RESUMEN Objetivo. Estimar la prevalencia del tracoma en poblaciones indígenas y no indígenas en determinadas zonas del estado de Maranhão, en el nordeste de Brasil. Métodos. Se trató de una encuesta de ámbito poblacional con muestreo probabilístico. Para el diagnóstico del tracoma, se realizó un examen ocular externo con una lupa frontal de 2,5X aumentos. Se estimó la prevalencia de la inflamación tracomatosa folicular (TF) en la población infantil de 1 a 9 años y la prevalencia de la triquiasis tracomatosa (TT) en la población de 15 años o más. Se obtuvieron las frecuencias relativas de las características sociodemográficas y ambientales. Resultados. En el estudio participaron 7 971 personas, 3 429 de poblaciones no indígenas y 4 542 de poblaciones indígenas. La prevalencia de la TF en las poblaciones no indígenas e indígenas fue de 0,1% y 2,9%, respectivamente, en tanto que la de la TT en las poblaciones indígenas fue de 0,1%. Conclusiones. La prevalencia de la TF y la TT en las dos unidades de evaluación del estado de Maranhão estuvo dentro de los límites recomendados para la eliminación del tracoma como problema de salud pública. Sin embargo, la prevalencia de la TF fue mayor en la unidad de evaluación indígena, lo que indica una mayor vulnerabilidad de esta población a la enfermedad. La prevalencia de la TF inferior al 5,0% implica una reducción de la transmisión, que puede haber sido consecuencia tanto de la mejora de las condiciones socioeconómicas como de la aplicación de la estrategia SAFE de la Organización Mundial de la Salud.

ABSTRACT Objective. To estimate the prevalence of trachoma in indigenous and non-indigenous populations in selected areas of the state of Maranhão, in northeastern Brazil. Methods. This was a population-based survey with probabilistic sampling. For the diagnosis of trachoma, external ocular examination was performed using head magnifying loupes, at 2.5X magnification. The prevalence of trachomatous inflammation – follicular (TF) in children aged 1–9 years and the prevalence of trachomatous trichiasis (TT) in the population aged ≥15 years were estimated. Relative frequencies of sociodemographic and environmental characteristics were obtained. Results. The study included 7 971 individuals, 3 429 from non-indigenous populations and 4 542 from indigenous populations. The prevalence of TF in non-indigenous and indigenous populations was 0.1% and 2.9%, respectively, and the prevalence of TT among indigenous populations was 0.1%. Conclusions. The prevalence of TF and TT in the two evaluation units in the state of Maranhão were within the limits recommended for the elimination of trachoma as a public health problem. However, the prevalence of TF was higher in the indigenous evaluation unit, indicating a greater vulnerability of this population to the disease. The prevalence of TF of below 5.0% implies a reduction in transmission, which may have resulted from improved socioeconomic conditions and/or the implementation of the World Health Organization SAFE strategy.

RESUMO Objetivo. Estimar a prevalência do tracoma em populações indígenas e não indígenas em áreas selecionadas do estado do Maranhão, na região Nordeste do Brasil. Métodos. Inquérito de base populacional com amostragem probabilística. Para o diagnóstico de tracoma, foi realizado exame ocular externo com o auxílio de lupas binoculares com ampliação de 2,5×. Foram estimadas a prevalência de inflamação tracomatosa folicular (TF) em crianças de 1 a 9 anos de idade e a prevalência de triquíase tracomatosa (TT) na população com idade ≥15 anos. Foram obtidas as frequências relativas das características sociodemográficas e ambientais. Resultados. O estudo incluiu 7 971 indivíduos (3 429 de populações não indígenas e 4 542 de populações indígenas). A prevalência de TF nas populações não indígenas e indígenas foi de 0,1% e 2,9%, respectivamente, e a prevalência de TT entre as populações indígenas foi de 0,1%. Conclusões. A prevalência de TF e TT nas duas unidades de avaliação no estado do Maranhão ficou dentro dos limites recomendados para a eliminação do tracoma como problema de saúde pública. No entanto, a prevalência de TF foi maior na unidade de avaliação indígena, indicando uma maior vulnerabilidade dessa população à doença. A prevalência de TF abaixo de 5,0% implica uma redução na transmissão, que pode ter sido resultado de melhores condições socioeconômicas e da implementação da estratégia SAFE da Organização Mundial da Saúde.

