Abstract Objective: The objective of the study was to analyze the differences between survivors and non-survivors with non-reperfused ST-segment elevation myocardial infarction (STEMI) and to identify the predictors of in-hospital mortality. Methods: A retrospective cohort study included non-reperfused STEMI patients from October 2005 to August 2020. Patients were classified into survivors and non-survivors. We compared patient characteristics, treatments, and outcomes among the groups and identified factors associated with in-hospital mortality. Results: We included 2442 patients with non-reperfused STEMI and we found a mortality of 12.7% versus 7.2% in reperfused STEMI. The main reason for non-reperfusion was delayed presentation (96.1%). Non-survivors were older, more often women, and had diabetes, hypertension, or atrial fibrillation. The left main coronary disease was more frequent in non-survivors as well as three-vessel disease. Non-survivors developed more in-hospital heart failure, reinfarction, atrioventricular block, bleeding, stroke, and death. The main predictors for in-hospital mortality were renal dysfunction (HR 3.41), systolic blood pressure < 100 mmHg (HR 2.26), and left ventricle ejection fraction < 40% (HR 1.97). Conclusion: Mortality and adverse outcomes occur more frequently in non-reperfused STEMI. Non-survivors tend to be older, with more comorbidities, and have more adverse in-hospital outcomes.

Resumen Objetivo: Analizar las diferencias entre los sobrevivientes y no sobrevivientes con infarto agudo de miocardio no reperfundido y conocer los predictores de mortalidad intrahospitalaria. Métodos: Estudio de cohorte retrospectiva que incluyó pacientes con infarto agudo de miocardio no reperfundido de octubre de 2005 a agosto de 2020. Se clasificaron los pacientes de acuerdo a su estado de sobrevida y se compararon las características clínicas, tratamientos y desenlaces para poder identificar los predictores de mortalidad intrahospitalaria. Resultados: Se incluyeron 2442 pacientes con infarto agudo de miocardio no reperfundido, en los que se encontró una mortalidad de 12.7% vs 7.2% los que si recibieron tratamiento de reperfusión. La principal razón para no recibir tratamiento de reperfusión fue el retraso en la atención médica (96.1%). Los no sobrevivientes tuvieron mayor edad, fueron mujeres y tuvieron mayor frecuencia de diabetes, hipertensión y fibrilación atrial. El tronco de la coronaria izquierda y la enfermedad trivascular fueron más frecuentes en los que no sobrevivieron. Los pacientes que no sobrevivieron desarrollaron más insuficiencia cardiaca, reinfarto, bloqueo atrioventricular, sangrados, evento vascular cerebral y muerte. Los principales predictores de mortalidad intrahospitalaria fueron: insuficiencia renal (HR 3.41), tensión arterial sistólica al ingreso < 100 mmHg (HR 2.26) y fracción de eyección del ventrículo izquierdo < 40% (HR 1.97). Conclusiones: Los pacientes con infarto de miocardio no reperfundido tienen mayor mortalidad y desenlaces adversos. Los no sobrevivientes fueron mayores, con más comorbilidades y desarrollaron más desenlaces adversos intrahospitalarios.

SUMMARY OBJECTIVE: COVID-19 has brought emerging public health emergency and new challenges. It configures a complex panorama that has been requiring a set of coordinated actions and has innovation as one of its pillars. In particular, the use of digital tools plays an important role. In this context, this study presents a screening algorithm that uses a machine learning model to assess the probability of a diagnosis of COVID-19 based on clinical data. METHODS: This algorithm was made available for free on an online platform. The project was developed in three phases. First, an machine learning risk model was developed. Second, a system was developed that would allow the user to enter patient data. Finally, this platform was used in teleconsultations carried out during the pandemic period. RESULTS: The number of accesses during the period was 4,722. A total of 126 assistances were carried out from March 23, 2020, to June 16, 2020, and 107 satisfaction survey returns were received. The response rate to the questionnaires was 84.92%, and the ratings obtained regarding the satisfaction level were higher than 4.8 (on a 0–5 scale). The Net Promoter Score was 94.4. CONCLUSION: To the best of our knowledge, this is the first online application of its kind that presents a probabilistic assessment of COVID-19 using machine learning models exclusively based on the symptoms and clinical characteristics of users. The level of satisfaction was high. The integration of machine learning tools in telemedicine practice has great potential.

