sedentary lifestyle that increases health risks in this population. Objective: To study the association of physical activity and the use of electronic screen devices with the body mass index (BMI) and gender in urban schoolchildren aged between 10 to 12 years from the city of Popayán (Cauca, Colombia). Materials and methods: A comparative prospective cross-sectional study, with univariate and bivariate analyses, was carried out using a simple random sampling of 440 students between the ages of 10 and 12 years (220 boys/220 girls). The Physical activity Questionnaire for Older Children (PAQ-C) was applied. Results: There is an association between moderate levels of physical activity and hours spent in front of electronic screen devices (X2=598.6; p=0.00). Likewise, an association between the level of physical activity and gender of schoolchildren was found (X2=13.551; p=0.004). Conclusions: Children who frequently use television, computers, and/or video games show low to moderate levels of physical activity.

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