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Abstract Human development is influenced by the interaction between biological and social factors. This study aimed to verify the moderating effect of social risk on the relationship between biological risk and child development. Data were collected on 201 children, aged 6 to 72 months. The independent variable was measured by the biological risk index, and the moderator variable by the social risk index was assessed by the Denver II test. Linear regression, effect size, and analysis of moderation were used to verify the relationship between BRI and the child development (Denver II), and the moderating effect of the SRI. BRI was negatively associated with child development, the interaction between the BRI and SRI increased the explained variance in the Denver II result to 14%. The SRI was also a significant moderator of the Language and Gross Motor domains. This research evidence that social risk moderates the relationship between biological risk and child development, the more social risk factors, the stronger this relationship becomes. On the other hand, it can be said that some social factors favor child development, even in the presence of biological risk factors.

Resumo O desenvolvimento humano é influenciado pela interação entre fatores biológicos e sociais. Este estudo teve como objetivo verificar o efeito moderador do risco social na relação entre risco biológico e desenvolvimento infantil. Os dados foram coletados em 201 crianças, com idades entre 6 e 72 meses. A variável independente foi medida pelo índice de risco biológico, e a variável moderadora pelo índice de risco social. O desenvolvimento infantil foi avaliado por meio do teste Denver II. Regressão linear, tamanho do efeito e análise de moderação foram utilizados para verificar a relação entre IRB e o desenvolvimento infantil (Denver II) e o efeito moderador do IRS. O IRB associou-se negativamente ao desenvolvimento infantil, a interação entre o IRB e o IRS aumentou a variância explicada no resultado do Denver II para 14%. O IRS também foi um moderador significativo dos domínios Linguagem e Motor Grosso. Esta pesquisa evidenciou que o risco social é um moderador da relação entre risco biológico e desenvolvimento infantil; quanto mais fatores de risco social, mais forte essa relação se torna. Por outro lado, pode-se dizer que alguns fatores sociais favorecem o desenvolvimento infantil, mesmo na presença de fatores de risco biológicos.

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Resumen El aumento de la población de adultos mayores y su mayor demanda de atención en salud en Paraguay, requiere de una evaluación multidimensional que identifique sus condiciones de riesgo o deterioro. El objetivo de esta investigación, fue evaluar el estado de salud y nutrición de una muestra de adultos mayores que acudieron a la consulta ambulatoria del Hospital Geriátrico de la Previsional, en la Asunción, Paraguay. La investigación tuvo un diseño observacional, descriptivo y de corte transverso, de 108 adultos mayores a quienes se les realizó la Valoración Geriátrica Integral (VGI) y se evaluaron parámetros nutricionales. La edad promedio fue de 71 años con predominio del sexo femenino. De acuerdo al IMC, el 64% presentó sobrepeso u obesidad. De acuerdo a la VGI, 18% presentó riesgo nutricional, 43% dependencia leve para las actividades de la vida diaria y 12% para las actividades instrumentales. El 18% mostró déficit cognitivo, el 6% depresión y el 30% riesgo social. La población se caracterizó por presentar altas frecuencias de exceso de peso e hipertensión, con una baja frecuencia de riesgo de desnutrición, las mayores limitaciones se dieron en las actividades básicas de la vida diaria y en el riesgo social. El ser mujer y el exceso de peso se asociaron significativamente con las limitaciones básicas funcionales. Este trabajo constituyó uno de los primeros en el país sobre adultos mayores ambulatorios, permitiendo configurar una línea de base de las áreas comprometidas o en riesgo de declinación y desarrollar estrategias y acciones preventivas para promover un envejecimiento saludable.

Abstract The increase in the population of older adults and their more significant demand for health care in Paraguay requires a multidimensional evaluation to identify risks or deteriorating conditions. The objective of this research was to evaluate the health and nutrition status of a sample of older adults who attended the Geriatric Hospital of the Social Security for outpatient consultation. The research had a cross-sectional descriptive observational design, which included 108 older adults who underwent the Comprehensive Geriatric Assessment (CGA) and whose nutritional parameters were evaluated. Their average age was 71 years, with a predominance of females. According to their BMI, 64% were overweight or obese. As for the CGA, 18% presented a nutritional risk, 43% had mild dependence on activities of daily living and 12% on instrumental activities, 18% had a cognitive deficit, 6% had depression, and 30% had social risk. The population was characterized by a high prevalence of overweight and hypertension and a low frequency of risk of malnutrition. The most significant limitations were in the basic activities of daily life and social risk. Being female and being overweight were significantly associated with basic functional limitations. This work was one of the first in the country on ambulatory older adults, allowing the establishment of a baseline for areas where health is compromised or at risk of decline and the development of preventive strategies and actions to promote healthy aging.