Abstract Cognitive impairment and depression are common conditions during aging and may be associated with age, however, several studies indicate that they usually occur together and the coexistence of these two pathologies decrease the quality of life in the elderly. The objective of this study was to analyze the relationship between depression and cognitive impairment in older adults. For which a bibliographic review was carried out through the analysis of research published in journals that are part of the Scopus, ScienceDirect, Elsevier and PubMed database, from 2015 to 2021. The studies reviewed showed that depression and deterioration have both a direct (one intervenes in the other) and an indirect relationship, there are common associated factors such as age, concomitant diseases, psychosocial and biological factors. All this affects the well-being of the elderly and currently it is about mitigating this effect with protection and help programs for the elderly.

Resumen El deterioro cognitivo y la depresión son padecimientos frecuentes durante el envejecimiento y pueden estar asociados a la edad; sin embargo, varios estudios indican que suelen presentarse de manera conjunta y la coexistencia de estas dos patologías disminuyen la calidad de vida en la tercera edad. El objetivo del presente trabajo fue analizar la relación entre depresión y deterioro cognitivo en los adultos mayores, para lo cual se efectuó una revisión bibliográfica mediante el análisis de investigaciones publicadas en revistas que son parte de la base de datos como Scopus, ScienceDirect, Elsevier y PubMed, desde el año 2015 hasta el 2021. Los estudios revisados mostraron que la depresión y el deterioro tienen una relación, tanto directa (una interviene en la otra), como indirecta, y que a su vez, existen factores asociados en común como la edad, enfermedades concomitantes, factores psicosociales y biológicos. Todo esto afecta el bienestar del adulto mayor y en la actualidad se trata de mitigar este efecto con programas de protección y ayuda en la tercera edad.

Abstract Introduction: In the COVID-19 pandemic context, the TraceCOVID-19 online platform was created. Additionally, a daily phone call, made by family doctors or nurses, was recommended by the government’s Directorate-General of Health for all the patients who were suspected of, or infected by, SARS-CoV-2. With the rising number of suspected cases of the disease, it was essential to reduce the need for contacts to the strictly needed, centralizing the monitoring on the patients themselves and breaking the Inverse Care Law. Objectives: To create a call center that would facilitate the COVID-19 patients’ monitoring, reducing the need for daily contacts, and allowing healthcare professionals to choose a contact periodicity based on the patients’ symptoms, risk factors, and diagnostic test results forecast. To place the patients at the center of care, promoting their autonomy. Method: Creation and parameterization of an online call center through the Amazon Connect® solution; creation and sharing of a protocol based on this monitoring model with all of Almada-Seixal’s primary healthcare professionals; creation of a shared Excel® worksheet for internal organization and definition of contact periodicity. Results: The project was active from the 26th of April to the 15th of July 2020. During this period, it was possible to reduce daily contacts by 58.5%. The most frequently chosen contact periodicity was a call every three days. The call center received an average of 52 telephone calls per day. Discussion/Conclusion: The existence of a call center allowed the extension of the interval between contacts, reduced the medical and nursing team workhours dedicated to the TraceCOVID-19 monitoring, and freed human resources that became available to resume other healthcare activities. It was possible to optimize the clinical monitoring model for COVID-19 patients, based on proximity and patient-centered care.

