Accidentes con material biológico en trabajadores de la salud. Palmira-Valle del Cauca. 2014-2016.

Introduction: Sanitary professionals are exposed daily to different biological risks generated by their work environment Objective: Describe the profile of work accidents caused by biological risks in a secondary level health care institution. Palmira-Valle del Cauca. 2014-2016. Materials and methods: Descriptive, retrospective study performed with 37 reports. For the quantitative variables, central tendency and dispersion were calculated, and for the qualitative variables, proportions and ratios. To analyze the relation between variables the Pearson’s chi-squared test, fisher or the median were used according to the distribution of data, considering a value of p≤0,05 as significant. Results: Most of the workers injured were young women, mainly auxiliary nurses which were injured by sharps (needles) during morning shifts and in services of greater demand (emergencies and hospitalization). 89% of the workers exposed to biological risk did not use safety materials or equipment at the moment of the accident. The frequent causes were needle manipulation and movements of the patient when performing assistant procedures. Hands were the most affected area. Conclusions: The object that caused the accident, the place of the injury, the service, the age of the worker, the shift and the charge in the health care service institution, determined the profile of the work accidents which registered the greatest number of work accidents with exposure to biological risks; the most frequent causes were associated to the manipulation of sharp objects when the assistant or nurse attends the patient.Introducción: Los profesionales sanitarios están expuestos diariamente a diferentes riesgos biológicos generados por su ambiente laboral. Objetivo: Describir el perfi l de los accidentes laborales por riesgo biológico en una institución de salud de segundo nivel de complejidad. Palmira-Valle del Cauca. 2014-2016. Materiales y métodos: Estudio descriptivo, retrospectivo, realizado con 37 reportes. A las variables cuantitativas se les calcularon medidas de tendencia central y dispersión y a las cualitativas proporciones y razones. Para analizar la relación entre variables se usaron los Test del Chi cuadrado, Fisher o Medianas de acuerdo a la distribución de los datos, considerando un valor de p≤0,05 como signifi cante. Resultados: La mayoría de los trabajadores accidentados fueron mujeres jóvenes, principalmente enfermeras auxiliares las cuales fueron lesionadas por elementos punzantes (agujas) durante los turnos matutinos y en los servicios de mayor demanda (urgencias y hospitalización). El 89 % de los trabajadores expuestos al riesgo biológico no utilizaron materiales o equipos de seguridad al momento del accidente. Las causas frecuentes fueron la manipulación de agujas y los movimientos del paciente al realizar procedimientos asistenciales. Las manos fueron el área más afectada. Conclusiones: El elemento vulnerante, el sitio de la lesión, el servicio, la edad del trabajador, el turno y el cargo en la institución prestadora de servicios de salud, determinaron el perfi l de los accidentes de trabajo, que registraron el mayor número de accidentes laborales con exposición a riesgo biológico; las causas más frecuentes se asociaron con la manipulación de elementos punzantes cuando la asistente atiende al paciente

Diagnosis and Treatment of Autoimmune Hepatitis

RESUMEN: La hepatitis autoinmune (HAI) es una enfermedad crónica, progresiva, más frecuente en mujeres y de etiología desconocida, caracterizada histológicamente por infiltrado de células mononucleares en el tracto portal y bioquímicamente por hipertransaminasemia e hipergamaglobulinemia y por la presencia de autoanticuerpos específicos para el hígado. La respuesta al tratamiento inmunosupresor es generalmente buena y la resolución tanto bioquímica como histológica de la inflamación se logra en el 87% de los pacientes en tres años después de haber iniciado dicho tratamiento. Diversos estudios han demostrado que, en ausencia de tratamiento, la enfermedad lleva rápidamente a fibrosis y la tasa de mortalidad es mayor del 80% a los cinco años del diagnóstico. Por el contrario, si el paciente ya presenta cirrosis hepática el tratamiento disminuye la respuesta inflamatoria y la progresión histológica de la fibrosis. La expectativa de vida de los pacientes que responden al tratamiento excede el 90% a los 10 años y es de 80% a los 20 años; sin embargo, 10-15% no tienen respuesta adecuada o satisfactoria al tratamiento médico. En este artículo se revisan el tratamiento estándar y las nuevas opciones para el manejo de esta enfermedad.ABSTRACT: Autoimmune hepatitis is a chronic, progressive disease, more frequent in women than in men, and of unknown etiology. Histologically, it is characterized by mononuclear cell infiltration in the portal tract, and biochemically by elevation of transaminases, hypergammaglobulinemia, and the presence of liver specific autoantibodies. Response to immunosuppressive treatment is generally good and the resolution of inflammation, both biochemically and histologically, is achieved in 87% of patients in 3 years after immunosuppressive treatment is started. Several studies have shown that in the absence of treatment the disease progresses rapidly to fibrosis, and the mortality rate is higher than 80% in the 5 years following diagnosis in untreated patients. Nevertheless, even if the patient has liver fibrosis, treatment decreases the inflammatory response and the histological progression of fibrosis. Life expectancy of patients who respond to treatment exceeds 90% at 10 years, and is 80% at 20 years; however, 10-15% of patients do not have satisfactory response to medical treatment. Standard treatment and new therapeutic options are reviewed in this article