Resumo A avaliação de perguntas de questionário de inquérito de saúde no Brasil limita-se, na maioria das vezes, aos testes-piloto e debriefing das entrevistas. O objetivo do presente artigo é contribuir para preencher essa lacuna ao apresentar uma metodologia de avaliação cognitiva para identificação de perguntas potencialmente “problemáticas” quanto à sua formulação e o que ocorre, na interação entrevistador-entrevistado, ao aplicá-las em entrevistas com o uso de questionário padronizado em um inquérito regional de saúde. O estudo utilizou dois roteiros padronizados para identificação de dificuldades de redação e/ou compreensão e avaliação da interação entrevistador-entrevistado. Dentre as 513 perguntas do questionário individual de pesquisa, 68 questões foram indicadas como sendo potencialmente problemáticas à compreensão e comunicação pelos entrevistados. As perguntas que apresentaram problemas na sua formulação, com maior pontuação (>40), foram aquelas relacionadas à quantificação de tempo; ao grau de dificuldade para o autocuidado; à situação no trabalho e à estimação do rendimento. Dentre as perguntas apontadas como problemáticas na avaliação pelo Sistema de Apreciação de Perguntas (SAP), o autocuidado e horas trabalhadas estão entre aquelas que também tiveram pontuação alta na avaliação da interação.

Abstract The evaluation of health survey questions in Brazil is limited, in most cases, to pilot tests and interview debriefing. The purpose of this article is to contribute to filling this gap by presenting a cognitive assessment methodology for identifying potentially “problematic” questions regarding their formulation and what happens in the interviewer-interviewee interaction, when applying them in interviews using the standardized questionnaire in a regional health survey. In this study, two standardized scripts were used to identify difficulties in writing and/or understanding and evaluating the interviewer-interviewee interaction. Among the 513 questions in the individual research questionnaire, 68 questions were indicated as being potentially problematic for the interviewees to understand and communicate. The questions that presented problems in their formulation, with the highest score (>40), were those related to the quantification of time; the degree of difficulty for self-care; work situation and income estimation. Among the questions identified as problematic in the evaluation by the Question Appraisal System (SAP), self-care and hours worked are among those that also scored high in the interaction evaluation.

Abstract The evaluation of health survey questions in Brazil is limited, in most cases, to pilot tests and interview debriefing. The purpose of this article is to contribute to filling this gap by presenting a cognitive assessment methodology for identifying potentially “problematic” questions regarding their formulation and what happens in the interviewer-interviewee interaction, when applying them in interviews using the standardized questionnaire in a regional health survey. In this study, two standardized scripts were used to identify difficulties in writing and/or understanding and evaluating the interviewer-interviewee interaction. Among the 513 questions in the individual research questionnaire, 68 questions were indicated as being potentially problematic for the interviewees to understand and communicate. The questions that presented problems in their formulation, with the highest score (>40), were those related to the quantification of time; the degree of difficulty for self-care; work situation and income estimation. Among the questions identified as problematic in the evaluation by the Question Appraisal System (SAP), self-care and hours worked are among those that also scored high in the interaction evaluation.

Resumo A avaliação de perguntas de questionário de inquérito de saúde no Brasil limita-se, na maioria das vezes, aos testes-piloto e debriefing das entrevistas. O objetivo do presente artigo é contribuir para preencher essa lacuna ao apresentar uma metodologia de avaliação cognitiva para identificação de perguntas potencialmente “problemáticas” quanto à sua formulação e o que ocorre, na interação entrevistador-entrevistado, ao aplicá-las em entrevistas com o uso de questionário padronizado em um inquérito regional de saúde. O estudo utilizou dois roteiros padronizados para identificação de dificuldades de redação e/ou compreensão e avaliação da interação entrevistador-entrevistado. Dentre as 513 perguntas do questionário individual de pesquisa, 68 questões foram indicadas como sendo potencialmente problemáticas à compreensão e comunicação pelos entrevistados. As perguntas que apresentaram problemas na sua formulação, com maior pontuação (>40), foram aquelas relacionadas à quantificação de tempo; ao grau de dificuldade para o autocuidado; à situação no trabalho e à estimação do rendimento. Dentre as perguntas apontadas como problemáticas na avaliação pelo Sistema de Apreciação de Perguntas (SAP), o autocuidado e horas trabalhadas estão entre aquelas que também tiveram pontuação alta na avaliação da interação.