Resumo Introdução: No âmbito da pandemia COVID-19 foi criada a plataforma TraceCOVID-19, preconizando a Direção-Geral da Saúde o contacto telefónico diário de todos os doentes suspeitos ou infetados por SARS-CoV-2 pelas equipas de família. Com o crescente número de casos suspeitos era essencial reduzir a necessidade de contactos ao mínimo indispensável, centralizando a vigilância nos próprios doentes e contrariar a Lei dos Cuidados Inversos. Objetivos: Criar um call center que facilitasse as tarefas de acompanhamento dos doentes em TraceCOVID-19, diminuindo a necessidade de contactos diários e permitindo aos profissionais de saúde a escolha de uma periodicidade de vigilância consoante o estado do doente/data prevista do resultado de teste de diagnóstico. Colocar o doente no centro da decisão do seu estado de saúde, promovendo a sua autonomia. Método: Criação e parametrização de um call center através da solução Amazon Connect®; criação e divulgação, por todos os profissionais do ACeS Almada-Seixal, de um protocolo baseado neste modelo de vigilâncias; criação de uma folha Excel® partilhada para organização interna e definição de periodicidades de contacto. Resultados: O projeto decorreu entre 26 de abril e 15 de julho de 2020. Durante este período foi possível reduzir os contactos realizados diariamente em 58,5%, sendo a periodicidade de vigilância de três em três dias a mais escolhida pelos profissionais. O call center recebeu em média 52 chamadas telefónicas por dia. Discussão/Conclusão: A existência de um call center permitiu alargar o intervalo entre contactos, reduzir as horas de trabalho médicas e de enfermagem dedicadas a vigilâncias TraceCOVID-19, libertando recursos humanos que ficaram disponíveis para retomar a restante atividade assistencial. Foi possível otimizar o modelo de acompanhamento clínico de doentes COVID-19, tendo por base um atendimento de proximidade, centrado no doente.

ABSTRACT The proposals for teaching mathematics are very complex and have been over time, at the upper basic level, where there are more complex phases that the student must deal with. The intention of this document was to determine what the teachers of the mathematics area of two public schools think about Piaget´s psychology in the education of mathematics in students and thus validate a doctoral proposal of the main author of this article. The research was carried out with a cross-section of the month of January and March 2021, through a study with a quantitative approach. A survey with 10 items was applied to the total population, that is, the convenience sample was used, which consisted of 36 people from the two educational units. Cronbach's alpha resulted in 0.9. It was concluded that the hypothesis that teachers do use Piaget's principles in their teachings, but not enough, since the highest indicators barely reached 57.8%, it was also found that in the correlational analysis, the formal operational variable it has an impact of 85.5% on mathematics education.

RESUMEN Las propuestas de enseñanza de la matemática son muy complejas y lo han sido a lo largo del tiempo, en el nivel básico superior, en donde se presentan fases más complejas con las que el estudiante debe lidiar. La intención de este documento fue la de determinar lo que piensan los docentes del área de matemáticas de dos escuelas públicas sobre psicología Piagetana en la educación de la matemática en estudiantes y con ello validar una propuesta doctoral de la autora principal de este artículo. La investigación se hizo con un corte transversal del mes de enero y marzo del 2021, a través de un estudio de enfoque cuantitativo. Se aplicó una encuesta con 10 ítems al total de una población, es decir, se emplea la muestra por conveniencia, que fueron 36 personas de las dos unidades educativas. El alfa de Cronbach resultó en 0.9. Se concluyó que la hipótesis de que los docentes si emplean los principios de Piaget en sus enseñanzas, pero no lo suficiente, pues los indicadores más altos apenas llegaban al 57,8%, además se encontró que en el análisis correlacional, la variable formal operacional tiene un impacto del 85,5% sobre la educación de la matemática.

ABSTRACT The main objective of this research was to demonstrate that the use of comic causes the learning of reading, as a development competence of the child's school life. The scope of the research revolves around the childcare centers of the Municipality of Guayaquil, where their 85 basic level teachers were surveyed, the instrument was validated with a Cronbach's alpha of 0.957, the quantitative approach was applied in a survey from which six questions were extracted, three on the independent variable of comic use and three with the dependent variable of learning to read. It was concluded that the descriptive results contributed to the fact that the method is effective and the correlation between both variables was 0.933, which indicates that the impact is very high.

RESUMEN El objetivo principal de esta investigación fue la de demostrar es que el uso del comic, provoque el aprendizaje de la lectura, como competencia de desarrollo de la vida escolar del niño. El alcance de la investigación gira al entorno de los centros de cuidado de niños del Municipio de Guayaquil, en donde se encuestaron a sus 85 docentes de nivel básico, el instrumento fue validado con un alfa de Cronbach de 0,957, el enfoque cuantitativo se aplicó en una encuesta de la cual se extrajeron seis preguntas, tres sobre la variable independiente de uso del comic y tres con la variable dependiente de aprendizaje de la lectura. Se concluyó que los resultados descriptivos aportaron a que el método es efectivo y la correlación entre ambas variables fue de 0,933, lo que indica que el impacto es muy alto.

