Centro de Atención de la Salud Mental Comunitario + Hogar Protegido en Nuevo Chimbote - Ancash

En la presente investigación inicia desde un análisis y diagnóstico urbano del territorio de Nuevo Chimbote concluyendo en una propuesta arquitectónica, dando solución a una problemática social que es la salud mental, en la actualidad los servicios brindados en este sector son limitados ya que no existe una infraestructura enfocada en el tema, de tal manera se vuelve una necesidad que requiere ser cubierta para controlar las cifras elevadas de las personas con problemas de salud mental. Es notable como este tema no es priorizado por los gobiernos a pesar de su importancia y el impacto que tiene sobre la sociedad. La estructura de la investigación es mediante capítulos que contiene marco teórico, metodología, localización e investigación programática mediante datos cualitativos y cuantitativos, dando como resultado el diseño del proyecto arquitectónico acorde a las necesidades del usuario objetivo, este se fundamenta en los requerimientos del nuevo modelo de atención comunitario de la salud mental enfocado en ambientes que busquen la atención, rehabilitación y reinserción del paciente. Por otro lado, es importante brindar un servicio complementario a las personas en situación de calle que respalde que estas personas sean integradas con la población. Se tendrá como base 3 elementos: naturaleza, integración, infraestructura, que a través de un equilibrio generen un entorno de confort y mejora del paciente.In the present investigation it starts from an urban analysis and diagnosis of the territory of Nuevo Chimbote concluding in an architectural proposal, giving solution to a social problem that is mental health, at present the services provided in this sector are limited since there is no infrastructure focused on the subject, in such a way it becomes a necessity that needs to be covered to control the high numbers of people with mental health problems. It is remarkable how this issue is not prioritized by governments despite its importance and the impact it has on society. The structure of the research is through chapters that contains theoretical framework, methodology, location and programmatic research through qualitative and quantitative data, resulting in the design of the architectural project according to the needs of the target user, this is based on the requirements of the new model of community mental health care focused on environments that seek patient care, rehabilitation and reintegration. On the other hand, it is important to provide a complementary service to people in street situations that support these people to be integrated with the population. It will be based on 3 elements: nature, integration, infrastructure, that through a balance generate an environment of comfort and improvement of the patient.Tesi

Diseño de análisis y estrategias financieras para medir el impacto de arrendamientos financieros en empresas dedicadas al entretenimiento.

Actualmente las empresas poseen diversas alternativas de financiamiento para adquirir activos a largo plazo como préstamos bancarios o arrendamiento financiero, ante estas opciones es necesario llevar a cabo evaluaciones para tomar la decisión del financiamiento a utilizar conforme a las necesidades y posibilidades de la entidad como capacidad de pago de cuotas constantes mensuales durante el plazo establecido en el contrato, de optar por el préstamo bancario, otorgar una garantía hipotecaria. Además de tener en cuenta los beneficios que otorgan al adquirir el pasivo mediante el financiamiento seleccionado, como deducciones de renta obtenida, depreciaciones, capacidad de endeudamiento y por ende también se deben de considerar las desventajas de la fuente de financiamiento seleccionado. El desarrollo económico empresarial ha demostrado un impacto circunstancial que genera el arrendamiento financiero, teniendo en cuenta que es una herramienta de financiamiento importante que se debería tomar en consideración al momento de adquirir activos como maquinaria, bienes muebles e inmuebles necesarios para el negocio en marcha y la generación de la fuente, tanto en la mejora de la productividad como en las finanzas de la entidad. El objetivo de la investigación es medir el impacto del arrendamiento financiero mediante estrategias y razones financieras, específicamente en las empresas dedicadas al entretenimiento. Además, se evalúa si el arrendamiento financiero es la elección más viable a la obtención de un préstamo bancario en una institución financiera y por lo tanto el impacto que tiene la elección de financiamiento en los Estados Financieros y su análisis mediante índices financieros. La investigación se desarrolló utilizando el enfoque cuantitativo mediante el método hipotético deductivo, para ello se utilizó la encuesta como herramienta de recolección de datos ii estadísticos. Se encuestaron a personal clave de las empresas dedicadas al entretenimiento, respecto a las fuentes de financiamiento que utilizan para la adquisición de activos, análisis financieros que realizan para llevar a cabo la interpretación de Estados Financieros y razones financieras para evaluar el estado económico de la entidad para la toma de decisiones e implementación de estrategias financieras para tener finanzas saludables. Con el fin de tener una mejor comprensión de la investigación se desarrolló un caso práctico en el que se realizó una comparación entre la obtención de un préstamo bancario y un arrendamiento financiero utilizando las mismas tasas de intereses y el mismo plazo, para el cual se elaboraron tablas de amortización de los pagos del arrendamiento y préstamo para verificar el saldo real pagado al término del contrato contraído. Los resultados que reflejaron la realización de la encuesta muestran que la opción que más utilizan para la compra de un bien mueble o inmueble es el arrendamiento financiero debido a que económicamente es más accesible que la compra del bien. En base a los resultados obtenidos se concluyó que el arrendamiento financiero es una opción viable para que las entidades puedan adquirir un bien mueble o inmueble a largo plazo y se recomendó que esta fuente de financiamiento debe de ser evaluada si la entidad necesita bienes para su operatividad sin descapitalizarse