Abstrato Introdução: O sobrepeso e a obesidades ao considerados uma epidemia que afeta a população de todas as idades. As características presentes nas díades da mãe e do filho na escola, como a sensibilidade à recompensa por comer demais e dependência alimentar, podem ser potenciais reguladores do peso corporal. Objetivo: Conhecer a influência da sensibilidade à recompensa, o vício no alimento e o estado nutricional materno na sensibilidade e à recompensa, o vício no alimento e o estado nutricional da criança. Metodologia: Desenho descritivo-correlacional. Amostra composta por 218 díades. O peso e a estatura foram medidos, um cartão de dados socio-demographic foi aplicado e quatro instrumentos de medição. Os dados foram capturados e analisados usando o SPSS. Resultados: O 69,3% das mães presentavam sobrepeso e obesidade, nas crianças 27,9%. Eles relatara malta sensibilidade à recompensa (38,4 e 40,4), médias mais altas naqueles com sobrepeso e obesidade (p <0,001). 13,8% das mães e 8,3% das filhos tinham dependência alimentar. Mães e crianças com dependência alimentar tivera um maior e score de sensibilidade à recompensa (p <0,001). O índice de massa corporal, a sensibilidade à recompensa e a dependência alimentar da mãe influenciaram o índice de massa corporal da criança (p <0,005). Conclusões: Essas características da mãe estariam presentes nos filhos, poderiam aumentar com o aumento da idade, persistir na ida de adulta e serem transmitidas a os futuros filhos.

Introduction: Overweight and obesity are considered an epidemic that affects the population of all ages. The characteristics present in the mother and school age children dyads such as sensitivity to the reward upon eating in excess and the addiction to food can be potential regulators of body weight. Objective: Understand the influence of sensitivity to rewards, addiction to food and the maternal nutritional status in regard to sensitivity to rewards, addiction to food and nutritional status of children. Methodology: Descriptive-correlational design. Sample composed by 218 pairs. Weight and size were measured, applying a sociodemographic data card, as well as four measurement instruments. The data was captured and analyzed throughout SPSS. Results: 69.3% of the mothers were overweight and obese, and 27.9% of the children. They reported high sensitivity to reward (38.4 and 40.4), and mean higher in those overweight and obese (p < .001). 13.8% of mothers and 8.3% of the children presented addiction to food. Mothers and children with addiction to food showed a higher score of sensitivity to reward (p < .001). The body mass index, sensitivity to reward and addiction to food on the mothers’ behalf influenced the body mass index of the child (p < .005). Conclusions: These maternal characteristics would be present in children, they can increase according to age, persist into adult age and be transmitted towards their future children.

Resumen Introducción: El sobrepeso y la obesidad se consideran una epidemia que afecta a la población de todas las edades. Las características presentes en las diada madre e hijo escolar como la sensibilidad a la recompensa al comer en exceso y la adicción a la comida pueden ser potenciales reguladores del peso corporal. Objetivo: Conocer la influencia de la sensibilidad a la recompensa, la adicción a la comida y estado nutricio materno sobre la sensibilidad a la recompensa, la adicción a la comida y estado nutricio del hijo. Metodología: Diseño descriptivo-correlacional. Muestra conformada por 218 diada. Se midió el peso y talla, se aplicó una cédula de datos sociodemográficos, y cuatro instrumentos de medición. Los datos se capturaron y analizaron mediante el SPSS. Resultados: El 69.3% de las madres presentaron sobrepeso y obesidad, en los hijos el 27.9%. Reportaron alta sensibilidad a la recompensa (38.4 y 40.4), medias mayores en aquellos con sobrepeso y obesidad (p < .001). El 13.8% de las madres y el 8.3% de los hijos presentaron adicción a la comida. Madres e hijos con adicción a la comida presentaron mayor puntaje de sensibilidad a la recompensa (p < .001). El índice de masa corporal, sensibilidad a la recompensa y adicción a la comida de la madre influyeron sobre el índice de masa corporal del hijo (p < .005). Conclusiones: Estas características de la madre estarían presentes en los niños, podrían aumentar conforme aumenta la edad, persistir en la edad adulta y ser trasmitidas hacia sus futuros hijos.