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High social risk has been associated with mortality, but information on this relationship in remote rural communities is limited. Using the social determinants of health (SDH) specified in the Gijon's social-familial evaluation scale (SFES), we aimed to assess mortality risk according to levels of social risk in community-dwelling older adults living in rural Ecuador. Following a longitudinal population-based design, this study prospectively followed 457 individuals for an average of 8.2 ± 2.6 years. A total of 115 (25.2 %) individuals died during the study years. The mean Gijon's SFES score was 9.4 ± 2.8 points among survivors versus 12.3 ± 4 points among those who died (p < 0.001). Separate models using individual SDH components as exposures showed that deficits in family situation, social relationships and support networks were significantly associated with mortality, whereas economic status and housing factors were not. A Cox-proportional hazard model, with the Gijon's SFES score stratified in tertiles, showed a more than 5-fold increase in mortality among individuals in the third tertile compared with those in first and second tertiles, after adjusting for relevant covariates (HR: 5.36; 95 % C.I.: 3.09 - 9.32). Study results indicate an important contribution of high social risk to mortality, and may help to identify potential interventional targets that are focused on encouraging social interactions, and that may reduce mortality in older adults living in remote settings.

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RESUMEN Introducción: actualmente, el estudio de las relaciones del individuo con las condiciones de su trabajo resulta de gran interés. Objetivo: analizar la influencia de factores psicosociales de riesgo en el clima y estrés laboral de los trabajadores de un hospital básico en la ciudad de Ambato, en Ecuador. Materiales y métodos: estudio no experimental, transversal y prospectivo. A cincuenta trabajadores se le aplicaron tres encuestas: CoPsoq-istas21 (versión 2), cuestionario de clima laboral FOCUS-93 y el cuestionario para la evaluación del estrés (versión 3) de la Pontificia Universidad Javeriana. Se utilizaron la prueba de Chi-cuadrado de Pearson, con un nivel de significancia del 0,05, para descartar la hipótesis nula, y la regresión lineal curvilínea para determinar la influencia de los factores en las dos variables dependientes. Resultados: la estima (100 % de desfavorabilidad), las exigencias psicológicas (94 %) y la doble presencia (90 %) fueron los factores psicosociales peor calificados por los informantes. Solo el 40,5 % de los participantes consideraron su clima laboral como satisfactorio; y se registró en el 80 % de la población la presencia de síntomas fisiológicos y psicoemocionales provocados por el estrés. La inseguridad sobre el futuro y el apoyo social/calidad de liderazgo, fueron las subvariables que mayor número de inferencias estadísticas tuvieron con el estrés y el clima laboral. Conclusiones: los factores de riesgo psicosociales influyeron en la percepción negativa del clima laboral y en el incremento de la sintomatología del estrés.

ABSTRACT Introduction: currently, the study of the relationships between people and their work conditions are of great interest. Objective: to analyze the influence of risk psychosocial factors in the labor climate and stress of the workers of a basic hospital in the city of Ambato, Ecuador. Materials and methods: non-experimental, cross-sectional and prospective study. Three surveys were applied to 50 workers: the CoPsoQ-ista21 (version 2), the FOCUS-93 labor climate questionnaire, and the stress evaluation inventory of the Pontificia Universidad Javeriana (version 3). Pearson's Chi-square test, with a significance level of 0.05, was used to discard the null hypothesis, and curvilinear linear regression was used to determine the influence of the factors on the two dependent variables. Results: esteem (100 % unfavorableness), psychological demands (94 %) and double presence (90 %) were the psychosocial factors the informers rated worst. Only 40.5 % of the participants considered their work climate as satisfactory; and the presence of physiological and psycho-emotional symptoms caused by stress was recorded in 80 % of the population. Conclusions: psychosocial risk factors influenced the negative perception of the labor environment and the increase of stress symptoms.

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OBJECTIVE: To characterize the association of children's social risk factors with total number of emergency department (ED) visits or hospitalization and time to first subsequent ED or hospitalization. STUDY DESIGN: This was a retrospective cohort study of patients seen at a general pediatric clinic between 2017 and 2021 with documented ≥1 social risk factors screened per visit. Negative binomial or Poisson regression modeled ED utilization and hospitalizations as functions of the total number of risk factors or each unique risk factor. Time-varying Cox models were used to evaluate differences between those who screened positive and those who screened negative, controlling for demographic and clinical covariates. RESULTS: Overall, 4674 patients (mean age, 6.6 years; 49% female; 64% Hispanic; 21% Black) were evaluated across a total of 20 927 visits. Children with risk factors had higher rates of attention-deficit hyperactivity disorder, failure to gain weight, asthma, and prematurity compared with children with no risk (all P < .01). Adjusted models show a positive association between increased total number of factors and ED utilization (incidence rate ratio [IRR], 1.18; 95% CI, 1.12-1.23) and hospitalizations (IRR, 1.36; 95% CI, 1.26-1.47). There were no associations between a positive screen and time to first ED visit (hazard ratio [HR], 0.95; 95% CI, 0.85-1.06; P = .36) or hospitalization (HR, 1.15; 95% CI, 0.84-1.59; P = .40). CONCLUSIONS: Social risk factors were associated with increased ED utilization and hospitalizations at the patient level but were not significantly associated with time to subsequent acute care use. Future research should evaluate the effect of focused interventions on health care utilization, such as those addressing food insecurity and transportation challenges.