Abstract: During the year 2020, as a result of the COVID-19 pandemic and the crisis that our country is going through, there have been countless job terminations in our Canton Machala, being essential to analyze if the protection action is the ideal means to guarantee rights of public servants who have been dismissed from their jobs. The protection action is an attractive and peculiar constitutional and legal tool of the Ecuadorian legal system; therefore, the present work is oriented to the study of this action, in order to establish its nature and determine if this is a viable mechanism for the protection of the rights of public servants who have been separated from their jobs.

Resumen: Durante el año 2020, producto de la pandemia del COVID-19 y la crisis que atraviesa nuestro país, se han producido un sinnúmero de desvinculaciones laborales en nuestro Cantón Machala, siendo fundamental analizar si la acción de protección es el medio idóneo para garantizar los derechos de los servidores públicos que han sido desvinculados de sus puestos laborales. La acción de protección es una atrayente y peculiar herramienta constitucional y legal del ordenamiento jurídico ecuatoriano; por tanto, el presente trabajo está orientado al estudio de esta acción, con la finalidad de fundamentar su naturaleza y determinar si ésta es un mecanismo viable para la protección de los derechos de los servidores públicos que han sido desvinculados de sus puestos laborales.

Resumen Introducción: el uso de implantes personalizados es un tratamiento utilizado con mayor frecuencia, valorando y comparando su comportamiento frente a implantes convencionales. Este estudio tuvo como objetivo analizar si las zonas de esfuerzo del implante personalizado son diferentes a las que presenta el implante prefabricado convencional mediante fotoelasticidad. Métodos: muestra n=10 dientes premolares superiores, n=10 implantes personalizados sinterizados y n=10 implantes prefabricados convencionales, sometidos a 3 presiones fijas y controladas, observados a través de un polariscopio para analizar la distribución del esfuerzo generados. Resultados: zonas de esfuerzo presentes en las diferentes muestras analizadas aplicando 3 presiones. La cantidad de esfuerzo en la presión 1 (test de Chi-cuadrado, p=0,596) es diferente entre los dos tipos de implantes al igual que con la presión 2 (test de Chi-cuadrado, p=0,407), al aplicar la presión 3 (test de Levene, p=0,899) no hay diferencia en la distribución de fuerzas entre los dos tipos de implantes. Conclusiones: se determinó que el implante prefabricado convencional distribuye y concentra mejor el esfuerzo generado bajo diferentes presiones en comparación con el implante personalizado sinterizado.

Abstract Introduction: the use of custom implants is a very common treatment; we assess and compare their behavior against that of conventional implants. This study aimed to make sure that the stress zones of the custom implant are different from those presented by the conventional prefabricated implant by photoelasticity. Methods: we subjected samples of n=10 bicuspid teeth, n=10 sintered custom implants, and n=10 conventional prefabricated implants to 3 fixed and controlled forces and observed the samples through a polariscope to analyze the distributions of effort generated. The effort zones present in the different samples were analyzed under 3 different forces. Results: the amounts of effort in the two types of implants under force 1 (chi-square test, p=0.596) are different, as is also the case under force 2 (chi-square test, p=0.407). Under force 3 (Levene test, p=0.899), there is no difference in the distributions of effort between the two types of implants. Conclusions: it was determined that the conventional prefabricated implant distributes and concentrates the effort generated under different forces better than the sintered custom implant.

ABSTRACT The empirical evidence prepared before the creation of this article suggests that high school students from a school in the city of Guayaquil have a low level of literacy, this information paved the way for the doctoral study of the main author of this document. The article aims to demonstrate the improvement of literacy after the use of strategies designed with a constructivist approach. The application of the pedagogical model was pre-evaluated for the 76 students and then their changes in reading and writing results were measured. An instrument of 23 items was applied to assess the results of the model and a survey with 9 items to collect impressions and it was found that constructivism impacted 89% of the students in their literacy skills. The conclusion was that the model is validated by the students and it was recommended that teachers should be encouraged to use the same method to reinforce the literacy level.

