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Background: Hidradenitis suppurativa (HS) is a chronic skin condition. Its complexity and impact on patients highlight the need for multidisciplinary care that can address the physical, psychological, and social aspects. Centers of excellence can ideally provide the necessary infrastructure, resources, and expertise to effectively treat HS. However, there are still no consolidated models of centers of excellence in HS, and establishing their foundations is an intricate research challenge. Purposely, design and co-creation as innovation techniques are helpful approaches to this type of research. Methods: In this study, we conducted a co-creation with consensus among HS specialists to propose the criteria and requirements to establish outpatient centers of excellence of HS in Brazil. We followed a linear process with mixed methods in 6 stages. Results: The process resulted in 10 categories for establishing outpatient centers, including their respective requirements, rationale, and classification. The categories include onboarding and welcoming; infrastructure and procedures; infusion therapy; flows and referrals; staffing; disease management; metrics during diagnosis; metrics during treatment; awareness and advocacy; research and education. Discussion: The idealized outpatient centers can play a role in the complete multidisciplinary treatment for HS and advancing the science of healthcare services by providing a focus for research, training, and translation of findings into practice.

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Vivemos nos últimos anos um momento difícil em relação ao ensino de qualidade na medicina veterinária brasileira. Por sua vez, a equideocultura brasileira possui destaque internacional pela alta demanda de empregabilidade e pela excelência de seu plantel. Sempre a frente do seu tempo, a Pontifícia Universidade Católica do Paraná, a PUCPR, possui um curso de 28 anos de história, onde a excelência no ensino é reconhecida de norte a sul do país. Ao longo dessa história, um dos grandes diferenciais da universidade são os grupos de estudos, que são realizados por áreas específicas no curso e que acontecem no contraturno do estudante. Um dos primeiros grupos de estudos formados na PUCPR, foi em 2003: o Grupo de Estudos em Reprodução Animal. E com um grande interesse dos estudantes pela área de equinos, em 2008 nasce o Grupo de Estudos em Reprodução de Equídeos que perdura até os dias de hoje com o nome de Liga Acadêmica em Reprodução de Equídeos lado a lado da Liga Acadêmica de Reprodução de Bovinos. Desde então, na área da reprodução equina, um trabalho realizado com os estudantes que simula a vida real de um haras de criação e um centro de reprodução equina junto ao rebanho didático da instituição. O que torna esse modelo de ensino da PUCPR especial é como ele é conduzido, levando o estudante através de trilhas ao longo da graduação que permite que ele realmente se forme podendo trabalhar e exercer na plenitude a reprodução equina. Ao longo de 23 anos, se observa que os profissionais ligados a reprodução equina e bovina, egressos do curso de medicina veterinária da PUCPR são referências em renomados criatórios de equinos no Brasil. Com todo esse trabalho desenvolvido ao longo dos 5 anos com esses estudantes temos a tranquilidade e a satisfação de entregar a sociedade profissionais extremamente capacitados, e prontos para o mercado do cavalo, de forma ética e respeitando os cavalos e todas as formas de bem-estar animal.(AU)

In recent years, we have experienced a difficult time in relation to quality teaching in Brazilian veterinary medicine. On the other hand, the Brazilian equideoculture has international prominence due to the high demand for employability and the excellence of its herd. Always ahead of its time, the Pontifical Catholic University of Paraná, PUCPR, has a course of 28 years of history, where excellence in teaching is recognized from north to south of the country. Throughout this history, one of the great differentials of the university are the study groups, which are carried out by specific areas in the course, and which take place in the student's after-school period. One of the first study groups formed at PUCPR was in 2003: the Animal Reproduction Study Group. And with a great interest of students in the equine area, in 2008 the Equine Reproduction Study Group was born, which lasts until today under the name of Academic League in Equine Reproduction side by side with the Academic League of Bovine Reproduction. Since then, around equine reproduction, work has been carried out with students that simulates the real life of a stud farm and an equine reproduction center with the institution's didactic herd. What makes this PUCPR teaching model special is how it is conducted, taking the student through paths throughout graduation that allow him to really graduate, being able to work and fully exercise equine reproduction. Over 23 years, it has been observed that professionals linked to equine and bovine reproduction, graduates of the PUCPR Veterinary Medicine course, are references in renowned equine breeding centers in Brazil. With all this work developed over the 5 years with these students, we have the tranquility and satisfaction of delivering extremely qualified professionals to society, ready for the horse market, ethically and respecting horses and all forms of welfare animal.(AU)