ABSTRACT Introduction : Difficult cannulation in cases of endoscopic retrograde cholangiopancreatography (ERCP) could be associated with several factors, including: type of major papilla, however, there are limited data regarding this possible association. Objectives : To determine the association between the type of papilla and difficult biliary cannulation. Materials and methods : A retrospective cross-sectional analytical study was conducted in patients over 18 years old who underwent ERCP on papilla naive, from July 2019 to April 2021, in a private institution. Unsuccessful cannulations were excluded. The papilla was classified based on Haraldsson classification. The crude association and adjusted for possible confounders between the type of papilla and difficult cannulation was evaluated. Relative risks (RR) and 95% confidence intervals were calculated. Results : 188 patients were included. The mean age was 55 years, 66% female. The most frequent indication was choledocholithiasis with 88.5%. The most frequent type of major duodenal papilla was type 1 (32%), followed by type 3 (27%), type 2 (25%) and type 4 (16%). Type 2, 3, 4 papillae showed a significant relationship with difficult cannulation compared to type 1 (p<0.001, p<0.001 and p=0.008 respectively). The indication other than choledocholithiasis also showed a significant relationship with difficult cannulation (p<0.001). In the adjusted analysis, the RR for difficult cannulation compared to type 1 papilla was: 2.51 (95% CI 1.23-5.94) for type 2 papilla, 3.72 (95% CI 1.79-7.71) for papilla type 3 and 3.41 (95% CI 1.54-7.71) for type 4. The indication other than choledocholithiasis was also associated with a higher risk of difficult cannulation with a RR of 2.36 (95% CI 1.57-3.56). The fistulotomy type precut was used more frequently in the type 3 papilla (46%), while the use of cannula was more frequent in the type 4 papilla (29.6%). Conclusions : Papilla types 2, 3 and 4 are associated with a higher risk of difficult cannulation. This should be considered when performing ERCP in order to reduce the risk of complications.

RESUMEN Introducción : La canulación difícil en casos de colangiopancreatografía retrógrada endoscópica (CPRE) podría asociarse a diversos factores incluyendo el tipo de papila mayor, sin embargo, existen datos limitados con respecto a esta posible asociación. Objetivos : Determinar la asociación entre el tipo de papila y la canulación biliar difícil. Materiales y métodos : Se realizó un estudio retrospectivo transversal analítico en pacientes mayores de 18 años en quienes se realizó CPRE en papila virgen, de julio 2019 a abril 2021, en una institución privada. Se excluyeron las canulaciones frustras. La papila fue clasificada en base a la clasificación de Haraldsson. Se evaluó la asociación cruda y ajustada a posibles confusores entre el tipo de papila y canulación difícil. Se calcularon los riesgos relativo (RR) e intervalos de confianza al 95%. Resultados : Se incluyeron 188 pacientes. La edad media fue 55 años, el 66% de sexo femenino. La indicación más frecuente fue coledocolitiasis con 88,5%. El tipo de papila duodenal mayor más frecuente fue el tipo 1 (32%), seguido de tipo 3 (27%), tipo 2 (25%) y tipo 4 (16%). Las papilas tipo 2, 3, 4 presentaron una relación significativa con canulación difícil comparadas con la tipo 1 (p<0,001, p<0,001 y p=0,008 respectivamente). La indicación diferente a coledocolitiasis también mostró una relación significativa con canulación difícil (p<0,001). En el análisis ajustado, El RR para canulación difícil en comparación con la papila tipo 1 fue: de 2,51 (IC 95% 1,23-5,94) para la papila tipo 2, 3,72 (IC 95% 1,79-7,71) para la papila tipo 3 y 3,41 (IC 95% 1,54-7,71) para la tipo 4. La indicación distinta a la coledocolitiasis también se asoció a un mayor riesgo de canulación difícil con un RR de 2.36 (IC95% 1,57-3,56). El precorte tipo fistulotomía fue usado con mayor frecuencia en la papila tipo 3 (46%) mientras que el uso de canulótomo fue más frecuente en la papila tipo 4 (29,6%). Conclusiones : Los tipos de papila 2, 3 y 4, están asociados a mayor riesgo de canulación difícil. Ello debe ser considerado al momento de realizar la CPRE a fin de reducir el riesgo de complicaciones.

ABSTRACT Introduction: arterial hypertension is a health problem with high prevalence worldwide, considered one of the main cardiovascular risk factors, being a very frequent reason for consultation, both in primary care and in emergency services. Objective: to determine the Therapeutic effectiveness of two homeopathic remedies in the treatment of Hypertensive Urgency and the comparison of these remedies. Method: quasi-experimental study of 60 patients with Hypertensive Urgency in the Emergency Department of the José Martí Cast of the "Marta Abreu" polyclinic, between January 2018 and December 2018. Patients with characteristics from the homeopathic point of view of Lachesis and Aconitum were chosen and they were also randomly divided into each of the remedies in a study group that applied the homeopathic remedy to the (200CH); 5 sublingual drops every 10 minutes and another control with Captopril (25 mg) 1 tablet in both cases the blood pressure was taken systematically. Results: the ages of 50 to 60 years and the female sex predominated, in addition in both remedies the BP was reduced fundamentally at 45 minutes in both the study group and the control group, the adverse effect in the study groups that prevailed was burning in the tongue and cough in the control groups. Conclusions: it was evidenced that the homeopathic remedies studied are effective in the Treatment of Hypertensive Urgency, lowering blood pressure as well as Captopril with minimal undesirable effects in relation to conventional treatment.