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AIM: To explore the influence of anxiety/depression symptoms and social risk in patients older than 65 years with type 2 diabetes mellitus (T2DM) both in non-adherence to pharmacological treatment (Non-AdhT) and in poor control of T2DM. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Adults over 65 years of age with T2DM treated at the Madrid Primary Care Service. MAIN MEASUREMENTS: Data collection: Electronic Health Record database. VARIABLES: Poor control of T2DM (HBA1c) and Non-AdhT (Morisky-Green test); main clinical variables: symptoms of depression/anxiety and social risk. Global multivariate logistic regression models and disaggregated by sex were used to Non-AdhT and poor T2DM control. RESULTS: Data were obtained on 884 subjects. Non-AdhT prevalence: 4.4%; prevalence of poor T2DM control: 37.2%. Multivariate logistic regression models for No-AdhT in men showed a higher risk if they had symptoms of anxiety/depression (OR: 3.88; 95%CI: 1.15-13.07); and in women, if they had social risk (OR: 5.61; 95%CI: 1.86-16.94). Multivariate logistic regression models for poor control of T2DM in men revealed a higher risk if they did not have AdhT (OR: 3.53; 95%CI: 1.04-12.02). CONCLUSIONS: In people over 65 years with T2DM, although Non-AdhT is low, the prevalence of poor T2DM control is high. Symptoms of depression or anxiety are a risk factor to Non-AdhT in men, while social risk has the same effect in women. Non-AdhT in men increases the risk of poor T2DM control. From a gender perspective, it is important to detect social and mental health problems in older adults with diabetes and to reinforce strategies to improve their adherence to drug treatment in these patients.

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BACKGROUND: Several studies have attempted to clarify the role of social determinants of health (SDH) on nutritional status of older adults, but results are inconsistent due to differences in SDH assessments at different levels of population development. In this study, we assessed this association in community-dwelling older adults living in rural Ecuador. Methods: SDH were measured by the Gijon's Social-Familial Evaluation Scale (SFES) and nutritional status by the Mini Nutritional Assessment (MNA®). Multivariate logistic regression models were fitted to assess the association between SDH components and nutritional status. Locally weighted scatterplot smoothing (LOWESS) and a generalized linear model were used to evaluate the potential non-linearity of the association between the Gijon's SFES and MNA® scores. RESULTS: A total of 295 individuals (mean age: 72.1 ± 7.6 years; 58% women) were enrolled. There was an inverse association between the total Gijon's SFES and nutritional status (OR: 0.75; 95% C.I.: 0.65-0.86; P < .001). Three of five components of the Gijon's SFES (family situation, social relationships, and support networks) were inversely associated with nutritional status in multivariate logistic regression models. A LOWESS plot, together with a generalized linear model, showed an inverse linear relationship between the continuous Gijon's SFES and MNA® scores. One standard deviation of increase in the continuous Gijon's SFES score (2.39 points) decreased the MNA® score by 0.78 points. CONCLUSION: Study results show a significant inverse association between high social risk and a good nutritional status. Components of the Gijon's SFES measuring social isolation are responsible for this association.

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OBJECTIVES: There is limited information on factors associated with poor cognitive performance in rural settings of Low- and Middle-Income Countries. Using the Three Villages Study Cohort, we assessed whether social determinants of health (SDH) play a role in cognitive performance among older adults living in rural Ecuador. METHODS: Atahualpa, El Tambo and Prosperidad residents aged ≥60 years received measurement of SDH by means of the Gijon Scale together with a Montreal Cognitive Assessment (MoCA). The association between SDH and cognitive performance (dependent variable) was assessed by generalized linear models, adjusted for demographics, years of education, cardiovascular risk factors, symptoms of depression and biomarkers of structural brain damage. RESULTS: We included 513 individuals (mean age: 67.9 ± 7.3 years; 58% women). The mean score on the Gijon scale was 9.9 ± 2.9 points, with 237 subjects classified as having a high social risk (≥10 points). The mean MoCA score was 19.6 ± 5.4 points. Locally weighted scatterplot smoothing showed an inverse linear relationship between SDH and MoCA scores. SDH and MoCA scores were inversely associated in linear models adjusted for clinical covariates (ß: -0.17; 95% C.I.: -0.32 to -0.02; p = 0.020), neuroimaging covariates (ß: -0.17; 95% C.I.: -0.31 to -0.03; p = 0.018), as well as in the most parsimonious model (ß: -0.16; 95% C.I.: -1.30 to -0.02; p = 0.026). CONCLUSIONS: Study results provide robust evidence of an inverse association between SDH and cognitive performance. Interventions and programs aimed to reduce disparities in the social risk of older adults living in underserved rural populations may improve cognitive performance in these individuals.

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RESUMO Um novo coronavírus, designado inicialmente como 2019-nCoV e pouco depois como Sars- CoV-2, surgiu em Wuhan, China, no final de 2019. Em janeiro de 2020, pelo menos 830 casos haviam sido diagnosticados em diversos países. O Sars-CoV-2 é o terceiro coronavírus a surgir na população humana nas últimas duas décadas - uma emergência que colocou as instituições globais de saúde pública em alerta máximo. Pouco mais de um ano depois, registram-se casos e óbitos na escala dos milhões no mundo, com o Brasil ocupando posição destacada tanto em número de casos quanto de óbitos. A sucessão de eventos desse período recente atualizou questões de grande importância: o esgarçamento civilizacional, a potencialização das vulnerabilidades de toda ordem e os riscos decorrentes. Neste ensaio, propõe-se uma reflexão sobre as consequências sociais da pandemia a partir de uma perspectiva socioantropológica, revisitando temas clássicos da saúde e das ciências sociais, como medo, risco e vulnerabilidade. Observou-se o recrudescimento de tendências e acirramento de tensões que fazem olhar o horizonte com preocupação, especialmente com relação à expansão de dispositivos de biopoder. Assim, o presente artigo associa-se ao esforço reflexivo em curso sobre efeitos potenciais da pandemia da Covid-19 sobre as formas de socialidade e as relações de poder no mundo atual.