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Abstract Background The chronic aspect that begins to characterize long COVID appeals to the need for interventions proposed by institutions such as the World Health Organization (WHO) and the National Institute for Health and Care Excellence (NICE) to manage the disease, emphasizing behavioral change and self-care. Objective To perform a narrative review of the psychological literature that offers intervention strategies in alignment with the recommendations of the long COVID management guidelines proposed by WHO and NICE. Method MEDLINE, EBSCO, Google Scholar, SciELO, PsycINFO, PubMed, Cochrane, and CONRICYT databases were consulted, using Boolean operators and keywords for an exhaustive search. Results The contributions of the studies were categorized into five intervention strategies based on WHO and NICE recommendation guidelines: Psychoeducation, Self-care, Support networks, Relaxation, and Goal setting. These are given a brief introduction and their relevance to the management of long COVID symptomatology is described. Discussion and conclusion The persistent condition of COVID-19 symptoms makes it necessary to recognize that lifestyle changes must be made, primarily focused on health care and prevention of worsening disease sequelae. These lifestyle changes can be achieved through behavior modification, focusing on protective factors such as education, self-care, support networks, relaxation techniques and, setting appropriate goals.

Resumen Antecedentes El aspecto crónico que empieza a caracterizar al COVID persistente hace un llamado a la propuesta de intervenciones desde instituciones como la Organización Mundial de la Salud (OMS) y el National Institute for Health and Care Excellence (NICE) para lograr un manejo de la enfermedad, el cambio conductual y el autocuidado. Objetivo Elaborar una revisión narrativa sobre la literatura psicológica que ofrece estrategias de intervención acordes a las recomendaciones de las guías de manejo del COVID persistente propuestas por la OMS y el NICE. Método Se consultaron las bases de datos MEDLINE, EBSCO, Google Scholar, SciELO, PsycINFO, PubMed, Cochrane y CONRICYT. Se utilizaron operadores booleanos y palabras claves para una búsqueda exhaustiva. Resultados Las aportaciones de los estudios fueron categorizadas en cinco estrategias de intervención basadas en las guías de recomendación de la OMS y el NICE: Psicoeducación, Autocuidado, Redes de apoyo, Relajación y Establecimiento de metas. En ellas se realiza una breve introducción y se expone su relevancia para el manejo de la sintomatología del COVID persistente. Discusión y conclusión El padecimiento persistente de los síntomas del COVID-19 hace necesario reconocer que deben realizarse cambios en el estilo de vida, principalmente enfocados en el cuidado de la salud y la prevención del empeoramiento de las secuelas de la enfermedad. Estos cambios en el estilo de vida podrán lograrse mediante la modificación de la conducta, orientándola a factores protectores como la educación, el autocuidado, las redes de apoyo, las técnicas de relajación y el establecimiento de metas adecuadas.

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Resumen El Festival Internacional Cervantino (FIC) es el evento turístico cultural más importante de la ciudad de Guanajuato, que atrae cada año a miles de visitantes. El objetivo de esta investigación fue determinar los factores que forman la experiencia de los asistentes al FIC, así como su relación con la percepción de la excelencia y del impacto económico, mediante la adaptación de un modelo estructural teórico basado en el modelo escandinavo de "Skot-Hansen y Linko y Silvanto". Se empleó una metodología cuantitativa, sustentada en un modelo de ecuaciones estructurales, basado en una encuesta hecha de manera no aleatoria por conveniencia a 709 visitantes en 2017. Los resultados identificaron que los factores ilustración, empoderamiento y entretenimiento, provocaron en los asistentes del festival, una experiencia memorable que anima, profundiza y enaltece de forma significativa sus vidas, aspecto que no siempre se ha valorado en este tipo de actividades. Además, la experiencia influye en la excelencia apreciada, impactando en la percepción de la calidad y profesionalismo de la organización y el nivel artístico del FIC. Los asistentes de este festival también percibieron que la excelencia apreciada en los factores de ilustración, empoderamiento y entretenimiento, beneficia la imagen positiva de Guanajuato; al fortalecerla como destino turístico, lo que repercute económicamente. Se concluye que el FIC logra buenas prácticas y políticas culturales, lo que es arduo de alcanzar y puede ser un argumento a favor de su propuesta.