RESUMEN Introducción: la hipertensión arterial es un problema de salud con alta prevalencia en todo el mundo, está considerada uno de los principales factores de riesgo cardiovascular y es motivo de consulta muy frecuente tanto en la atención primaria como en los servicios de urgencias. Objetivo: determinar la efectividad terapéutica de dos remedios homeopáticos en el tratamiento de la urgencia hipertensiva. Métodos: estudio cuasi experimental de 60 pacientes con urgencia hipertensiva que acudieron al Servicio de Urgencia del Policlínico “Marta Abreu” del Reparto “José Martí” entre enero y diciembre de 2018. Se escogieron pacientes con características desde el punto de vista homeopático de Lachesis y Aconitum, se dividieron de forma aleatoria en cada uno de los remedios en un grupo estudio al que se le aplicó el remedio homeopático a la 200 centesimal hahnemanniana: cinco gotas sublinguales cada 10 minutos y otro control con captopril (25mg), una tableta; en ambos casos se le tomó la presión arterial sistemáticamente. Resultados: predominaron las edades de 50 a 60 años y el sexo femenino, además en ambos remedios se redujo la presión arterial a los 45 minutos tanto en el grupo estudio como en el grupo control, el efecto adverso en el grupo estudio fue el ardor en la lengua y en el grupo control la tos. Conclusiones: los remedios homeopáticos estudiados son efectivos en el tratamiento de la urgencia hipertensiva y disminuyen la presión arterial tanto como el captopril, con efectos indeseables mínimos con relación al tratamiento convencional.

In parks and green areas of the district of Trujillo we can watch diverse birds of wild origin. Before its foundation, Trujillo was a carob forest, a situation that changed with the pass of the years. The obtaining of firewood and coal as an energy source, the change of land use for intensive agriculture and disorganized urbanism were the cause of its destruction, without considering the approach of sustainable cities over time. In order to assess the presence of wild birds associated with the flora and the urban environment, we conducted visits through thirty parks in the district of Trujillo and green areas of some public institutions. Using the method of sampling by points, in each green area, and according to the size, five observation points were defined by park, in which we stayed for 10 minutes, making the auditory and photographic record of the species; and of the flora related to the ornithofauna according to their way of life (herbs, shrubs, vines, climbers and trees). A total of 47 bird species were recorded, as well as 224 species of plants used as ornamentals, including 28 native ones, mainly herbs, shrubs and trees, which in one way or another, the birds find favorable conditions for feeding, resting and nesting. The varied existing flora allows the presence of birds from different communities, constituting a recreational attraction for people; we suggest to promote the planting of native species and their conservation

En parques y áreas verdes del distrito de Trujillo, se observan diversas aves de origen silvestre. Antes de su fundación, Trujillo era un bosque de algarrobo, situación que fue cambiando con el devenir de los años. La obtención de leña y carbón como fuente de energía, el cambio de uso del suelo para la agricultura intensiva y el urbanismo desordenado fueron la causa de su destrucción, sin considerar el enfoque de ciudades sostenibles en el tiempo. Con el objetivo de evaluar la presencia de las aves silvestres asociadas con la flora y el ámbito urbano, se realizaron recorridos por treinta parques del distrito de Trujillo y áreas verdes de algunas instituciones públicas. Utilizando el método de muestreo por puntos, en cada área verde, y en función al tamaño, se definieron cinco puntos de observación por parque, en los cuales se permaneció 10 minutos, realizando el registro auditivo y fotográfico de las especies; y de la flora relacionada con la ornitofauna según su forma de vida (hierbas, arbustos, bejucos, trepadoras, apoyantes y árboles). Se registraron un total de 47 especies de aves. Asimismo, 224 especies de plantas utilizadas como ornamentales, incluidas 28 nativas, principalmente hierbas, arbustos y árboles, que de una u otra forma, las aves encuentran las condiciones favorables para alimentación, descanso y anidamiento. La variada flora existente permite la presencia de aves de diferentes comunidades, constituyéndose en un atractivo recreacional para las personas; se sugiere promover la siembra de especies nativas y su conservación