Modelo de gestión del talento humano para la empresa Otorgo Envases S.A.S de Cali para el año 2021.

Ilustracion 1.Proceso Administrativo. Chiavenato (2003). 28 Ilustracion 2. Condiciones y ambientes de trabajo. 52 Ilustracion3. Modelo de gestión del talento humano otorgo envases 57La administración del talento humano dentro de las organizaciones juega un papel muy importante tanto para empleadores como para trabajadores ya que se encuentra en medio de ambos y establece los principios, políticas, reglas, deberes y derechos que deben asumir ambas partes de acuerdo con el marco legal, por ello es tan importante una eficiente administración del mismo. Esta importante gestión y administración ha ido evolucionando a través del tiempo, cambiando la ideología del hombre como maquina a persona con ideas, pensante, racional y necesaria en la realización de un puesto de trabajo o cargo. La administración del talento humano debe encargarse de reclutar personal idóneo para que desempeñe las funciones y cargos que requiera la empresa, por ello debe analizar y planear la selección, el perfil y su remuneración económica de acuerdo con su nivel educativo y experiencia. Este trabajo tiene como objetivo Diseñar un modelo de gestión del talento humano para la empresa otorgo envases de Cali, en el cual se deben analizar y estudiar los distintos modelos que resalte la cultura organización y que verdaderamente generen resultados satisfactorios.The management of human talent within organizations plays a very important role for both employers and workers since it is in the middle of both and establishes the principles, policies, rules, duties and rights that both parties must assume according to the legal framework. , for this reason an efficient administration of the same is so important. This important management and administration has evolved over time, changing the ideology of man as a machine to a person with ideas, thinking, rational and necessary in the performance of a job or position. The human talent administration must be in charge of recruiting suitable personnel to carry out the functions and positions required by the company, therefore it must analyze and plan the selection, the profile and their economic remuneration according to their educational level and experience. The objective of this work is to Design a human talent management model for the company I grant Cali packaging, in which the different models that highlight the organizational culture and that truly generate satisfactory results must be analyzed and studied

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

Accidentes con material biológico en trabajadores de la salud. Palmira-Valle del Cauca. 2014-2016.