Abstract The International Cervantino Festival (FIC) is the most important tourist cultural event in the city of Guanajuato since it attracts thousands of visitors every year. The objective of this research was to determine the factors that constitute the experience of FIC's attendees' as well as its relationship towards the perception of excellence and economic impact. A structural equation theoretical model based on the Scandinavian "Skot-Hansen and Linko and Silvanto" model was adapted for that purpose. A quantitative methodology was used, supported by a structural equations model, based on a survey with a non-random convenience sample of 709 visitors in 2017. Results identified that factors such as illustration, empowerment and entertainment produced a memorable experience among FIC attendees that encourages, deepens and heightens their lives in a meaningful way, an aspect that had not always been valued in these kinds of activities. Additionally, the experience also has an impact on perceived excellence, which impacts the perception of FIC's quality, professionalism, organization and artistic level. FIC's attendees also perceived that the excellence within illustration, empowerment and entertainment benefit Guanajuato's positive image strengthening the city as a touristic destination that leads to positive economic repercussions. It is concluded that FIC achieves good practices and cultural policies, a fact that is difficult to achieve and that can be an argument in favor of its cultural proposal.

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Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher's exact tests and the OS by Kaplan-Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (≥60 years) (1.84) compared with younger (≤40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity.

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INTRODUCTION: Inflammatory bowel disease (IBD) is a chronic and incurable entity. The aim of the Pan American Crohn's and Colitis Organisation (PANCCO) is to create awareness of IBD, with special emphasis on Latin America, and the primary objective of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU, the Spanish acronym) is to obtain the accreditation of the clinical and therapeutic criteria for the diagnosis and treatment of IBD. AIM: To carry out a consensus for evaluating the approval criteria that a Comprehensive Care Clinic for Latin American IBD patients must meet, to be considered a center of excellence. MATERIALS AND METHODS: Fourteen clinical experts participated in the consensus. They were made up of specialists in gastroenterology, with broad clinical experience, spanning several years, in managing the care of a large number of patients with IBD, as well as advanced specialists in IBD. Thirteen of the participants came from 11 Latin American countries (Argentina, Brazil, Colombia, Dominican Republic, Ecuador, Guatemala, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela) that have IBD clinics. An expert from Spain, representing the GETECCU, provided the methodologic support. The consensus consisted of 52 statements divided into three sections: 1) Structure indicators, 2) Process indicators, and 3) Result indicators. The Delphi panel method was applied. RESULTS: The present Latin American consensus describes the quality indicators that a Comprehensive Care Clinic for IBD patients must meet, to be considered a center of excellence, taking into account the needs of our region. CONCLUSIONS: This is the first Latin American consensus, jointly carried out by the PANCCO and GETECCU, to present accreditation standards for centers of excellence in the care of patients with IBD.

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Objetiva-se conhecer as repercussões das exigências do trabalho científico no cotidiano de bolsistas PQ/CNPq da Psicologia e as estratégias de conciliação desenvolvidas entre as demandas acadêmicas e as domésticas-familiares. Trabalhou-se com uma amostra não-probabilística de 85 mulheres, das 204 bolsistas PQ cadastradas no CNPq, respondentes ao questionário on-line; e com um subgrupo de 24 pesquisadoras respondentes à entrevista remota. Os resultados indicam que o cotidiano das pesquisadoras é significativamente afetado em diferentes esferas. Na tentativa de conciliação, recorrem ao suporte familiar e/ou contratam trabalhadoras domésticas/babás. Para a maioria, a maternidade não se configura como um obstáculo à excelência científica. Já em relação às relações amorosas-conjugais há conflitos em decorrência das exigências acadêmicas, os quais impactam negativamente nos investimentos profissionais. Concluímos que o cotidiano das bolsistas PQ está atravessado pela estrutural desigualdade de gênero impelindo-as a desenvolver estratégias de conciliação, as quais repercutem no âmbito doméstico-familiar e nos relacionamentos conjugais.

The objective of the present study was to understand the repercussions of the demands of scientific work on the daily life of Psychology PQ/CNPq fellows and the strategies developed to reconcile academic and domestic-family demands. We worked with a non-probabilistic sample of 85 women from the 204 PQ fellows registered at CNPq who answered the online questionnaire, and with a sub-group of 24 women researchers who answered the remote interview. The results indicate that the daily lives of female researchers are strongly affected in different spheres. In an attempt to conciliate, they resort to family support and/or hiring domestic workers/babysitters. For most of them, motherhood is not an obstacle to scientific excellence. On the other hand, in relation to love-marital relationships, there are conflicts due to academic demands, which negatively impact professional investments. We conclude that the daily life of the PQ fellows is crossed by the structural gender inequality, forcing them to develop strategies of conciliation, which have repercussions in the domestic-familial sphere and in the conjugal relationships.