ABSTRACT The current structure of the Spanish State of Autonomies is characterized by institutional pluralism and the autonomy of the different public administra tions. In this context, the principle of coordination is fundamental for the co hesion of the system, but experience shows that its implementation is difficult. This paper examines the set of actions carried out by the administrations in re lation to an occupational and public health problem raised in March 2016. The Public Health General Direction of Aragon’s Government was informed of a possible use of brake linings with asbestos to manufacture axles for agricultu ral machinery by a Company from Zaragoza; the collaboration from Aragon’s Institute of Occupational Safety and Health, the Industry Department and the Labour and Social Security Inspectorate were asked; the joint action of the se administrations detected the use of several models of brake linings with a content of 2-5% of Chrysotile. The brake linings came from a Chinese com pany. The axles nated are sold in several Spanish Autonomous Communities. A national alert was activated by the SIRIPQ (System of Rapid Exchange of Information on Chemical Products) which is coordinated by the Ministry of Health, Social Services and Equality. Several measures were taken including: ceasing the work with the brake linings, the replacement of brake linings with asbestos, the immobilization of brake linings in the company by application of the REACH Reglament, etc. This case shows that the cooperation and co-responsibility of public administrations from different territorial, sectoral and competence areas allows improving the occupational risks prevention and the public health.

RESUMEN La actual estructura del Estado de las Autonomías se caracteriza por el pluralismo institucional y la autonomía de las diferentes administraciones públicas. En este contexto el principio de coordinación es fundamental para la cohesión del Estado, pero la experiencia muestra que es difícil su puesta en práctica. En este trabajo se examinó el conjunto de actuaciones realizado por las administraciones en relación a un problema de salud laboral y de salud pública planteado en marzo de 2016. La Dirección General de Salud Pública del Gobierno de Aragón tuvo conocimiento de la posible utilización por una empresa de Zaragoza de zapatas de freno con amianto para fabricar ejes de maquinaria agrícola. Se recabó la colaboración del Instituto Arago nés de Seguridad y Salud Laboral (ISSLA), del Departamento de Industria y de la Inspección de Trabajo y Seguridad Social, dichas administraciones detectaron la utilización de varios modelos de zapatas con un contenido de crisotilo del 2-5%. Las zapatas procedían de una empresa china. Los ejes eran comercializados en varias Comunidades Autónomas. Se activó una alerta nacional a través del SIRIPQ (Sistema de Intercambio Rápido de In formación de Productos Químicos) coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad. Se tomaron medidas tales como el cese del trabajo con las zapatas, la sustitución de las ya instaladas mediante la aplica ción de un Plan Único de Trabajo, la inmovilización de las zapatas presentes en la empresa, etc. Este caso muestra que la cooperación y la corresponsabi lidad de administraciones públicas de diferentes ámbitos territoriales, secto riales y competenciales permite mejorar la prevención de riesgos laborales.

ABSTRACT The current structure of the Spanish State of Autonomies is characterized by institutional pluralism and the autonomy of the different public administra tions. In this context, the principle of coordination is fundamental for the co hesion of the system, but experience shows that its implementation is difficult. This paper examines the set of actions carried out by the administrations in re lation to an occupational and public health problem raised in March 2016. The Public Health General Direction of Aragon’s Government was informed of a possible use of brake linings with asbestos to manufacture axles for agricultu ral machinery by a Company from Zaragoza; the collaboration from Aragon’s Institute of Occupational Safety and Health, the Industry Department and the Labour and Social Security Inspectorate were asked; the joint action of the se administrations detected the use of several models of brake linings with a content of 2-5% of Chrysotile. The brake linings came from a Chinese com pany. The axles nated are sold in several Spanish Autonomous Communities. A national alert was activated by the SIRIPQ (System of Rapid Exchange of Information on Chemical Products) which is coordinated by the Ministry of Health, Social Services and Equality. Several measures were taken including: ceasing the work with the brake linings, the replacement of brake linings with asbestos, the immobilization of brake linings in the company by application of the REACH Reglament, etc. This case shows that the cooperation and co-responsibility of public administrations from different territorial, sectoral and competence areas allows improving the occupational risks prevention and the public health.

RESUMEN La actual estructura del Estado de las Autonomías se caracteriza por el pluralismo institucional y la autonomía de las diferentes administraciones públicas. En este contexto el principio de coordinación es fundamental para la cohesión del Estado, pero la experiencia muestra que es difícil su puesta en práctica. En este trabajo se examinó el conjunto de actuaciones realizado por las administraciones en relación a un problema de salud laboral y de salud pública planteado en marzo de 2016. La Dirección General de Salud Pública del Gobierno de Aragón tuvo conocimiento de la posible utilización por una empresa de Zaragoza de zapatas de freno con amianto para fabricar ejes de maquinaria agrícola. Se recabó la colaboración del Instituto Arago nés de Seguridad y Salud Laboral (ISSLA), del Departamento de Industria y de la Inspección de Trabajo y Seguridad Social, dichas administraciones detectaron la utilización de varios modelos de zapatas con un contenido de crisotilo del 2-5%. Las zapatas procedían de una empresa china. Los ejes eran comercializados en varias Comunidades Autónomas. Se activó una alerta nacional a través del SIRIPQ (Sistema de Intercambio Rápido de In formación de Productos Químicos) coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad. Se tomaron medidas tales como el cese del trabajo con las zapatas, la sustitución de las ya instaladas mediante la aplica ción de un Plan Único de Trabajo, la inmovilización de las zapatas presentes en la empresa, etc. Este caso muestra que la cooperación y la corresponsabi lidad de administraciones públicas de diferentes ámbitos territoriales, secto riales y competenciales permite mejorar la prevención de riesgos laborales.