ABSTRACT A new coronavirus, initially designated as 2019-nCoV and after that as SARS-CoV-2, emerged in Wuhan, China, in late 2019. By January 2020, at least 830 cases had been diagnosed in several countries. SARS-CoV-2 is the third coronavirus to emerge in the human population in the last two decades - an emergency that has set global public health institutions on high alert. A little more than a year later, cases and deaths are counted in millions worldwide, with Brazil holding a prominent position in the number of cases and deaths. The succession of events in this recent period brought up highly relevant issues: civilizational fraying, increased vulnerabilities, and resulting risks. In this essay, we propose some reflections on the social consequences of the pandemic from a socio-anthropological perspective, revisiting classic public health and social sciences themes such as fear, risk, and vulnerability. We observed resurging trends and escalating tensions, which leaves us with a horizon of great concern, especially regarding the expanding biopower devices. Thus, we join the ongoing reflexive effort on the potential effects of the COVID-19 pandemic on sociality and power relationship forms in today's world.

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A noção de periculosidade da infância pobre vem sendo construída, desde as políticas higienistas do início do século passado, figurando a escola, muitas vezes, como solução para a desigualdade social. Tratou-se de pesquisa qualitativo-descritiva, a partir de entrevistas individuais com trabalhadores de um Núcleo de Educação de Tempo Integral, acerca das crianças e adolescentes em situação de risco e vulnerabilidade social, a partir da teoria das Representações Sociais. Os discursos dos entrevistados descrevem as crianças e adolescentes como vítimas tanto da rua como de suas próprias famílias, percebidas como perigosas e negligentes. Emerge a imagem de uma escola que não apenas instrui e ensina, mas cuida e protege os alunos de uma realidade dura e cruel, alunos cujas famílias não apresentam condições adequadas de exercer o cuidado necessário. Concluindo, tal proteção é descrita como importante para a defesa da sociedade, pois as crianças e adolescentes pobres aparecem não como estando em risco social, mas como sendo o próprio risco.

The notion of dangerousness of poor childhood has been constructed, since the hygienist policies of the beginning of the last century, with school as often a solution to social inequality. This was a qualitative-descriptive research, based on individual interviews with workers of a Center for Full-time Education for children and adolescents at risk and social vulnerability, based on the theory of Social Representations. The interviewees' speeches describe children and adolescents as victims of both, the street and their own families, perceived as dangerous and negligent. Emerges the image of a school that not only instructs and teaches but takes care of and protects students from a harsh and cruel reality, students whose families do not have adequate conditions to exercise the necessary care. Thus, such protection is described as important for the defense of society, since poor children and adolescents appear not as being at social risk, but as the risk themselves.

La noción de peligrosidad de la infancia pobre se ha construido a partir de las políticas higienistas del siglo pasado en los cuales se ubica la escuela, a menudo, como una solución a la desigualdad social. Este fue un estudio cualitativo-descriptivo, a partir de entrevistas individuales con los empleados de un Núcleo de Educación de tiempo integral, sobre los niños y adolescentes en situación de riesgo y vulnerabilidad social, a partir de la teoría de las representaciones sociales. Los discursos de los encuestados describen los niños y adolescentes como víctimas tanto de la calle como de sus propias familias, percibidas como peligrosas y negligentes. Emerge la imagen de una escuela que no sólo instruye y enseña, pero cuida y protege a los estudiantes de una realidad dura y cruel, alumnos cuyas familias no presentan condiciones adecuadas de ejercer el cuidado necesario. En conclusión, esta protección es descrita como importante para la defensa de la sociedad, porque los niños y adolescentes pobres no configuran como personas en situación de riesgo social, mas como sendo ellos el propio riesgo.

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Este artigo analisa os sentidos atribuídos ao jovem configurado pela atual política pública brasileira de aprendizagem profissional e como operam as tecnologias de governo do indivíduo na produção da noção de risco social. Trata-se de um estudo documental com base na teoria de leitura de Mikhail Bakhtin, na qual se analisam os enunciados objetivando a sua desnaturalização. Um conjunto de normativas atinentes a essa política foi selecionado, lido e analisado enquanto textos e intertextos a produzir uma rede dialógica complexa que evidencia o posicionamento do Estado em relação ao significado de ser aprendiz, o qual envolve a noção de proteção social, portanto direcionado ao público alvo da política de assistência social. O sentido da identidade do jovem considerado de risco é o principal alvo da política, que regulamenta o trabalho antes dos 18 anos identificando-o como aprendiz. O estudo evidencia o caráter normativo e regulador desse processo, embora a esfera social seja complexa e requeira uma revisão constante. Diante da naturalização do conceito de juventude constatado, as políticas públicas voltadas para o jovem apresentam-se contraditórias e distantes das demandas específicas desta população. Este estudo aponta para a necessidade de problematizar os sentidos da proteção social para o jovem e para a sociedade, bem como os seus efeitos, especialmente na política de aprendizagem profissional, a qual não afeta somente o seu destinatário, mas a toda a sociedade, uma vez que atua na fabricação de um modelo identitário e gesta a existência dos indivíduos objetivando sua conformação.(AU)

