Permacultura y sostenibilidad agrícola

La permacultura es más que un tipo de agricultura. En algunos casos, considerada una variante de la agricultura ecológica, reproduce y pone en práctica a través de sus principios los objetivos de la agroecología; es "un nuevo enfoque científico que surge en los últimos años debido a los importantes problemas ambientales y sociales de la agricultura moderna y la necesidad de lograr un cambio hacia sistemas más sostenibles" (Sarandón y Flores, 2014: 11). Asimismo, puede concebirse como un modo de vida opcional, una técnica de jardinería, o en otros casos, puede llegar a cumplir un papel primordial en países subdesarrollados, donde su práctica es una necesidad y una forma eficaz de asegurar la seguridad alimentaria. Además, a diferencia de los demás tipos de agricultura, que constituyen un método de producción económica, en este caso, se trata más bien de una filosofía de vida, en la que prima la cooperación y convivencia pacífica entre las personas y unos valores éticos. Es considerada también una contracultura espacial, que anhela la obtención de un alto grado de autosuficiencia de las fincas agrícolas, y la creación de agroecosistemas sostenibles. Esta nueva forma de trabajar la tierra cumple un papel fundamental en lo que se refiere a la gran labor social y ambiental que hay detrás de cada proyecto, a nivel mundial, nacional y también en el marco local, contribuyendo a la conservación de los paisajes agrarios, que a la vez constituyen el patrimonio cultural de las regiones. Además, estudios recientes han demostrado que los rendimientos por unidad de superficie en la producción de alimentos, en sistemas de policultivo, que también se rigen por esta metodología, pueden llegar a tener valores superiores con respecto a los sistemas de monocultivo. Dada la fuerte dependencia de las Islas Canarias del exterior, en el abastecimiento de alimentos, estas recientes investigaciones proporcionan una oportunidad para lograr un mayor grado de autosuficiencia alimentaria, y una mayor resiliencia agroecológica de las fincas agrícolas. "Aunque existen muchos países en los que la permacultura está mucho más desarrollada que en España o en Canarias, existen algunos ejemplos vivos que, aunque no son numerosos, sí resultan interesantes", (Costa del Forcallo, 2008). En nuestro archipiélago, se localizan principalmente en la zona de medianías, por poseer "unas condiciones más benignas para el cultivo, y por haber tenido una mayor regularidad, puesto que esta franja altitudinal ha sido la base de la dieta alimentaria de los canarios, a lo largo de la historia de las islas" (Rodríguez Brito, 1992: 71). La mayoría de estos proyectos están enfocados a la producción de alimentos. Otros, en cambio, están enfocados a la educación ambiental y a las actividades terapéuticas en contacto con la naturaleza, donde se trata de inculcar a los más pequeños la importancia de cuidar del medio ambiente.Permaculture is more than one type of agriculture. In some cases, considered a variant of organic farming, plays and implements through its principles of agroecology objectives; It is "a new scientific approach that emerged in recent years, due to the important environmental and social problems of modern agriculture, and the need for a shift towards more sustainable systems" (Sarandon and Flores, 2014: 11). It can also be conceived as a way of optional technical gardening life or in other cases, you can get to play a key role in developing countries, where the practice is a necessity and an efficient way to ensure food security. In addition, unlike other types of agriculture, which are a method of economic production, in this case, it is more a philosophy of life, in which raw cooperation and peaceful coexistence between people and ethical values. It is also considered a space counterculture, yearning to obtain a high degree of self-sufficiency of farms, and creating sustainable agro-ecosystems. This new way of working the land plays a key role in relation to the great social and environmental work behind each project, globally, nationally and in the local context, contributing to the conservation of agricultural landscapes , which in turn they constitute the cultural heritage of the regions. In addition, recent studies have shown that yields per unit area in food production, in polyculture systems, which are also governed by this ideology, can have higher values compared to monoculture systems. Given the heavy dependence of the islands outside in the food supply, these recent studies provide an opportunity to achieve a greater degree of food self-sufficiency, and greater resilience of agro-ecological farms. Permaculture can be a way to learn how to optimize the use of natural resources sustainably, increasing the food security of our archipelago, and helping to preserve the island's agricultural areas. "Although there are many countries where permaculture is much more developed than here in Spain or the Canary Islands specifically, there are few living examples that although many if not interesting" (http://www.rinconesdelatlantico.com/num2/permacultura.html , accessed on 09.10.2015). In our islands, are located mainly in the midlands area, by having "a more benign conditions for cultivation, and for having more regular, since it has been the basis of the diet of canaries, along the history of the islands "(Rodriguez Brito, 1992: 71). Most of these projects are focused on food production and the "generation of soils," Alfred Yeomans (1950). Others, however, are focused on environmental education, and therapeutic activities in contact with nature, where it is the smallest instill the importance of protecting the environment

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Catálogo de los recursos pesqueros continentales de Colombia

El documento que presentamos al público tiene una importancia tanto para la academia y centros de investigación como para las autoridades, tomadores de decisiones y el público en general, en aras de la generación de una conciencia colectiva sobre la problemática asociada a los recursos pesqueros y la necesidad de tomar medidas urgentes para su aprovechamiento sostenible por el bien común. En este contexto, el “Catalogo de los recursos pesqueros continentales de Colombia” contiene la información científicamente válida que ha llevado a establecer que las especies de peces de consumo y en consecuencia con alto valor comercial en aguas continentales son 173, cifra que probablemente se ampliará con futuros estudios y nuevos datos. De las especies listadas, 31 se encuentran categorizadas con algún grado de amenaza, siendo precisamente la causa el aprovechamiento derivado de su valor comercial, y que de continuar el aprovechamiento descontrolado, a la brevedad estaremos presenciando su extinción.Bogotá, D. C

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research