El objetivo es conocer las repercusiones de las exigencias del trabajo científico en la vida cotidiana de becadas PQ/CNPq en Psicología y las estrategias de conciliación desarrolladas entre las exigencias académicas y domésticas-familiares. Se trabajó con una muestra no probabilística de 85 mujeres de las 204 becadas PQ registradas en el CNPq que respondieron al cuestionario online, y con un subgrupo de 24 investigadoras que respondieron a la entrevista remota. Los resultados indican que la vida cotidiana de las investigadoras se ve fuertemente afectada en diferentes ámbitos. En un intento de conciliación, recurren a la ayuda familiar y/o contratan a trabajadoras domésticas/niñeras. Para la mayoría de ellas, la maternidad no es un obstáculo para la excelencia científica. Sin embargo, en lo que respecta a las relaciones amoroso-matrimoniales, existen conflictos debidos a las exigencias académicas, que repercuten negativamente en las inversiones profesionales. Concluimos que la vida cotidiana de las becadas PQ está atravesada por la desigualdad estructural de género, instándolas a desarrollar estrategias de conciliación que repercuten en el ámbito doméstico-familiar y en las relaciones conyugales.

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Se tiene presente el principio martiano de que "Educar es depositar en cada hombre toda la obra humana, es ponerlo a nivel de su tiempo, es preparar al hombre para la vida", por eso, esta semblanza es un homenaje a la ilustre académica Alicia Evarista Fernández Hernández, quien con 12 años edad comenzó su labor como educadora al incorporarse a la Campaña de Alfabetización y a otras tareas asignadas por la Revolución; martiana ferviente, educadora por excelencia, ha transmitido durante más de cuatro décadas sus experiencias y sus doctrinas de amor y sabiduría a distintas generaciones de estudiantes de Enfermería, Medicina, profesores, profesionales de la salud de Cuba y otros pueblos del mundo. Es objetivo de esta semblanza referir los aspectos más relevantes de su magistral obra educativa, académica y revolucionaria, apoyados en testimonios, revisión de documentos, entrevistas a familiares y compañeros, que, sin dudas, describen de modo fehaciente su trayectoria como estudiante, enfermera, profesora, académica e investigadora. Alicia Fernández constituye un referente teórico-práctico, ejemplo de dedicación, altruismo y un modelo de conducta a seguir por las nuevas generaciones de galenos, enfermeros, profesores y otros profesionales de la salud que se forman integralmente en las universidades de las Ciencias Médicas cubanas(AU)

We keep in mind Marti's principle that "to educate is to deposit all human work in each man, to put him at the level of his time, and to prepare him for life"; therefore, this semblance is a tribute to the illustrious academician Alicia Evarista Fernández Hernández who began her work as an educator at the age of twelve by joining the literacy campaign and other tasks assigned by the Revolution. She has been a passionate defender of Marti's ideas and an educator par excellence who has passed her experiences and doctrines of love and wisdom to different generations of nursing and medical students, professors and other health professionals from Cuba and other peoples of the world for more than four decades. The objective of this semblance is to present the most relevant aspects of her masterful educational, academic and revolutionary work supported by evidence, document reviews, and interviews with family members and colleagues which undoubtedly describe her career as a student, nurse, professor, academician, and researcher. Alicia Fernández is a theoretical and practical referent, an example of dedication and altruism, and a behavior model to the new generations of doctors, nurses, professors and other health professionals who are fully trained in the Cuban universities of Medical Sciences(AU)

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Spondyloarthritis (SpA) is one of the most complex rheumatological diseases to diagnose and treat because, in the early stages of the disease, the inflammatory low back pain is often difficult to identify, and patients are diagnosed when they already have advanced structural processes. There is an urgent need to establish healthcare models that allow optimization of the management of these patients. The objective of this work is to propose a care model that is adaptable to the factual realities of Latin America. A systematic search of the literature terms (MeSH) was performed to search associated terms. Taking the model of the REAL-PANLAR project as an example and incorporating some related literature, a model of centers of excellence for SpA in Latin America is proposed that can be reasonably established and implemented. This model proposes 3 types of centers of excellence for SpA according to the level of complexity of each institution, and its criteria are defined based on indicators of structure, processes, and results. This is the first effort in Latin America to try to standardize the care of patients with spondyloarthritis. Key Points • The unmet needs in Latin America in the care of SpondyloArthritis (SpA), demand solutions that facilitate the rapid and assertive access of patients to specialized centers such as Center of Excellence in SpA. • This project facilitates the standardization of high-quality care for patients with SpA, starting from its diagnosis and up to clinical follow-up. • Due to standardization of care, better clinical and safety outcomes are achieved for patients, as well as patient-reported outcomes. • By standardized models of care, will be achieved a reduction in the progress of this pathology and optimization in the use of high-complexity services and high-cost therapies, improving cost-efficiency for public health systems in each country.

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Este estudo objetivou investigar as variáveis pessoais e os fatores contextuais relacionados com a excelência de pesquisadores de ambos os gêneros e de diferentes áreas do conhecimento. A amostra foi constituída por 109 pesquisadores, bolsistas de produtividade do Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), que trabalham em instituições de ensino superior de várias regiões do Brasil. Utilizou-se o Questionário do Perfil de Excelência online formado por perguntas semi-abertas relacionadas a recursos pessoais, fatores acadêmicos e de fatores contextuais. Os resultados obtidos apontam para diferenças estatisticamente significantes de frequência de respostas entre os gêneros quanto à paixão pelo trabalho para enfrentar novos projetos de pesquisa, uso do suporte social, utilização de empregados para conciliar a vida pessoal com a profissional, na ocupação do tempo livre na realização de viagens e nas atividades com a família. Os resultados sugerem a natureza multivariada do fenômeno da excelência científica, convergindo na sua manifestação fatores pessoais e contextuais. Ambos os fatores merecem ser considerados quando se procura promover a sua realização profissional e produtividade. (AU)

This study aimed to investigate personal variables and contextual factors related to the excellence of researchers of both genders and different areas of knowledge. The sample consisted of 109 researchers, National Scientific and Technological Development Council (CNPq) productivity fellows, who work in higher education institutions in various regions of Brazil. The Online Excellence Profile Questionnaire was used. This questionnaire consists of semi-open questions about personal resources, academic factors and contextual factors. The results obtained indicate statistically significant difference frequency of answers between genders regarding the passion for work face new research projects, use of social support, use of employees to reconcile the personal life of the professional, in the occupation of free time with travel and in family activities. The results suggest a multivariate nature of the phenomenon of scientific excellence, converging in its manifestation personal and contextual factors. Both factors deserve to be considered when seeking to promote their professional fulfillment and productivity. (AU)

Este estudio tuvo como objetivo investigar las variables personales y los factores contextuales relacionados con la excelencia de los investigadores de ambos sexos y de diferentes áreas del conocimiento. La muestra consistió en 109 investigadores, becarios de productividad del Consejo Nacional de Desarrollo Científico y Tecnológico (CNPq), que trabajan en instituciones de educación superior en varias regiones de Brasil. Se utilizó el cuestionario de perfil de excelencia en línea. Este cuestionario consta de preguntas semiabiertas sobre recursos personales, factores académicos y factores contextuales. Los resultados obtenidos apuntan a diferencias estadísticamente significativas en la frecuencia de respuestas entre los géneros con respecto a la pasión por el trabajo para hacer frente a nuevos proyectos de investigación, el uso del apoyo social, el uso de empleados para conciliar la vida personal del profesional, la ocupación del tiempo libre para viajar y actividades familiares. Los resultados sugieren la naturaleza multivariante del fenómeno de la excelencia científica, convergiendo en su manifestación factores personales y contextuales. Ambos factores merecen ser considerados a la hora de promover su realización y productividad profesional. (AU)

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Se tiene presente el principio martiano de que el elogio oportuno fomenta el mérito; por eso, esta semblanza es un homenaje a la profesora consultante Asunción Toledo del Rey, quien desde edad temprana se incorporó a las disímiles tareas asignadas por la Revolución; martiana, educadora por excelencia, ha transmitido durante más de cuatro décadas sus doctrinas de amor y sabiduría a distintas generaciones de estudiantes de Enfermería de Cuba y otros pueblos del mundo. Es objetivo de esta semblanza referir los aspectos más relevantes de su obra educativa y revolucionaria, apoyados en testimonios, revisión de documentos, entrevistas a familiares y compañeros, que, sin dudas, describen de modo fehaciente su trayectoria como estudiante, enfermera y profesora. Asunción Toledo del Rey constituye un referente teórico-práctico, un ejemplo a seguir por todas las generaciones de estudiantes de Enfermería que se forman integralmente en las universidades de las Ciencias Médicas cubanas(AU)

Bearing in mind the principle of José Martí that "timely praise encourages the merit" we present this biographical sketch as a tribute to the Consultant Professor Asunción Toledo del Rey who performed different tasks assigned by the Revolution since she was very young. She is a supporter of the ideas of José Martí and an educator par excellence that has conveyed her doctrines of love and wisdom to many generations of Nursing students in Cuba and other countries in the world for more than four decades. The aim of this biographical sketch is to highlight the most relevant aspects of her educational and revolutionary work, which is supported by evidences, document reviews and interviews to relatives and co-workers who, undoubtedly, irrefutably describe her career as a student, nurse and professor. Asunción Toledo del Rey is a theoretical and practical referent and an example to be followed by all generations of Nursing students who receive a comprehensive education and training in our Cuban universities of medical sciences(AU)