Introduction: Renal failure (RF) is a post cardiac transplantation predictor of morbimortality. The combined cardiorenal transplant (CCRTx) in cardiac transplantation (CTx) candidates with chronic renal disease is a therapeutic option. Our aim was to evaluate the CCRTx follow up outcomes in a single Centre. Material and methods: Between 2/1993 and 12/2014 we performed 442 CTx. Since 2006, 20 patients (p) underwent CCRTx using allografts from the same donor. The inclusion criteria were: RF with CrCl d" 40 mil/min or dialysis requirement in CTx candidates. All p received Thymoglobulin and immunosuppression with tacrolimus, mycophenolate mofetil and steroids.Median follow up: 46 months (7-96). Results: Mean age: 58±7 years, 85% were male. Mean Creatinine (Cr): 3,1±2,5 mg/dl and ClCr 27,5+10 mil/min. Three p required dialysis during the pre-transplantation phase and 4 p were under chronic dialysis. Etiologies: cardiomyopathies: coronary 10 p, noncoronary 9 p and re CTx, 1 p; nephropathies: nephroangiosclerosis 5 p, cardiorenal syndrome 10 p, diabetes 2 p, glomerulopathy 1 p, polycystosis 1 p and toxic nephritis 1 p. At 30 days and 1 year post CCRTx, Cr was 1,2±0,4 mg/dl and 1,1±0,2 mg/dl respectively. In-hospital mortality was 3/20 p (15%), 2 p due to sepsis and 1 p due to cardiac graft failure. Late mortality 5/17 p (29 %), 4p due to sepsis and 1 p due to liver sarcoma. Survival at 1 and 3 years was 76 and 72%, respectively. Conclusions: In our series CCRTx was a safe and effective treatment for CTx candidates with CrCl < 40 ml/min.

Introducción: La insuficiencia renal (IR) es predictor de morbimortalidad postrasplante cardíaco (TxC). El trasplante cardiorenal (TxCR) combinado en candidatos a TxC con enfermedad renal severa, es una opción terapéutica. Nuestro objetivo es evaluar los resultados y seguimiento del TxCR en un único Centro. Material y métodos: Entre febrero de 1993 y diciembre de 2014 se realizaron 442 TxC. Desde el año 2006 se efectuaron TxCR con único donante en 20 pacientes (p). Los criterios de selección fueron: IR con ClCr d" 40 mil/min o requerimiento de diálisis en candidatos a TxC. Todos los p recibieron timoglobulina e inmunosupresión con tacrolimus, micofenolato mofetil y esteroides. La mediana de seguimiento fue 46 meses (7-96). Resultados: Edad media 58±7 años y 85% eran hombres. La creatinina (Cr) media 3,1±2,5 mg/dl y ClCr 27,5+10 mil/min. Requirieron diálisis 3p en el período pre trasplante y 4p se encontraban en diálisis crónica. Etiología de miocardiopatías dilatadas: coronaria 10p, no coronaria 9p y reTxC 1p; nefropatías: nefroangioesclerosis 5p, síndrome cardiorenal 10p, diabetes 2p, glomerulopatía 1p, poliquistosis 1p y nefritis tóxica 1p. La Cr a 30 días y a 1 año del TxCR fue 1,2±0,4 mm/dl y 1,1±0,2 mg/dl respectivamente. La mortalidad hospitalaria fue de 3/20p (15%), 2p por sepsis y 1p por falla del injerto cardíaco. Mortalidad alejada 5/17p (29%), 4p por sepsis y 1p por sarcoma hepatocelular. La supervivencia a 1 y 3 años fue del 76 y 72%. Conclusiones: En nuestra serie el TxCR fue un tratamiento seguro y eficaz en candidatos a TxC y con ClCr < 40 mil/min.