This article analyses the meanings attributed to the young person as seen by Brazilian public policy of professional apprenticeship and how the government technologies of the individual work on the production of the concept social risk. It is a documental study based on Mikhail Bakhtin's reading theory, in which utterances are analysed aiming at their denaturalisation. A set of norms regarding this policy has been selected, read and analysed as texts and intertexts, producing a complex dialogic web and casting light on the positioning of the state government concerning the meaning of apprentice and social protection, therefore directed to the target audience of this social care policy. The meaning of the identity of the youth seen as at risk is the main target of this policy, which regulates work before the age of 18, identifying the young person as an apprentice. This study evinces the characteristics of this process as normative and regulatory, although the social sphere is complex, requiring constant revision. Considering the naturalisation of the meaning of youth, the public policies for the young person are presented as contradictory and distant from the specific needs of this population. This study shows the necessity to problematize the meanings of social care for youth and for society, and its effects, particularly regarding the policy for professional apprenticeship, which affects not only its receiver, but also the whole society, since it acts on the fabrication of an identity model and manages the existence of the individuals, aiming at their conformity.(AU)

Este articulo analiza los sentidos atribuidos al joven configurado por la actual política pública brasilera de aprendizaje profesional y cómo operan las tecnologias de gobierno del individuo en la producción de la noción de riesgo social. Es un estudio documental basado en la teoría de lectura Bajtiniana, que analiza los enunciados buscando su desnaturalización. Un conjunto de normativas referidas a esa política fueron analizados como textos e intertextos que producen una red dialógica compleja que evidencia el posicionamiento del Estado en relación al significado de ser aprendiz, el cual involucra la noción de protección social, por lo tanto direccionado al público objeto de la política de asistencia social. El sentido de la identidad del joven considerado en riesgo es el principal objetivo de la política, que reglamenta el trabajo antes de los 18 años identificándolo como aprendiz. El estudio evidencia el caracter normativo y regulador de ese proceso aunque la esfera social sea compleja y requiera una revisión constante. Delante de la naturalización del concepto de juventud constatado, las políticas públicas volcadas hacia el joven se presentan contradictorias y distantes de las demandas específicas de ésta población. Este estudio apunta la necesidad de problematizar los sentidos de la protección social para el joven y la sociedad, también como sus efectos, especialmente en la política de aprendizaje profesional, la cual no afecta solamente su destinatario, sino a toda la sociedad, una vez que actua en la fabricación de un modelo identitario y gesta la existencia de los indivíduos buscando su conformación.(AU)

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ANTECEDENTES Y OBJETIVO En el contexto actual de pandemia por el SARS-CoV-2, el Sistema de Protección Integral a la Infancia Chile Crece Contigo requiere evaluar la situación de gestantes, niños y niñas para prevenir riesgos psicosociales durante las cuarentenas. Por ello, se encuentran buscando herramientas que tengan como objetivo detectar o evaluar vulneración de derechos o experiencias psicosociales adversas durante situaciones de emergencia. En este contexto el Departamento de Gestión de los Cuidados solicita esta síntesis de evidencia con el objetivo de identificar herramientas aplicadas en situaciones de crisis, emergencia y desastres a niños, niñas y gestantes, de esta manera informar a la toma de decisiones. METODOLOGÍA Se formularon estrategias de búsqueda en las bases de datos PubMed, EMBASE, Epistemonikos y Social System Evidence para identificar revisiones sistemáticas que abordaran la pregunta formulada. Como las RS no siempre reportaron adecuadamente los resultados, se extrajeron los datos de los estudios primarios incluidos en las RS. Se incluyeron todo tipo de herramientas (escalas, pautas, cuestionarios, listas de verificación, etc.) que fueran aplicadas a mujeres gestantes niños, niñas y adolescentes de entre 0 a 15 años, con el objetivo de detectar situaciones de vulneración de derechos como violencia física, psicológica y sexual. Los criterios de exclusión iniciales corresponden a excluir escalas para evaluar el riesgo suicida en niñas, niños y adolescentes en contextos de no emergencia y estudios de prevalencia de trastornos mentales. Además, se excluyeron revisiones que comparan la efectividad de hacer screening versus no hacerlo. No se analizaron comparadores de ningún tipo. RESULTADOS Se utilizó una revisión sistemática, de la cual se obtuvieron los siguientes resultados: -Se identificaron dos tipos de herramientas enfocadas en evaluar la salud sexual y reproductiva (planificación familiar, salud materna y violencia de género) y abuso sexual contra niños, niñas y mujeres en situaciones de emergencia. -La evidencia encontrada proviene de contextos de conflicto armado, campamento de refugiados y guerras.

