6 research outputs found

    Identificaci贸n de los factores que han incidido en la crisis de los hospitales p煤blicos de Cali y en el buen desarrollo del sistema general de seguridad social en salud de Colombia

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    En este ensayo se busca establecer cu谩les fueron los factores que incidieron en la crisis de los hospitales p煤blicos de la ciudad de Cali, Mario Correa Rengifo y Hospital Universitario del Valle y su relaci贸n directa con el Sistema General de Seguridad Social en Salud. Se presentan cu谩les fueron las fuerzas econ贸micas, pol铆ticas y sociales que impulsaron desde 1949 la aparici贸n de la Seguridad Social en Salud en Colombia, y posteriormente convergieron en la creaci贸n del Sistema Nacional de Salud de 1975; cu谩les fueron las fuerzas supranacionales que impulsaron la creaci贸n del Sistema General de Seguridad Social en Salud en 1993; adem谩s se establece el choque de dos proyectos de Estado-Naci贸n a partir de 1991, el Estado Neoliberal y el Estado Social de Derecho. Con el prop贸sito de generar una opini贸n publica bien informada, contextualizada y soberana, el siguiente ensayo pretende dar a entender cu谩l es el proyecto de Estado-Naci贸n al que est谩 ligado la aprobaci贸n de la Ley 100 de 1993 en salud, y por consecuencia cu谩les fueron los factores que incidieron en la crisis de los hospitales p煤blicos de la ciudad de CaliTrabajo de grado (Comunicador Social-Periodista) -- Universidad Aut贸noma de Occidente. Facultad de Comunicaci贸n Social, 2005PregradoComunicador(a) Social 鈥 Periodist

    Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

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    Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

    Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

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    Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42路4% vs 44路2%; absolute difference -1路69 [-9路58 to 6路11] p=0路67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0路0011). ICU mortality was higher in MICs than in HICs (30路5% vs 19路9%; p=0路0004; adjusted effect 16路41% [95% CI 9路52-23路52]; p<0路0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0路80 [95% CI 0路75-0路86]; p<0路0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status

    Cognitive decline in Huntington's disease expansion gene carriers

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    Reduced Cancer Incidence in Huntington's Disease: Analysis in the Registry Study