O presente estudo objetivou descrever as características dos óbitos que tiveram como causa básica a hanseníase, registrados no Sistema de Informações sobre Mortalidade (SIM), e comparar estas características entre os grupos de óbitos cujos casos foram notificados e não notificados no Sistema de Informação sobre Agravos de Notificação (Sinan). Foram incluídos os óbitos com causa básica hanseníase, ocorridos no Brasil no período 2004-2009, e os casos registrados de hanseníase entre 1975-2010. Realizou-se o relacionamento probabilístico das bases do SIM e Sinan. Dos 1.463 óbitos por hanseníase registrados no SIM, 44,2% não foram encontrados no Sinan. Do total dos óbitos, a maioria foi de homens (72,5%), com 60 ou mais anos de idade (56,6%), ocorridos em hospitais (65,3%) e com assistência (45,8%). Dos 820 óbitos identificados no Sinan, 92% foram multibacilares, 45,2% tinham alta por cura no Sinan e 38,9%, óbito. Foram encontrados óbitos por hanseníase que estão registrados no SIM, mas não foram notificados no Sinan. O relacionamento das bases permitiu identificação de subregistros e inconsistências entre os sistemas.

This study sought to describe the characteristics of deaths with leprosy as the underlying cause recorded in the Mortality Information System (SIM) and compare these characteristics with the groups of cases where the cause of death was reported, or failed to be reported, in the National Case Registration Database (Sinan). Deaths with leprosy as the underlying cause occurring in Brazil in the 2004-2009 period, and cases of leprosy from 1975 to 2010 were included. The probabilistic bases of SIM and Sinan were compared. Of the 1,463 deaths from leprosy recorded in SIM, 44.2% were not recorded in Sinan. Of the total number of deaths, the majority were men (72.5%), aged 60 or older (56.6%), occurring in hospitals (65.3%) and with due care (45.8%). Of the 820 deaths identified in Sinan, 92% were patients with multibacillary disease, 45.2% were discharged as cured by Sinan and 38.9% died. Deaths due to leprosy were found on SIM that were not notified to Sinan. The data base linkage enabled identification of ancillary records and inconsistencies between the systems.

O presente estudo objetivou descrever as características dos óbitos que tiveram como causa básica a hanseníase, registrados no Sistema de Informações sobre Mortalidade (SIM), e comparar estas características entre os grupos de óbitos cujos casos foram notificados e não notificados no Sistema de Informação sobre Agravos de Notificação (Sinan). Foram incluídos os óbitos com causa básica hanseníase, ocorridos no Brasil no período 2004-2009, e os casos registrados de hanseníase entre 1975-2010. Realizou-se o relacionamento probabilístico das bases do SIM e Sinan. Dos 1.463 óbitos por hanseníase registrados no SIM, 44,2% não foram encontrados no Sinan. Do total dos óbitos, a maioria foi de homens (72,5%), com 60 ou mais anos de idade (56,6%), ocorridos em hospitais (65,3%) e com assistência (45,8%). Dos 820 óbitos identificados no Sinan, 92% foram multibacilares, 45,2% tinham alta por cura no Sinan e 38,9%, óbito. Foram encontrados óbitos por hanseníase que estão registrados no SIM, mas não foram notificados no Sinan. O relacionamento das bases permitiu identificação de subregistros e inconsistências entre os sistemas.

This study sought to describe the characteristics of deaths with leprosy as the underlying cause recorded in the Mortality Information System (SIM) and compare these characteristics with the groups of cases where the cause of death was reported, or failed to be reported, in the National Case Registration Database (Sinan). Deaths with leprosy as the underlying cause occurring in Brazil in the 2004-2009 period, and cases of leprosy from 1975 to 2010 were included. The probabilistic bases of SIM and Sinan were compared. Of the 1,463 deaths from leprosy recorded in SIM, 44.2% were not recorded in Sinan. Of the total number of deaths, the majority were men (72.5%), aged 60 or older (56.6%), occurring in hospitals (65.3%) and with due care (45.8%). Of the 820 deaths identified in Sinan, 92% were patients with multibacillary disease, 45.2% were discharged as cured by Sinan and 38.9% died. Deaths due to leprosy were found on SIM that were not notified to Sinan. The data base linkage enabled identification of ancillary records and inconsistencies between the systems.

This paper presents an implementation of Artificial Neural Networks (ANN) for acoustic fingerprints recognition, applied to the identification of marine vessels. In many cases, the vessel recognition process from an audible signal is performed by human operators, which could lead to failures in the identification process. Before entering the ANN classification process, the signal is filtered and its spectral characteristics are extracted. A comparison of the classification process between three types of neural networks is presented.