The Evaluation of Public Policies from the Perspective of the Agenda 21 of Culture: a Case Study

This research shows the results of the implementation of a public cultural policy at the municipal level and has as a main objective to evaluate, from the perspective of the agenda 21 of culture, the program "Art for social development" by the Municipal Institute of Art and Culture developed in a secondary-level boarding school located at the Topolobampo community, in the municipality of Ahome, Mexico. A QUAN-QUAL methodology was used with instruments like questionnaires applied to the young participants and interviews with the workshop facilitators and administrative staff. Guitar, painting and theatre workshops were given, through which the development of new artistic expression skills was achieved, as well as contributing to the strengthening of social behaviors such as tolerance, patience and interpersonal communication, among others. It was found the constant need of having permanent programs of integral training, both in the field of artistic training and socio-emotional, giving priority to groups at risk, such as students of the boarding school that mostly come from families of scarce resources, some of the low performance academic and aggressive behavior. The conclusion is that public policies are required to promote greater articulation of education and culture in order to have a stronger impact on the social and cultural inclusion of young people

Liderazgo y cambio cultural en la organización para la sustentabilidad

Two substantial elements, leadership and organizational change, are addressed in this work with the intention of highlighting its importance and relationship either conjugate in appropriate strategies, would point to the evolution of the organizations and the fulfillment of the objectives of contributing to a real sustainable development, especially based on the protection of the environment. The role of business as factors for progress in societies with a push commune should have references to the relevant social responsibility, compliance away from a half or worse, stands simulations. Leadership is important because it empowers the leader with the mission to achieve social awareness among members of the organization, which would affect a significant and democratic internal change, but also socially legitimate, which is also determined as a change in the culture of the organization. Leadership, organization, organizational culture, strategies, economic development and progress: To analyze this, a theoretical and commented on essentials breakdown occurs here. The vision of international organizations and several authors and studies are addressed to arrive at a strategic proposal for sustainability, while considering the issue remains unfinished to the current conditions of environmental degradation, social inequality, uncertainty and ambiguity.Dos elementos sustanciales, liderazgo y cambio organizacional, se abordan en este trabajo con la intención de resaltar su importancia y su relación que, bien conjugada en estrategias adecuadas, apuntarían a la evolución de las organizaciones y al cumplimiento de los objetivos de contribuir a un auténtico desarrollo sustentable basado especialmente en el cuidado del medio ambiente. Se destaca el papel que juegan las empresas como factores de progreso en las sociedades y con un accionar que debería tener como una de sus referencias a la correspondiente responsabilidad social, alejándose de un cumplimiento a medias o, peor aún, de simulaciones. El liderazgo es importante porque faculta al dirigente con la misión de lograr la conciencia social entre los miembros de la organización, lo cual incidiría en un cambio interno significativo y democrático, pero a la vez socialmente legítimo, lo cual se determina también como un cambio en la cultura de la organización. Para analizar lo anterior, se presenta un desglose teórico y comentado sobre elementos esenciales: liderazgo, organización, cultura organizacional, estrategias, desarrollo económico y progreso. En este trabajo se hace una revisión de teorías y de la visión de organismos internacionales para arribar a una propuesta estratégica para la sustentabilidad, sin dejar de considerar que el tema permanece inacabado ante las actuales condiciones de degradación ambiental, desigualdad social, incertidumbre y ambigüedad

Perception of the performance of tourism activity towards sustainability in Loreto, Baja California Sur, Mexico

Loreto es un destino turístico que cuenta con características sobresalientes para la práctica del turismo cultural y de naturaleza, tiene el distintivo como Pueblo Mágico otorgado por la Secretaría de Turismo de México; además, es parte del área de influencia del Parque Nacional Bahía de Loreto. A partir de lo anterior, el presente trabajo se centra en la caracterización y desempeño de la actividad turística considerando la percepción del turista y actores clave del lugar. Se utilizó una metodología de tipo cualitativa con enfoque descriptivo, utilizando entrevistas, encuestas y guías de observación. Los resultados muestran una percepción positiva y una satisfacción sobresaliente del turista acerca de la calidad, el cuidado y conservación de los atractivos culturales y naturales del destino, no obstante, los actores clave perciben prácticas no sostenibles y falta de consenso en la toma de decisiones. A la vez, se aprecia una actividad creciente de iniciativas privadas y gubernamentales que pueden favorecer las prácticas del turismo sostenible.Loreto is a tourist destination that has outstanding characteristics for the practice of cultural and nature tourism, it has a distinctive as a Magical Town granted by the Tourism Secretary of Mexico; It is also part of the area of influence of Loreto Bay National Park. Based on the foregoing, the present work focuses on the characterization and performance of the tourist activity considering the perception of the tourist and key actors of the place. A qualitative methodology with a descriptive approach was used, using interviews, surveys and observation guides. The results show a positive perception and an outstanding satisfaction of the tourist about the quality, care and conservation of the cultural and natural attractions of the destination; however, the key actors perceive unsustainable practices and lack of consensus in decision making. At the same time, there is an increasing activity of private and governmental initiatives that can favor sustainable tourism practices

Organizational culture assessment of sustainable hotel companies in Mazatlán; four case studies

La presente investigación presenta los resultados de cuatro estudios de caso en empresas hoteleras ubicadas en Mazatlán, México y que se orientan hacia la sostenibilidad como forma de administrarse y hacer negocios. El objetivo fue realizar una evaluación de la cultura organizacional de estas empresas que pretenden ser identificadas como sostenibles. El estudio se realiza con la premisa de darle continuación a trabajos anteriores sobre el tema ya realizados, que utilizaron el Organization Culture Assesment Instrument (OCAI)1 para la evaluación de la cultura, con la diferencia de que aquí se utilizaron además instrumentos de corte cualitativo como la entrevista y la observación no participante. Los resultados muestran una orientación, en todos los casos de estudio, hacia una cultura organizacional de tipo clan lo cual difiere en cuanto a los que obtuvieron los autores mencionados, por lo que se infiere que el contexto geográfico, cultural e histórico juega un papel determinante en cuanto a la forma en que se puede alcanzar la sostenibilidad en una empresa.This paper presents the results of four case studies of hotel companies located in Mazatlan, Mexico whose form of management and doing business is oriented towards sustainability. The objective was to carry out an evaluation of the organizational culture of these companies that seek to be identified as sustainable. The study is carried out with the premise of giving continuity to previous research on the subject already conducted using the Organization Culture Assessment Instrument (OCAI) for the evaluation of culture, with the difference that qualitative tools such as interview and non-participant observation have been used. In every case study the results show an orientation towards a clan-like organizational culture, which differs in terms of those obtained by the authors mentioned. Therefore, it may be inferred that the geographical, cultural and historical context plays a decisive role in terms of the way in which sustainability can be achieved in a company

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake