La asociatividad como estrategia para gestionar los procesos de desarrollo empresarial y solución a problemáticas sociales

Constant change, economic instability, poor access to resources for some sectors, personal crises and uncertainties are characteristic features in today’s personal and business contexts. Networks, alliances, associations and groups; Are a mechanism of cooperation between companies and / or individuals, where their participation is voluntary and is used to obtain individual benefits (strengthening, sustainability, consumption, economies of scale, market access, innovation, and social problems) Articulated of the members. This study, applied, documental, descriptive, qualitative, and exploratory, is oriented to the analysis and description of some associative schemes as a strategy to manage the processes of business development and solution to social problems. The findings found, evidenced associativity strategies such as: networks, fairs, shared consumption, cluster, temporary or definitive alliances; One of the most important elements for its creation is the construction and maintenance of these associations are the bonds of trust between the members and the community over time. The benefits of forming partnerships for organizations allow: To add efforts, talents and wills, Maximizing efforts, minimizing costs, improving quality, providing sustainability, improving competitiveness in general and achieving greater social welfare.El cambio constante, la inestabilidad económica, el poco acceso a recursos para algunos sectores, las crisis personales e incertidumbres son aspectos característicos en los contextos actuales en los ámbitos personales y empresariales. Las redes, las alianzas, asociaciones y agrupaciones; son un mecanismo de cooperación entre empresas y/o personas, donde su participación es voluntaria y se recurre para obtener beneficios individuales (fortalecimiento, sostenibilidad, consumo, economías de escala, acceso a mercados, innovación, y problemáticas sociales) mediante la acción conjunta y articulada de los integrantes. Este estudio, de carácter aplicado, documental, descriptivo, cualitativo, y exploratorio, está orientado al análisis y descripción de algunos esquemas asociativos Como estrategia para gestionar los procesos de desarrollo empresarial y solución a problemáticas sociales. Los hallazgos encontrados, evidencian estrategias de asociatividad tales como: redes, ferias, consumo compartido, cluster, alianzas temporales o definitivas; uno de los elementos más importantes para su creación es la construcción y mantenimiento de estas asociaciones son los lazos de confianza entre los integrantes y la comunidad a lo largo del tiempo. Las bondades de conformar asociaciones para las organizaciones permiten: Sumar esfuerzos, talentos y voluntades, maximizar esfuerzos, minimizar costos, mejorar calidad, proporcionar sostenibilidad, mejorar competitividad en general y alcanzar un mayor bienestar social

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030