Disfunción sexual en mujeres con esclerosis sistémica

Introducción: la disfunción sexual (DS) es común entre las mujeres con enfermedades crónicas, incluyendo esclerosis sistémica (ES). Se ha asociado con características como la duración de la enfermedad, dolor, disminución de la actividad funcional, entre otras. Desde nuestro conocimiento, aún no contamos con datos locales. Objetivos: evaluar la frecuencia de DS en mujeres con ES; describir las características sociodemográficas, clínicas y psicológicas asociadas con la DS en mujeres con ES. Materiales y métodos: estudio observacional, analítico y de corte transversal. Se incluyeron mujeres de entre 20 y 59 años con diagnóstico de ES, según los criterios de clasificación del European League Against Rheumatism/American College of Rheumatology (ACR/EULAR 2013). Se excluyeron pacientes con enfermedades crónicas no controladas, otras patologías reumatológicas autoinmunes, e inactividad sexual o patología genitourinaria no relacionadas a ES en las últimas 4 semanas. La DS se evaluó con la versión en español del cuestionario índice de función sexual femenina (Female sexual function index, FSFI). Resultados: se incluyeron 56 pacientes. El 78,57% presentó DS y 19,64% era sexualmente inactiva debido a la enfermedad. Escala visual análoga (EVA) de fatiga (coeficiente β: -0,08, IC 95%: -0,14 a -0,02; p<0,01), edad (coeficiente β: -0,23, IC 95%: -0,40 a -0,05; p=0,01) y fibromialgia (coeficiente β: -11,90, IC 95%: -17,98 a -5,82; p<0,01) mostraron una asociación significativa e independiente con DS en el análisis multivariado. Conclusiones: la DS es frecuente entre las mujeres con ES, y las pacientes más jóvenes, sin fibromialgia y con menor fatiga presentaron una mejor funcionalidad sexual

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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

Las NIIF para las PYMES y su impacto en la toma de decisiones financieras en empresas del sector textil de confecciones de ropa en el distrito de La Victoria en el 2017

The present work was realized by the intention of analyzing the impact of the NIIF for the SMES in the capture of financial decisions in the companies of the textile sector of confections of clothes in the district of La Victoria. In addition, inside the investigation there is looked that the small and medium companies know like to take decisions of a guessed right way, with regard to the adoption of the NIIF for the SMES. For the development of this investigation the international procedure of information have been born in mind financiers for the small and medium companies and principal ratios that are in use for a guessed right capture of decisions; in addition, is explained the importance of the small and medium companies in our country. On the other hand, the practical case based on the Effective company Blue Trading E.I.R.L, which will adopt the NIIF for the SMEs applying the Section 13: Inventory and Section 17: Property, Plant and Equipment. For it, one used the parameters that they must be considered to be to adopt for the first time the NIIF for the SMEs. With the practical case one tries to demonstrate that to adopt the international norm generates that the financial statements are solid and show a correct value that allows to the managers to analyze the information and to could take financial guessed right decisions. Finally, there is looked that the NIIF for the SMES influence positively the capture of financial decisions companies of the textile sector of confections of clothes the district of La Victoria.TesisEl presente trabajo fue realizado con el propósito de analizar el impacto de las NIIF para las PYMES en la toma de decisiones financieras en las empresas del sector textil de confecciones de ropa en el distrito de la Victoria. Además, dentro de la investigación se busca que las pequeñas y medianas empresas conozcan como tomar decisiones de manera acertada, con respecto a la adopción de las NIIF para las PYMES. Para el desarrollo de esta investigación se ha tomado en cuenta las normas internacionales de información financieras para las pequeñas y medianas empresas y las principales ratios que se utilizan para una acertada toma de decisiones; además, se explica la importancia de las pequeñas y medianas empresas en nuestro país. Por otro lado, el caso práctico se basó en la empresa Eficaz Blue Trading E.I.R.L, la cual adoptará las NIIF para las Pymes aplicando la Sección 13: Inventario y Sección 17: Propiedad, Planta y Equipo. Para ello, se utilizó los parámetros que deben considerarse para adoptar por primera vez las NIIF para las Pymes. Con el caso práctico se pretende demostrar que adoptar la norma internacional genera que los estados financieros sean sólidos y muestren un correcto valor que permita a los gerentes analizar la información y puedan tomar decisiones financieras acertadas. Por último, se busca que se las NIIF para las PYMES influyan positivamente en la toma de decisiones financieras en empresas del sector textil de confecciones de ropa en el distrito de la Victoria