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BACKGROUND: Tuberculosis (TB) is one of the top 10 causes of death worldwide; in 2016, over 95% of TB deaths occurred in low- and middle-income countries. Although the incidence and deaths from TB have decreased in Brazil in recent years, the disease has increased in the vulnerable population, whose diagnosis is more delayed and the chances for abandonment and deaths are significantly higher. This study aimed to identify high-risk areas for TB mortality and evidence their social determinants through a sensitive tailored social index, in a context of high inequality in South Brazil. METHODS: A multistep statistical methodology was developed, based on spatial clustering, categorical principal components analysis, and receiver operating characteristic curves (ROC). This study considered 138 spatial units in Curitiba, South Brazil. TB deaths (2008-2015) were obtained from the National Information Mortality System and social variables from the Brazilian Human Development Atlas (2013). RESULTS: There were 128 TB deaths recorded in the study: the mortality rate was 0.9/100,000 inhabitants, minimum-maximum: 0-25.51/100,000, with a mean (standard deviation) of 1.07 (2.71), and 78 space units had no deaths. One risk cluster of TB mortality was found in the south region (RR=2.64, p=0.01). Considering the social variables, several clusters were identified in the social risk indicator (SRI): income (899.82/1752.94; 0.024), GINI Index (0.41/0.45; 0.010), and overcrowding (25.07/15.39; 0.032). The SRI showed a high capacity to discriminate the TB mortality areas (area under ROC curve 0.865, 95% CI: 0.796-0.934). CONCLUSIONS: A powerful risk map (SRI) was developed, allowing tailored and personalised interventions. The south of Curitiba was identified as a high-risk area for TB mortality and the majority of social variables. This methodological approach can be generalised to other areas and/or other public health problems.

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OBJETIVO: Determinar la prevalencia de caries temprana de la infancia en niños en riesgo social y analizar sus factores de riesgo asociados. MÉTODO: Se realizó un estudio descriptivo de corte transversal con 246 niños de 24 a 71 meses de edad, reclutados de 13 barrios marginales, en Santiago, Chile. Se utilizó un cuestionario para obtener información sobre etnia, peso al nacer, edad y educación de la madre, uso de biberón nocturno, cepillado de dientes y visitas dentales. La caries temprana de la infancia fue registrada de acuerdo a la definición aceptada por la Academia Americana de Pediatría Dental. Se utilizó un análisis de regresión logística múltiple para investigar la influencia de los factores de riesgo en la experiencia de caries. RESULTADOS: La prevalencia de caries temprana de la infancia fue de un 63%. Los análisis bivariados mostraron asociaciones entre etnicidad, educación de la madre, uso de biberón nocturno, visitas dentales y caries temprana de infancia. El modelo multivariado final, mostró que los niños cuyas madres tenían un bajo nivel de educación tenían mayores probabilidades de desarrollar caries temprana de la infancia. CONCLUSIÓN: Los niños estudiados tuvieron una alta prevalencia de caries temprana de la infancia, siendo la educación de la madre, el determinante más importante.

OBJECTIVE: The aim of the present study was to evaluate the prevalence of early childhood caries (ECC) among children at social risk and to analyze its associated determinants. METHOD: A cross-sectional study with 246 children aged 24 to 71 months, recruited from 13 different slums, below the poverty line, in Santiago, Chile was performed. An interviewer-administered questionnaire was used to obtain information from the parents on ethnicity, birth weight, mother's age and education, night bottle feeding, tooth brushing and dental visits. Early childhood caries was defined using the American Academic of Pediatric Dentistry criteria. Multiple logistic regression analysis with a stepwise selection procedure was used to investigate the influence of risk factors on the early childhood caries experience. RESULTS: The prevalence of early childhood caries was 63%. Bivariate analyses showed associations among ethnicity, mother's education, bottle feeding at night, dental visits and caries experience. The final multivariate model showed that children whose mothers had a low level of education were more likely to develop early childhood caries. CONCLUSIONS: The children at social risk studied had a high prevalence of early childhood caries, with the education of the mother as the most important determinant.

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Resumen Objetivo: Analizar la relación entre habilidades para la vida y riesgos vitales en adolescentes escolarizados. Método: Esta es una investigación cuantitativa descriptiva-correlacional, en la que se aplicó la escala de habilidades para la vida de Díaz, Rosero, Melo y Aponte (2013), y se diseñó un cuestionario de identificación de riesgos vitales y una ficha de caracterización. La muestra fueron 107 estudiantes (adolescentes entre 12 y 17 años) de 9°, 10° y 11° de bachillerato de una institución educativa pública de la ciudad de Armenia, y fueron seleccionados a través de un muestreo no probabilístico. Resultados: En las habilidades para la vida prevalecen: empatía (65,4 %), toma de decisiones (57,9 %), solución de problemas y conflictos (62,6 %). Los riesgos psicosociales identificados son: relacional (81,3 %), intergrupal (95,3 %), personal (97,2 %), psicológico (96,3 %), y comunitarios (96,3 %). Existe correlación entre manejo de sentimientos y emociones, tensiones y estrés con regulación emocional y reconocimiento de fuentes de estrés (p=0,566); manejo de tensiones y estrés, y comunicación efectiva y asertiva con humildad y estrategias específicas (p=0,5) como respirar profundamente y tener pensamientos saludables (p=0,605). Conclusiones: Una relación sana con los padres mejora sus habilidades para la vida, pero disminuye el reconocimiento de riesgos en el hogar y el ambiente; interacciones conflictivas con los padres afectan las habilidades para la vida; manejar sentimientos y emociones se relaciona con la regulación y expresión emocional, así, quien aprehende afectivamente a explorar su vida emocional tiene mejores habilidades para identificarlas, implementarlas y expresarlas al momento de tomar decisiones.