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Optimal treatment outcomes for breast cancer are dependent on a timely diagnosis followed by an organized, multidisciplinary approach to care. However, in many low- and middle-income countries, effective care management pathways can be difficult to follow because of financial constraints, a lack of resources, an insufficiently trained workforce, and/or poor infrastructure. On the basis of prior work by the Breast Health Global Initiative, this article proposes a phased implementation strategy for developing sustainable approaches to enhancing patient care in limited-resource settings by creating roadmaps that are individualized and adapted to the baseline environment. This strategy proposes that, after a situational analysis, implementation phases begin with bolstering palliative care capacity, especially in settings where a late-stage diagnosis is common. This is followed by strengthening the patient pathway, with consideration given to a dynamic balance between centralization of services into centers of excellence to achieve better quality and decentralization of services to increase patient access. The use of resource checklists ensures that comprehensive therapy or palliative care can be delivered safely and effectively. Episodic or continuous monitoring with established process and quality metrics facilitates ongoing assessment, which should drive continual process improvements. A series of case studies provides a snapshot of country experiences with enhancing patient care, including the implementation of national cancer control plans in Kenya, palliative care in Romania, the introduction of a 1-stop clinic for diagnosis in Brazil, the surgical management of breast cancer in India, and the establishment of a women's cancer center in Ghana.

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Este estudo teve como objetivo investigar as variáveis pessoais e contextuais que influenciam a produção da excelência em pesquisadores brasileiros. Participaram do estudo 109 pesquisadores, bolsistas de produtividade do CNPq nível 1, selecionados pela plataforma Lattes. O Questionário do Perfil de Excelência foi administrado on-line e composto de perguntas semiabertas sobre aspectos cognitivos, de personalidade, biográficos e contextuais. A análise das respostas por área científica e gênero foram feitas pelo qui-quadrado. Houve diferenças significativas entre homens e mulheres das diferentes áreas científicas quanto à fase de interesse pela profissão, na idade adulta para mulheres e infância para homens, bem como em relação às características persistência e inconformismo, mais valorizadas pelas mulheres para a carreira científica. Os resultados sugerem que o gênero e a área de conhecimento influenciam mais as variáveis pessoais do que as contextuais na excelência científica. (AU)

This study aimed to investigate personal and contextual variables that influence the production of excellence in Brazilian researchers. For this, 109 researchers were selected from the Lattes Platform, classified as level 1 by the CNPQ agency. The Excellence Profile Questionnaire was administered online and comprised of semi-open questions about cognitive, personality, biographical and contextual aspects. The analysis of the answers by scientific area and gender was made using the chi-square test. Significant differences were found between men and women from the different scientific areas regarding the career interest phase, in adulthood for women and childhood for men. Gender differences were related to the characteristics of persistence and nonconformity, which was more valued by women for a scientific career. The results suggest that gender and the area of knowledge influence personal variables more than contextual variables in scientific excellence. (AU)

Este estudio tuvo como objetivo investigar variables personales y contextuales que influencian la producción de la excelencia en investigadores brasileños. Participaron del estudio 109 investigadores, becarios de productividad del CNPq nivel 1, seleccionados por plataforma Lattes. El Cuestionario del Perfil de Excelencia fue administrado on-line y compuesto de preguntas semi abiertas sobre aspectos cognitivos, de personalidad, biográficos y contextuales. El análisis de las respuestas por área científica y género fueron hechas por el Chi-cuadrado. Se observaron diferencias significativas entre hombres y mujeres de las diferentes áreas científicas con respecto a la fase de interés por la profesión, en la edad adulta para las mujeres y en la infancia para los hombres, así como en relación con las características persistencia e inconformismo más valoradas por las mujeres para la carrera científica. Los resultados sugieren que, con respecto a la excelencia científica, el género y el área de conocimiento influyen más en las variables personales que en las contextuales. (AU)

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Resumen Desde hace unos años, las organizaciones colegiadas de la profesión farmacéutica se han visto desafiadas, no solo por agentes externos, sino también por los propios profesionales. Hay una cierta crítica de respuesta, especialmente en aspectos que tienen que ver con el rol que deben jugar en el desarrollo y la actividad de la práctica profesional, en sus fines domésticos, externos e internos, y en las características que deben poseer como organizaciones al servicio de estos profesionales y la sociedad. Entendemos que el desarrollo, la revisión y actualización de la bioética, así como la formación en esta materia en las organizaciones profesionales, contribuye a esa excelencia transversal en la profesión, provoca un conocimiento real de esta en todas sus dimensiones y otorga poder para actuar en total libertad frente a las amenazas o restricciones internas o externas.

