La Imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia

Como futuros profesionales en Psicología, se hace necesario desarrollar habilidades y destrezas que permitan hacer un adecuado acompañamiento psicosocial en escenarios de violencia. Dichas habilidades apuntan a diseñar estrategias que promuevan en las víctimas del conflicto, el desarrollo de sus potencialidades, logrando de esta manera mitigar el dolor y ayudar en su proceso de su reconstrucción. El uso de la narrativa, permite al equipo psicosocial conocer la historia a partir de los hechos o sucesos narrados por las propias víctimas, logrando de esta manera tener acceso a la manera como éstas interpretan la realidad. La narrativa, entonces, como estrategia de abordaje psicosocial, permite trasladar eventos pasados a la actualidad, construir una historia a partir de la subjetividad, darle sentido y valor al tener en cuenta las emociones, el dolor y la desesperanza de los propios protagonistas de la historia. Para aplicar dichas técnicas, es necesario entonces que el equipo psicosocial desarrolle ciertas habilidades, dentro de las cuales se encuentra la empatía, la escucha activa, la interpretación del lenguaje no verbal, entre otras. Por esta razón es importante que la narrativa se convierta no solo en una herramienta a través de la cual el profesional conoce una historia, sino que se puedan aprovechar dichos espacios para que las victimas logre identificar, a través de la narración de experiencias pasadas, sus potencialidades, exponer y sanar el dolor y empezar a construir un nuevo proyecto de vida. Para lograr desarrollar las destrezas anteriormente mencionadas, se abordan diferentes narrativas tomadas del libro “Voces: Relatos de violencia y esperanza en Colombia”. A partir de éstas narrativas se crea un escenario de análisis y reflexión, que permiten realizar un abordaje psicosocial de atención a las víctimas del conflicto, diseñando algunas preguntas que permiten profundizar la narrativa y posteriormente diseñando algunas propuestas de acciones encaminadas a atender a los protagonistas de las historias. Posteriormente se realiza una reflexión a partir del caso Pandurí, logrando identificar los emergentes psicosociales y estableciendo algunos mecanismos de intervención psicosocial con el fin de potenciar los recursos de afrontamiento de las víctimas.As future professionals in Psychology, it is necessary to develop skills and abilities that allow adequate psychosocial accompaniment in violence scenarios. These skills aim to design strategies that promote the development of their potential in the victims of the conflict, thus mitigating the pain and helping in the process of its reconstruction. The use of narrative allows the psychosocial team to know the story from the facts or events narrated by the victims themselves, thus gaining access to the way they interpret reality. Narrative, then, as a strategy of psychosocial approach, allows past events to be transferred to the present, to build a story based on subjectivity, to give meaning and value when taking into account the emotions, pain and despair of the protagonists of the event. history. To apply these techniques, it is necessary for the psychosocial team to develop certain skills, among which is empathy, active listening, interpretation of non-verbal language, among others. For this reason, it is important that the narrative becomes not only a tool through which the professional knows a story, but that these spaces can be exploited so that the victims can identify, through the narration of past experiences, their potentialities, expose and heal the pain and start building a new life project. In order to develop the aforementioned skills, different narratives taken from the book "Voices: Stories of Violence and Hope in Colombia" are addressed. From these narratives a scenario of analysis and reflection is created, which allows us to carry out a psychosocial approach of attention to the victims of the conflict, designing some questions that allow to deepen the narrative and later designing some proposals of actions aimed at attending the protagonists of the stories. Afterwards, a reflection was made from the Pandurí case, identifying the psychosocial emergencies and establishing some psychosocial intervention mechanisms in order to enhance the coping resources of the victim

Asociación entre la presencia de anticuerpos contra Leptospira y lesiones renales en bovinos

El estudio tuvo como objetivo determinar la posible relación entre la presencia de lesiones denominadas «Riñón con Manchas Blancas» (RMB) y la seroprevalencia de Leptospira spp en bovinos sacrificados en el matadero del cantón Manta, provincia Manabí, Ecuador. Se tomaron muestras de sangre a 320 bovinos para detectar anticuerpos contra bacterias del género Leptospira utilizando la técnica de microaglutinación. Asi-mismo, se hizo una revisión macroscópica de los riñones y se tomaron muestras para el análisis histopatológico. La seroprevalencia de Leptospira spp fue de 50.9% y la fre-cuencia de lesiones renales fue de 18.13%. Se encontró la presencia de los ocho serovares evaluados, siendo mayor la frecuencia de los serovares Pomona, Icterohaemorragiae y Bratislava. Los animales serológicamente positivos a Leptospira presentan 40.56 más probabilidad de presentar lesiones específicas asociadas con la enfermedad al momento del sacrificio (p<0.00001; OR=40.56; IC 95%= 9.86-169.79). Se determinó asociación signi-ficativa entre la presencia de lesiones renales con los serovares Icterohaemorragiae, Canicola, Hardjo y Wolffi. No se encontró asociación entre la presencia de lesiones con el sexo de los animales ni con el cantón de procedencia. Se concluye que existe relación entre la seroprevalencia a Leptospira spp y la presencia de lesiones renales (RMB)

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

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