RESUMEN La evidencia empírica preparada antes de la creación de este artículo, sugiere que los estudiantes de bachillerato de un colegio de la ciudad de Guayaquil, tienen un bajo nivel de lectoescritura, esta información allanó el camino para el estudio doctoral de la autora principal de este documento. El artículo tiene como objetivo demostrar la mejora de la lectoescritura luego del uso de estrategias diseñadas con un enfoque constructivista. La aplicación del modelo pedagógico, fue a los 76 estudiantes pre evaluados y luego se midieron sus cambios en los resultados de lectoescritura. Se aplicó un instrumento de 23 ítems para valorar los resultados del modelo y una encuesta con 9, para recoger las impresiones y se encontró que el constructivismo impactó en el 89% de los estudiantes en sus competencias de lectoescritura. La conclusión fue que el modelo es validado por los estudiantes y se recomendó que se debería alentar a los docentes a que empleen el mismo método para reforzar el nivel lectoescritor.

ABSTRACT The purpose or objective of the research was to evaluate Lewin's model of group dynamics in high school adolescents from public schools, and the Educational Unit Colegio Fiscal República de Filipinas of the city of Guayaquil was taken as a reference, through of a cross-sectional, descriptive and correlational study that used a survey with 8 questions on the Likert scale, 1 being the value for strongly disagreement and 5 for strongly agreeing, applied to 148 students out of a total of 240, which make up the 6 classrooms of the baccalaureate cycle. The instrument's validation index, Cronbach's alpha, reached 0.919. The hypothesis raised as the planning of the groups with the Lewin method had positive effects on the execution of group activities was demonstrated with the Kolmogorov-Smirnov test where the p value was equal to 0.000, that is, less than the α equal to 0.005. The value of the correlation of variables determined that Lewin's method had positive effects of 91.4% in the execution of group activities and it was concluded that Lewin's theory of change in group dynamics can be a slow process to implement, but it was shown that it is very safe.

RESUMEN El propósito u objetivo de la investigación fue el de evaluar el modelo de dinámicas de grupo de Lewin, en adolescentes de bachillerato de colegios públicos, y se tomó a la Unidad Educativa Colegio Fiscal República de Filipinas de la ciudad de Guayaquil como referente, a través de un estudio de corte transversal, de alcance descriptivo y correlacional que utilizó una encuesta con 8 preguntas en escala de Likert siendo 1 el valor para muy desacuerdo y 5 para el muy de acuerdo, aplicadas a 148 estudiantes de un total de 240, que componen las 6 aulas del ciclo de bachillerato. El índice de validación del instrumento, alfa de Cronbach, llegó a 0,919. La hipótesis planteada como la planificación de los grupos con el método de Lewin tuvo efectos positivos en la ejecución de las actividades grupales fue demostrada con la prueba de Kolmogorov-Smirnov en donde el p valor fue igual a 0,000, es decir menor al α de 0,005. El valor de la correlación de variables determinó que el método de Lewin tuvo efectos positivos del 91,4% en la ejecución de las actividades grupales y se concluyó que la teoría del cambio en las dinámicas de grupo de Lewin puede ser un proceso lento de implementar, pero quedó demostrado que es muy seguro.

Abstract Introduction: Morquio syndrome is a rare autosomal recessive hereditary disease, characterized by the presence of a carbohydrate metabolism disorder, generating a decrease in the quality of life. Clinical case: newborn of 37.6 weeks with APGAR 7-9, who shows signs of distal and oral cyanosis, accompanied by a decrease in oxygen saturation to 70% minutes after birth. Subsequently, the diagnostic suspicion of this disease was identified due to the phenotypic characteristics and clinical manifestations, which was corroborated by genetic study. Conclusions: The diagnosis of Morquio syndrome was established in the first moments of birth, the manifestations observed in the case presented were the classic ones reported in the medical literature, the genetic study confirmed the diagnosis.

Resumen Introducción: el síndrome de Morquio es una rara enfermedad hereditaria autosómica recesiva, caracterizada por la presencia de un trastorno del metabolismo de los glúcidos, generando disminución de la calidad de vida. Caso clínico: recién nacido a término de 37.6 semanas con APGAR 7-9, que minutos después de nacido muestra signos de cianosis distal y bucal, acompañado de disminución en la saturación de oxígeno al 70%. Posteriormente, se identificaron características fenotípicas y manifestaciones clínicas que permitieron la sospecha diagnóstica de esta enfermedad, lo que se corroboró mediante estudio genético. Conclusiones: El diagnóstico de síndrome de Morquio se logró establecer en los primeros momentos del nacimiento, las manifestaciones observadas en el caso que se presenta fueron las clásicas que informa la literatura médica, el estudio genético confirmó el diagnóstico.