Abstract For some years, the collegiate organizations of the pharmaceutical profession are being challenged, not only by external agents, but also by the professionals themselves. There is a certain criticism in the response, especially in aspects that have to do with the role they must play in the development and activity of professional practice, in their domestic, external and internal purposes and in the characteristics they must possess as organizations in service of these professionals and society. We understand that the development, revision and updating of Bioethics, as well as training in this field in professional organizations, contributes to that transcendent excellence in the profession, provokes a real knowledge of it in all its dimensions and with the power to act in total freedom from threats or internal or external restrictions.

Resumo Há alguns anos, as organizações colegiadas da profissão farmacêutica estão sendo desafiadas, não somente por agentes externos, mas também pelos próprios profissionais. Existe certa crítica de resposta, em especial em aspectos que estão relacionados com o papel que devem desempenhar e com a atividade da prática profissional, em seus fins domésticos, externos e internos, e nas características que devem possuir como organizações ao serviço desses profissionais e da sociedade. Entendemos que o desenvolvimento, a revisão e a atualização da Bioética, bem como a formação nessa matéria nas organizações profissionais, contribuem para a excelência transversal na profissão, promovem um conhecimento real desta em todas suas dimensões e outorgam poder para agir em total liberdade ante as ameaças ou as restrições internas ou externas.

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El perfeccionismo es un constructo psicológico relacionado con la excelencia y una manifestaciónóptima de alta capacidad intelectual (ACI). El objetivo principal de este trabajo fue comparar las tipologías y dimensiones de perfeccionismo entre jóvenes de ACI y un grupo de comparación apareado por género y edad. Se seleccionaron 137 participantes con diagnóstico de ACI y un grupo de 137 de comparación apareado por género y edad. La media de edad fue de 11.77 años (DT = 1.99). Como herramientas se utilizaron la Almost Perfect Scale-Revised (APS-R) y la Escala de Perfeccionismo Positivo y Negativo 12 (PNPS-12). El análisis de conglomerados para la muestra total, identificó la presencia de tres agrupaciones de participantes (No perfeccionista, Perfeccionista no saludable/negativo, y Perfeccionista saludable/positivo). El grupo de ACI presentó una mayor prevalencia de perfeccionistas de tipo saludables y una menor prevalencia de perfeccionistas de tipo no saludable, en comparación con el grupo de alumnos sin diagnóstico de ACI. Cuando se compararon las puntuaciones medias de APS-R y PNPS-12 entre los grupos de ACI y grupo de comparación, se encontraron diferencias estadísticamente significativas en altos estándares, orden, discrepancia, perfeccionismo positivo y perfeccionismo negativo. En todos los casos el grupo de comparación presentó puntaciones medias mayores que el grupo de ACI. Estos resultados tienen implicaciones claras en la comprensión de la expresión fenotípica del perfeccionismo relacionado con la excelencia y la manifestación óptima del alto potencial intelectual.

Perfectionism is a psychological construct related o excellence and an optimal manifestation of high intellectual ability (HIA). The main goal of the present work was to compare types and dimensions of perfectionism in students with HIA and an age-gender matched comparison group. We selected 137 participants with diagnosis of HIA and a comparison group of 137 matched by gender and age. The mean age was 11.77 years (SD = 1.99). The Almost Perfect Scale-Revised (APS-R) and the Positive and Negative Perfectionism Scale-12 (PNPS-12) were used. The cluster analysis for the total sample identified 3 groups of participants (non-perfectionist, unhealthy perfectionist/negative, and healthy perfectionist/positive). The HIA group presented a higher prevalence of healthy perfectionists and a lower prevalence of unhealthy perfectionists, in comparison with the group of students without a diagnosis of HIA. When comparing the average scores of APS-R and PNPS-12 between the ACI and the comparison group, statistically significant differences were found in high standards, order, discrepancy, positive and negative perfectionism. In all cases, the comparison group yielded higher mean scores than the HIA group. These results have clear implications in the understanding of the phenotypic expression of perfectionism related to excellence and optimal manifestation of the high intellectual potential.