Abstract Objective: This paper aims to analyze the relationship between life skills and vital risks in adolescents who attend school. Method: This is a quantitative correlational descriptive-research; in this research a scale based on life skills by Diaz, Rosero, Melo and Aponte (2013) was applied, and also a vital risk identification questionnaire and a sheet of characterization were designed. 107 from ninth, tenth and eleventh grade students (adolescents aged 12-17) of a public high school from Armenia (Col) through a non-probabilistic were selected and sampled. Results: As result, life skills such as: empathy (65,4 %), decision-making (57,9 %), problem and conflict solving (62,6 %). Identified psychosocial risks are, as follows: relational (81,3 %), intergroup (95,3 %), staff (97,2 %), psychological (96,3 %), community (96,3 %). There is a correlation between feelings and emotions, tensions and stress with emotional regulation and recognition of sources of stress management (p = 0,566); tension and stress management, and effective and assertive communication with humility (p = 0,5) and specific strategies such as breathing deeply and thinking healthy thoughts (p = 0,605). Conclusions: A healthy relationship with parents improves life skills, but the recognition of risks at home and the environment decreases. Conflicting interactions with parents affect life skills. To cope with feelings and emotions is related with regulation and emotional expression, thus, who apprehends affectionately to explore on its own emotional life, has better skills to identify, implement and express them when making decisions.

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The unregulated oil exploitation in the Northern Ecuadorian Amazon Region (NEAR), mainly from 1964 to the 90's, led to toxic compounds largely released into the environment. A large majority of people living in the Amazon region have no access to drinking water distribution systems and collects water from rain, wells or small streams. The concentrations of major ions, trace elements, PAHs (polycyclic aromatic hydrocarbons) and BTEX (benzene, toluene, ethylbenzene, xylenes) were analyzed in different water sources to evaluate the impacts of oil extraction and refining. Samples were taken from the NEAR and around the main refinery of the country (Esmeraldas Oil Refinery/State Oil Company of Ecuador) and were compared with domestic waters from the Southern region, not affected by petroleum activities. In most of the samples, microbiological analysis revealed a high level of coliforms representing significant health risks. All measured chemical compounds in waters were in line with national and international guidelines, except for manganese, zinc and aluminum. In several deep-water wells, close to oil camps, toluene concentrations were higher than the natural background while PAHs concentrations never exceeded individually 2 ng·L-1. Water ingestion represented 99% of the total exposure pathways for carcinogenic and non-carcinogenic elements (mainly zinc) in adults and children, while 20% to 49% of the Total Cancer Risk was caused by arsenic concentrations. The health index (HI) indicates acceptable chronic effects for domestic use according the US-EPA thresholds. Nevertheless, these limits do not consider the cocktail effects of metallic and organic compounds. Furthermore, they do not include the social determinants of human exposure, such as socio-economic living conditions or vulnerability. Most (72%) of interviewed families knew sanitary risks but a discrepancy was observed between knowledge and action: religious beliefs, cultural patterns, information sources, experience and emotions play an important role front to exposure.

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Resumen El presente artículo de investigación plantea que la administración se ha constituido en un mecanismo tecnocientífico, generador de riesgo social; se parte de la visión en la que la ciencia y la técnica están plenamente vinculadas en el campo administrativo, enmarcadas en las condiciones y <avances> de la sociedad actual, lo cual hace que sus reflexiones y prácticas se sumen a los otros factores generadores de riesgo que se han venido configurando en el ámbito social, algunas de las cuales ya han sido estudiadas. En este sentido, se desarrolla una investigación interpretativa, cualitativa y de tipo exploratorio, fundamentada en la revisión narrativa. Al analizar la literatura se encuentra que existen algunas aproximaciones al respecto, desde otros enfoques, pero no se hallan trabajos que desarrollen explícitamente la concepción de la administración como mecanismo tecnocientífico y como factor generador de incertidumbre, con las consecuencias indeterminadas que puede tener para la sustentabilidad. Códigos JEL: L20, M14, O15, Z13.

Abstract This paper states that the management has become a techno-scientific mechanism, generator of social risk. It is based on the perspective in which science and technology are fully linked in the management field, framed in the conditions and 'advances' of today's society which means that their reflections and practices add to the other factors that generate social risk, some of which have been studied. The research is of an interpretative, qualitative and exploratory type, based on the narrative review. When analyzing the literature it is found that there are some approaches in relation to the subject, from other approaches, but there are no works that explicitly develop the conception of the management as a techno-scientific mechanism and as a generator of uncertainty with the indeterminate consequences that may have for sustainability Classification: L20, M14, O15, Z13.

Resumo O presente artigo de pesquisa afirma que a administração se tornou um mecanismo tecnocientífico, gerador de risco social; Baseia-se na visão em que a ciência e a tecnologia estão plenamente ligadas no campo administrativo, enquadradas nas condições e 'avanços' da sociedade atual, o que faz com que suas reflexões e práticas se somem aos demais fatores que geram risco que se configuraram no campo social, alguns dos quais já foram estudados. Nesse sentido, desenvolve-se uma pesquisa interpretativa, qualitativa e exploratória, baseada na revisão narrativa. Ao analisar a literatura é que há algumas aproximações sobre isso de outras abordagens, mas não funciona dessa desenvolver explicitamente o conceito de gestão como mecanismo de tecno-científica e factor de incerteza gerador com conseqüências indeterminadas ele pode ter para a sustentabilidade são. Classificações JEL: L20, M14, O15, Z13.