Introduction: Sanitary professionals are exposed daily to different biological risks generated by their work environment Objective: Describe the profile of work accidents caused by biological risks in a secondary level health care institution. Palmira-Valle del Cauca. 2014-2016. Materials and methods: Descriptive, retrospective study performed with 37 reports. For the quantitative variables, central tendency and dispersion were calculated, and for the qualitative variables, proportions and ratios. To analyze the relation between variables the Pearson’s chi-squared test, fisher or the median were used according to the distribution of data, considering a value of p≤0,05 as significant. Results: Most of the workers injured were young women, mainly auxiliary nurses which were injured by sharps (needles) during morning shifts and in services of greater demand (emergencies and hospitalization). 89% of the workers exposed to biological risk did not use safety materials or equipment at the moment of the accident. The frequent causes were needle manipulation and movements of the patient when performing assistant procedures. Hands were the most affected area. Conclusions: The object that caused the accident, the place of the injury, the service, the age of the worker, the shift and the charge in the health care service institution, determined the profile of the work accidents which registered the greatest number of work accidents with exposure to biological risks; the most frequent causes were associated to the manipulation of sharp objects when the assistant or nurse attends the patient.Introdução: Os professionais sanitários estão expostos diariamente a diferentes riscos biológicos gerados por seu ambiente de trabalho. Objetivo: Descrever o perfil dos acidentes no trabalho por risco biológico numa instituição de saúde de segundo nível de complexidade, na cidade de Palmira, Valle del Cauca, Colômbia (2014-2016). Materiais e Métodos: Estudo descritivo, retrospectivo, realizado com 37 relatórios. Às variáveis quantitativas se lhes calcularam medidas de tendência central e dispersão e às qualitativas proporções e razões. Para analisar a relação entre variáveis se usaram os Teste do Qui-quadrado, Fisher ou Medianas de acordo à distribuição dos dados, considerando um valor de p≤0,05 como significativo. Resultados: A maioria dos trabalhadores acidentados foram mulheres jovens, principalmente auxiliares de enfermagem as quais foram lesionadas por elementos perfurocortantes (agulhas) durante os turnos da manhã e nos serviços de maior demanda (emergências e hospitalização). O 89 % dos trabalhadores expostos ao risco biológico não utilizaram materiais ou equipamentos de segurança ao momento do acidente. As causas frequentes foram a manipulação de agulhas e os movimentos do paciente ao realizar procedimentos de cuidados de saúde. As mãos foram a área mais afeitada. Conclusões: O elemento vulnerável, o local da lesão, o serviço, a idade do trabalhador, o turno e o cargo na instituição fornecedora de serviços de saúde; determinaram o perfil dos acidentes no trabalho que registraram o maior número de acidentes com exposição a risco biológico; as causas mais frequentes se associaram com a manipulação de elementos pontiagudos quando a auxiliar de enfermagem cuidava do pacienteIntroducción: Los profesionales sanitarios están expuestos diariamente a diferentes riesgos biológicos generados por su ambiente laboral. Objetivo: Describir el perfi l de los accidentes laborales por riesgo biológico en una institución de salud de segundo nivel de complejidad. Palmira-Valle del Cauca. 2014-2016. Materiales y métodos: Estudio descriptivo, retrospectivo, realizado con 37 reportes. A las variables cuantitativas se les calcularon medidas de tendencia central y dispersión y a las cualitativas proporciones y razones. Para analizar la relación entre variables se usaron los Test del Chi cuadrado, Fisher o Medianas de acuerdo a la distribución de los datos, considerando un valor de p≤0,05 como signifi cante. Resultados: La mayoría de los trabajadores accidentados fueron mujeres jóvenes, principalmente enfermeras auxiliares las cuales fueron lesionadas por elementos punzantes (agujas) durante los turnos matutinos y en los servicios de mayor demanda (urgencias y hospitalización). El 89 % de los trabajadores expuestos al riesgo biológico no utilizaron materiales o equipos de seguridad al momento del accidente. Las causas frecuentes fueron la manipulación de agujas y los movimientos del paciente al realizar procedimientos asistenciales. Las manos fueron el área más afectada. Conclusiones: El elemento vulnerante, el sitio de la lesión, el servicio, la edad del trabajador, el turno y el cargo en la institución prestadora de servicios de salud, determinaron el perfi l de los accidentes de trabajo, que registraron el mayor número de accidentes laborales con exposición a riesgo biológico; las causas más frecuentes se asociaron con la manipulación de elementos punzantes cuando la asistente atiende al paciente

Diagnosis and treatment of autoimmune hepatitis Diagnóstico y tratamiento de la hepatitis autoinmune

Autoimmune hepatitis is a chronic, progressive disease, more frequent in women than in men, and of unknown etiology. Histologically, it is characterized by mononuclear cell infiltration in the portal tract, and biochemically by elevation of transaminases, hypergammaglobulinemia, and the presence of liver specific autoantibodies. Response to immunosuppressive treatment is generally good and the resolution of inflammation, both biochemically and histologically, is achieved in 87% of patients in 3 years after immunosuppressive treatment is started. Several studies have shown that in the absence of treatment the disease progresses rapidly to fibrosis, and the mortality rate is higher than 80% in the 5 years following diagnosis in untreated patients. Nevertheless, even if the patient has liver fibrosis, treatment decreases the inflammatory response and the histological progression of fibrosis. Life expectancy of patients who respond to treatment exceeds 90% at 10 years, and is 80% at 20 years; however, 10-15% of patients do not have satisfactory response to medical treatment. Standard treatment and new therapeutic options are reviewed in this article. La hepatitis autoinmune (HAI) es una enfermedad crónica, progresiva, más frecuente en mujeres y de etiología desconocida, caracterizada histológicamente por infiltrado de células mononucleares en el tracto portal y bioquímicamente por hipertransaminasemia e hipergamaglobulinemia y por la presencia de autoanticuerpos específicos para el hígado. La respuesta al tratamiento inmunosupresor es generalmente buena y la resolución tanto bioquímica como histológica de la inflamación se logra en el 87% de los pacientes en tres años después de haber iniciado dicho tratamiento. Diversos estudios han demostrado que, en ausencia de tratamiento, la enfermedad lleva rápidamente a fibrosis y la tasa de mortalidad es mayor del 80% a los cinco años del diagnóstico. Por el contrario, si el paciente ya presenta cirrosis hepática el tratamiento disminuye la respuesta inflamatoria y la progresión histológica de la fibrosis. La expectativa de vida de los pacientes que responden al tratamiento excede el 90% a los 10 años y es de 80% a los 20 años; sin embargo, 10-15% no tienen respuesta adecuada o satisfactoria al tratamiento médico. En este artículo se revisan el tratamiento estándar y las nuevas opciones para el manejo de esta enfermedad