RESUMO Objetivo. Estimar a aceitabilidade e a adoção de diretrizes de prática clínica (DPCs) e protocolos de atenção para mulheres com pré-eclâmpsia e eclâmpsia por profissionais da saúde e identificar os fatores facilitadores e barreiras à sua implementação. Métodos. Desenvolvemos um estudo qualitativo baseado em entrevistas semiestruturadas e grupos focais em cinco maternidades. As entrevistas foram coletadas para análise, sendo caracterizadas as barreiras e fatores facilitadores. Resultados. O estudo contou com a participação de 70 profissionais da saúde (52 mulheres e 18 homens) que trabalham em diferentes níveis do sistema de saúde. Em sua maioria, os profissionais e administradores estão cientes da existência de DPCs para pré-eclâmpsia e eclâmpsia e conhecem seu conteúdo, especialmente os que têm mais tempo de experiência. Em relação aos fatores facilitadores, os profissionais médicos e de enfermagem consideraram positivo o processo de elaboração e implementação de DPCs de alta qualidade. Houve consenso sobre a existência de limitações, especialmente no que diz respeito à falta de medicamentos, insumos e equipamentos necessários para cumprir e implementar as recomendações. Discussão. Os resultados do estudo deixam clara a necessidade de reforçar as estratégias que ajudam a estabelecer vínculos entre a pesquisa e as políticas públicas. A pesquisa futura deve priorizar a atenção aos usuários e o apoio aos decisores e responsáveis pela elaboração de políticas no sistema de saúde. Os atores do sistema de saúde dominicano reconhecem a metodologia GRADE como um instrumento apropriado para a formulação e implementação de DPCs. As barreiras à implementação exigem abordagens sistêmicas e abrangentes.

ABSTRACT Objective. Estimate the acceptability and adoption by health care workers of clinical practice guidelines and treatment protocols for women with preeclampsia/eclampsia and identify the facilitating factors and barriers to their implementation. Methods. A qualitative study was conducted, using semi-structured interviews and focus groups in five maternity hospitals. Interviews were compiled for analysis, and barriers and facilitators were characterized. Results. Seventy health professionals (52 female and 18 male) participated, representing different levels of the health system. The majority of workers and managers were aware of the existence and content of clinical practice guidelines (CPGs) for preeclampsia/eclampsia, especially the participants with more time in the health service. With respect to facilitating factors, both medical and nursing staff were positive about continued development and implementation of high-quality CPGs. There was consensus that limitations exist, especially with respect to a lack of the necessary medicines, supplies, and equipment to meet and implement the established recommendations. Discussion. The results of the study show the need to strengthen strategies that help close the gap between research and public policy. Studies suggest that research should focus on users, policymakers, and decisionmakers in the health system. The actors in the Dominican health system recognize the GRADE methodology as an appropriate instrument for the development and implementation of CPGs. Implementation barriers require systemic and comprehensive approaches.

RESUMEN Objetivo. Estimar la aceptabilidad y adopción de las guías de prática clínica (GPC) y protocolos de atención a la mujer con preeclampsia-eclampsia por parte del personal prestador de los servicios de salud, e identificar los factores facilitadores y las barreras para su implementación. Métodos. Se desarrolló un estudio cualitativo por medio de entrevistas semiestructuradas y grupos focales en cinco maternidades. Se recopilaron las entrevistas para su análisis y se caracterizaron las barreras y facilitadores. Resultados. Participaron 70 profesionales de la salud (52 de sexo femenino y 18 de sexo masculino) que se desempeñan en distintos niveles del sistema de salud, participaron. La mayoría de los prestadores y gerentes conocen la existencia de las GPC de eclampsia-preeclampsia y su contenido, sobre todo los participantes con más tiempo en el servicio. Para los facilitadores, se estableció una valoración positiva entre el personal médico y de enfermería ante el proceso de continuar con la elaboración e implementación de GPC de alta calidad. Hubo consenso en cuanto a la existencia de limitaciones, sobre todo, por la falta de medicamentos, insumos y equipos requeridos, para cumplir y aplicar las recomendaciones formuladas. Discusión. Los resultados del estudio exponen la necesidad de fortalecer estrategias que ayuden a cerrar la brecha entre la investigación y la política pública. Estudios fundamentan la investigación en priorizar la atención a los usuarios, y los encargados de formular políticas y los tomadores de decisiones en el sistema de salud. Los actores del sistema de salud dominicano reconocen la metodología GRADE como un instrumento apropiado para la formulación e implementación de GPC. Las barreras de implementación requieren de abordajes sistémicos e integrales.