Cuerpo Animal 2 - VT27 - 202102

El curso propone realizar un reconocimiento de la estructura macroscópica, microscópica y funcional de todo el organismo animal contemplando las diferencias entre las especies domésticas (carnívoros, felinos, equinos, bovinos, caprinos y ovinos). El aprendizaje iniciará con la revisión de la anatomía del cuerpo animal y su participación en el sistema locomotor, profundizando en el sistema nervioso y culminando con el sistema endocrino y reproductor. Este curso provee una visión integral y los fundamentos del desarrollo, anatomía, histología y fisiología del organismo de los animales domésticos. El curso de especialidad de la carrera de Medicina Veterinaria de carácter teórico-práctico dirigido a estudiantes del segundo nivel de la malla curricular, busca desarrollar la competencia general: Manejo de la información y pensamiento crítico (Nivel 1) y de las competencias específicas: Práctica Clínica (Nivel 1) y Profesionalismo (Nivel 1)

Urinary iodine excretion in healthy Mexican adults

The iodine nutritional status of a population is mainly measured by urinary iodine excretion (UI) and thyroid volume determined by ultrasound (US). The surveillance of nutritional iodine levels in the Mexican population has been insufficient. Our aim was to determine the UI in random samples from adults living in an urban area. We selected a sample of healthy individuals over the age of 18 that were students, physicians or administrative personnel at our Institution and had no known thyroid disease. Thyroid volume was determined by ultrasound in all volunteers as well as thyroid hormones and antithyroid antibodies and a urine sample was obtained. One hundred and two volunteers with a median age of 29, participated in the study. The group&rsquo;s median UI was 221 &mu;g/L,interquartile range(IQR)(135.0 to 356.8) and no differences were observed between genders: women had a UI of 218.0 &mu;g/L IQR (129.0 a 351.0) vs. 223.0 &mu;g/L IQR (138.0 to 374.0) in males, p 0.941. Excessive dietary iodine intake was established in 31.4% of all volunteers according to their UI, placing them at risk of thyroid dysfunction. It is fundamental to evaluate the national iodine nutritional status in Mexico. We discuss the current status of the nutritional state in the Americas, emphasizing that in Latin America and the observed tendency in the region to ingest a diet high in iodine.El estatus nutricional del yodo en una poblaci&oacute;n, principalmente es medido por la excreci&oacute;n del yodo urinario (UI) y el c&aacute;lculo del volumen tiroideo por ultrasonido (US). La vigilancia nutricional del yodo en la poblaci&oacute;n en M&eacute;xico ha sido escasa. El objetivo fue determinar la UI en una muestra casual en adultos sanos que habitan en un &aacute;rea urbana. Se seleccion&oacute; una muestra de individuos mayores de 18 a&ntilde;os, entre estudiantes, m&eacute;dicos y trabajadores administrativos de nuestra instituci&oacute;n, sanos, sin enfermedad tiroidea conocida. A todos los voluntarios se les determin&oacute; el volumen tiroideo por US, hormonas y anticuerpos antitiroideos y se les solicit&oacute; una muestra de orina. Participaron 102 voluntarios, mediana de 29 a&ntilde;os. La mediana de la UI del grupo fue 221 &mu;g/L, rango intercuart&iacute;lico(RIQ) (135.0 a 356.8), no hubo diferencias entre g&eacute;neros, las mujeres tuvieron una UI de, 218.0 &mu;g/L RIQ (129.0 a 351.0) vs 223.0 &mu;g/L RIQ (138.0 a 374.0) p 0.941. El 31.4% de los voluntarios mostraron una ingesti&oacute;n excesiva de yodo en la dieta de acuerdo a la UI, lo cual los coloca en riesgo de sufrir disfunci&oacute;n tiroidea. Es necesario considerar la evaluaci&oacute;n Nacional del estatus nutricional del yodo, en M&eacute;xico. En el art&iacute;culo se discute la situaci&oacute;n actual del estatus nutricional en las Am&eacute;ricas, haciendo &eacute;nfasis en Latinoam&eacute;rica y a la tendencia de la regi&oacute;n a la dieta excedida en yodo