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Perfectionism is a psychological construct related o excellence and an optimal manifestation of high intellectual ability (HIA). The main goal of the present work was to compare types and dimensions of perfectionism in students with HIA and an age-gender matched comparison group. We selected 137 participants with diagnosis of HIA and a comparison group of 137 matched by gender and age. The mean age was 11.77 years (SD = 1.99). The Almost Perfect Scale-Revised (APS-R) and the Positive and Negative Perfectionism Scale-12 (PNPS-12) were used. The cluster analysis for the total sample identified 3 groups of participants (non-perfectionist, unhealthy perfectionist/negative, and healthy perfectionist/ positive). The HIA group presented a higher prevalence of healthy perfectionists and a lower prevalence of unhealthy perfectionists, in comparison with the group of students without a diagnosis of HIA. When comparing the average scores of APS-R and PNPS-12 between the ACI and the comparison group, statistically significant differences were found in high standards, order, discrepancy, positive and negative perfectionism. In all cases, the comparison group yielded higher mean scores than the HIA group. These results have clear implications in the understanding of the phenotypic expression of perfectionism related to excellence and optimal manifestation of the high intellectual potential.

El perfeccionismo es un constructo psicológico relacionado con la excelencia y una manifestación óptima de alta capacidad intelectual (ACI). El objetivo principal de este trabajo fue comparar las tipologías y dimensiones de perfeccionismo entre jóvenes de ACI y un grupo de comparación apareado por género y edad. Se seleccionaron 137 participantes con diagnóstico de ACI y un grupo de 137 de comparación apareado por género y edad. La media de edad fue de 11.77 años (DT = 1.99). Como herramientas se utilizaron la Almost Perfect Scale-Revised (APS-R) y la Escala de Perfeccionismo Positivo y Negativo 12 (PNPS-12). El análisis de conglomerados para la muestra total, identificó la presencia de tres agrupaciones de participantes (No perfeccionista, Perfeccionista no saludable/negativo, y Perfeccionista saludable/positivo). El grupo de ACI presentó una mayor prevalencia de perfeccionistas de tipo saludables y una menor prevalencia de perfeccionistas de tipo no saludable, en comparación con el grupo de alumnos sin diagnóstico de ACI. Cuando se compararon las puntuaciones medias de APS-R y PNPS-12 entre los grupos de ACI y grupo de comparación, se encontraron diferencias estadísticamente significativas en altos estándares, orden, discrepancia, perfeccionismo positivo y perfeccionismo negativo. En todos los casos el grupo de comparación presentó puntaciones medias mayores que el grupo de ACI. Estos resultados tienen implicaciones claras en la comprensión de la expresión fenotípica del perfeccionismo relacionado con la excelencia y la manifestación óptima del alto potencial intelectual.

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Management of rheumatoid arthritis (RA) in many Latin-American countries is impaired by fragmentation and scarce healthcare provision, resulting in obstacles to access, diagnosis, and treatment, and consequently in poor health outcomes. The aim of this study is to propose a comprehensive care program as a model to provide healthcare to RA patients receiving synthetic DMARDs in a Colombian setting by describing the model and its results. Health outcomes were prospectively collected in all patients entering the program. By protocol, patients are followed up during 24 months using a treat-to-target strategy with a patient-centered care (PCC) model, meaning that a patient should be seen by rheumatologist, physical and occupational therapist, physiatrist, nutritionist and psychologist, at least three times a year according to disease activity by DAS28. Otherwise, patients receive standard therapy. The incidence of remission and low disease activity (LDA) was calculated by periods of follow-up. A total of 968 patients entered the program from January 2015 to December 2016; 80.2% were women. At baseline, 41% of patients were in remission, 17% in LDA and 42% in MDS/SDA. At 24 months of follow-up, 66% were in remission, 18% in LDA and only 16% in MDS/SDA. Regarding DAS28, the mean at the beginning of the time analysis was 3.1 (SD 1.0) and after 24 months it was 2.4 (SD 0.7), showing a statistically significant improvement (p < 0.001). In all patients, the reduction of disease activity was 65% (95% CI, 58-71). Patients entering the PCC program benefited from a global improvement in disease activity in terms of DAS28.

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The document details Capital Expenditure that the Ministry of Health will undertake in the five year period 2019-2024.

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The implementation of excellence centers in specific diseases has been gaining recognition in the field of health; specifically in rheumatoid arthritis, where the prognosis of the disease is related to an early diagnosis and a timely intervention, it is necessary that the provision of health services is developed in an environment of quality, opportunity, and safety with the highest standards of care. A methodology that allows this implementation in such a way that is achievable by the most of the care centers is a priority to achieve a better attention to populations with this disease. In this paper, we propose a systematic and progressive methodology that will help all the institutions to develop successful models without faltering in the process. The expected impact on public health is defined by a better effective coverage of high-quality treatments, obtaining better health outcomes with safety and accessibility that reduces the budgetary impact for the health systems of our countries.

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