Resumen El presente estudio examina la identificación profesional de los profesionales de la comunicación en función de su comportamiento organizacional como parte de un entorno laboral. Su propósito consiste en conocer la forma en que la reputación organizacional y la compatibilidad percibida por el profesional sobre la organización donde labora afectan su identificación como profesional, y si esta sirve como mediadora para influir sobre su satisfacción laboral. En lo metodológico se acude a un modelamiento de ecuaciones estructurales basado en un instrumento transversal aplicado sobre 143 profesionales de comunicación social en Colombia. Los resultados obtenidos son coincidentes con las hipótesis planteadas. Se contribuye en la medida en que se evalúan constructos que exploran de manera plausible las percepciones y las conductas de los profesionales de la comunicación. Además, orienta sobre la forma en que ellos consideran se adaptan laboralmente a las estructuras organizacionales actuales y potencian su rendimiento.

Abstract This study examines the organizational behavior of communication professionals in a working environment. Its specific purpose is to determine the way in which the organizational reputation and the perceived fit with the organization affect their identification as professionals, and at the same time if this identification serves as a mediator for an eventual achievement of their job satisfaction. As for the methodology, the study conducts a cross-sectional survey applied to 143 professionals in social communication in Colombia, followed by a structural equation modeling-partial least square analysis. The results obtained are coincident with the hypotheses formulated. The study contributes as it evaluates several constructs that plausibly explore the organizational behavior of communication professionals, and guides how they consider they adapt to current organizational structures and enhance their performance.

Resumen Objetivo: Analizar las tendencias de admisiones y mortalidad hospitalaria por infarto agudo al miocardio (IAM) y evaluar la competencia hospitalaria de la Secretaría de Salud (SS) para tratarlo. Material y métodos. Enfoque de métodos mixtos: Jointpoint análisis de tendencias de hospitalizaciones y mortalidad hospitalaria entre 2005 y 2017, y encuesta en hospitales de la SS. Resultados: Las hospitalizaciones por IAM están aumentando entre hombres y pacientes >60 años. Las mujeres tienen mayor mortalidad. La encuesta incluyó 527 hospitales (2º nivel =471, 3er nivel =56). Los hospitales tienen competencias insuficientes para diagnosticar IAM (2º nivel 37%, 3er nivel 51%), realizar perfusión farmacológica (2º nivel 8.7%, 3er nivel 26.8%) y reperfusión mecánica (2º nivel 2.8%, 3er nivel 17.9%). Conclusiones: Existen disparidades en demanda, oferta y resultados en salud del IAM. Es aconsejable fortalecer las competencias, con perspectivas de género y edad, para diagnosticar y tratar IAM, y reducir su mortalidad efectivamente.

Abstract Objective: To analyze acute myocardial infarction (AMI) admissions and in-hospital mortality rates and evaluate the competence of the Ministry of Health (MOH) hospitals to provide AMI treatment. Materials and methods: We used a mixed-methods approach: 1) Joinpoint analysis of hospitalizations and in-hospital mortality trends between 2005 and 2017; 2) a nation-wide cross-sectional MOH hospital survey. Results: AMI hospitalizations are increasing among men and patients aged >60 years; women have higher mortality rates. The survey included 527 hospitals (2nd level =471; 3rd level =56). We identified insufficient competence to diagnose AMI (2nd level 37%, 3rd level 51%), perform pharmacological perfusion (2nd level 8.7%, 3rd level 26.8%), and mechanical reperfusion (2nd level 2.8%, 3rd level 17.9%). Conclusions: There are wide disparities in demand, supply, and health outcomes of AMI in Mexico. It is advisable to build up the competence with gender and age perspectives in order to diagnose and manage AMI and reduce AMI mortality effectively.