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Resumen El propósito de este estudio fue evaluar un modelo predictivo de sintomatología postraumática aguda (SPT) y de crecimiento post-estrés (CPE) en trabajadores que sufrieron un accidente laboral reciente. Se encuestaron 246 trabajadores (23.2% mujeres) entre los 18 y los 73 años. Se encontró que los principales predictores de la SPT son: severidad subjetiva del evento, afrontamiento religioso negativo, reinterpretación positiva y rumiación de tipos intrusiva, negativa y deliberada. A su vez, los principales predictores de CPE fueron: rumiación deliberada y afrontamiento religioso positivo. Se realizó un análisis de sendero para evaluar un modelo en el cual la rumiación intrusiva y la deliberada cumplen una función mediadora, obteniendo adecuados índices de ajuste. Se plantea la necesidad de contar con un método de evaluación temprana de las respuestas psicológicas tras un accidente.

Abstract The aim of this study is to evaluate a predictive model of acute posttraumatic symptomatology (PTS) and post-stress growth (PSG) in workers who suffered a recent work accident. To this end, 246 workers (23.2% women) were surveyed, aged between 18 and 73 years. The main predictors of PTS were subjective severity of event, negative religious coping, positive reinterpretation, and intrusive, brooding and deliberate rumination. At the same time, the main predictors of PSG were deliberate rumination and positive religious coping. A path analysis was performed to evaluate a model in which intrusive and deliberate rumination fulfill a mediating function, obtaining adequate goodness-of-fix indices. The need to have a method of early evaluation of psychological responses after an accident is proposed.

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Resumen Un estudio de corte transversal realizado entre 2012-2014 en adultos autónomos de Bogotá, mostró una prevalencia de 23% de demencia, encontrándose asociada con baja escolaridad, edad avanzada e hipertensión arterial. La relación de estos factores de riesgo con la progresión del dete rioro cognitivo no ha sido estudiada en nuestra población. Objetivo: evaluar la asociación entre factores de riesgo cardiometabólicos o sociales con la progresión a deterioro cognitivo leve (DCL) o demencia, en adultos autónomos de Bogotá. Material y métodos: una cohorte de sujetos normales y con DCL, del estudio de 2012-2014, se revaluó aplicándose el protocolo neuropsiquiátrico y neuropsicológico del estudio anterior. Se realizaron análisis de correspondencia múltiple y de regresión logística. Resultados: se revaluaron 215 adultos autónomos, 118 sujetos habían sido diagnosticados con cognición normal y 97 con DCL en el primer estudio; 73% fueron mujeres con edad promedio de 71(DE:7.3) años y escolaridad de 8.2 (DE: 5.4) años. Progresaron a demencia 6% de los sujetos en un tiempo de 4(DE:1) años. Un 75% de sujetos normales permaneció sin cambio y 22% progresó a DCL; mientras que 65% de sujetos con DCL no tuvo cambios y un 25% se normalizó. Progresar de normal a DCL se asoció con baja escolaridad OR=2.43 (IC95% 1.004-5.91; p=0.049) y de DCL a demencia con IMC<25 OR=6.3 (IC95% 1.26-31; p=0.025). Conclusión: tener baja escolaridad (<5 años) se asoció en los sujetos normales con un mayor riesgo de progresión a DCL, mientras que tener un IMC <25 aumentó el riesgo de progresión a demencia en los sujetos con DCL. No identificamos factores protectores en los sujetos que se nor malizaron. (Acta Med Colomb 2019; 44: 66-74).

Abstract A cross-sectional study carried out between 2012-2014 in autonomous adults of Bogotá showed a 23% prevalence of dementia, being associated with low schooling, advanced age and arterial hy pertension. The relationship between these risk factors and the progression of cognitive deterioration has not been studied in our population. Objective: to evaluate the association between cardio-metabolic or social risk factors with the progression to mild cognitive impairment (MCI) or dementia, in autonomous adults of Bogotá. Material and methods: a cohort of normal subjects with MCI, from the 2012-2014 study was re-evaluated applying the neuropsychiatric and neuropsychological protocol of the previous study. Multiple correspondence and logistic regression analyzes were performed. Results: 215 autonomous adults were re-evaluated; 118 subjects had been diagnosed with normal cognition and 97 with MCI in the first study; 73% were women with an average age of 71 (SD: 7.3) years and schooling of 8.2 (SD: 5.4) years. 6% of the subjects progressed to dementia in a time of 4 (SD: 1) years. 75% of normal subjects remained unchanged and 22% progressed to MCI while 65% of subjects with MCI did not change and 25% normalized. Progressing from normal to MCI was associated with low schooling OR = 2.43 (95% CI 1.004-5.91; p = 0.049) and from MCI to dementia with BMI≤25 OR = 6.3 (IC95% 1.26-31; p = 0.025). Conclusion: having low schooling (≤5 years) was associated in normal subjects with a higher risk of progression to MCI, while having a BMI ≤25 increased the risk of progression to dementia in subjects with MCI. Protective factors in subjects who normalized were not identified. (Acta Med Colomb 2019; 44: 66-74).

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