Nevus sebáceo de Jadassohn: descripción de 261 casos y su asociación con otros tumores

El nevus sebáceo de Jadassohn (NSJ) es una lesión congénita benigna pero por decenios se la consideró con alto potencial de malignización hacia el carcinoma basocelular (CBC), por lo que se sugería su resección precoz. Series recientes han establecido que muchas de las neoplasias diagnosticadas como malignas eran benignas. Nuestra revisión de 261 casos constituye un aporte al conocimiento del NSJ. Hasta ahora no ha habido series similares en Colombia, y en América Latina las publicaciones no superan los 60 pacientes. MATERIALES Y MÉTODOS: se analizaron 261 casos del archivo de histopatología de la Facultad de Medicina de la Universidad de Antioquia con diagnóstico de NSJ entre 1976 y 2008, incluyendo biopsias y resecciones. RESULTADOS: de los 261 pacientes, 143 eran hombres (54,8%) y 118 mujeres (45,2%); la edad promedio fue de 17,4 años; el NSJ estaba presente al nacimiento en el 90,4%. La localización más frecuente fue en el cuero cabelludo (62,5%). Presentaron tumores asociados 28 pacientes: siringocistadenoma papilífero (SCAP) 8 casos (3,1%), tumor del infundíbulo folicular (TIF) 5 casos (1,9%). Cuatro casos fueron de CBC (1,5%) con edad promedio de 40,7 años. Cuatro de 7 tumores diagnosticados previamente como CBC, fueron reclasificados como TIF. DISCUSIÓN: el SCAP fue el tumor más frecuentemente asociado, tal como aparece reportado por otros autores. En esta serie se encontró el TIF con una mayor frecuencia que en la literatura revisada. El CBC fue el único tumor maligno y se presentó solo en adultos. Los resultados de esta serie evidencian un comportamiento benigno del NSJ, por lo que se debiera replantear la necesidad de resección precoz. La revisión histológica del diagnóstico inicial demuestra que lesiones benignas pueden ser confundidas fácilmente con CBC, sobreestimando el potencial maligno de este hamartoma

Somos tres, cuatro o más (+): Hacia la construcción de vínculos sexuales libres

The couple's relationship is permeated by many meanings that go through the different sexual dynamics and the formation of bonds, in search of meaning, since immemorial times. This article aims to offer an approach to understand the new dynamics of sexual bonding, in stable couples in Latin America, in the last decade of the 21st century. Based on a documentary review, the article presents the new forms of love that have existed through time, showing that, although they are immersed in beliefs, cultures, and society itself, they still are taboo, accompanied, in addition, by a great lack of information about it. The article begins by showing the historical transits of sexuality as a couple, passing through the reflection of the romantic and sexual affective bond, to culminate with a dissertation on the various non-monogamous sexual practices. Lastly, the article concludes with an invitation to understand the resignify sexual life as a couple, oriented towards new transformations, meanings, and novel ways of seeing and experiencing love and sexuality.La relación de pareja está permeada por&nbsp;un sinnúmero de significados que atraviesan las diferentes dinámicas sexuales y la formación de vínculos, en búsqueda de un sentido, desde tiempos inmemorables. El presente artículo pretende ofrecer un acercamiento a la comprensión de las nuevas dinámicas de vinculación sexual, en parejas estables de Latinoamérica, en el último decenio del siglo XXI. A partir de una revisión documental, el artículo muestra las nuevas formas del amor que han estado presentes en el tiempo, evidenciando que, aunque están inmersas en creencias, culturas y la misma sociedad, continúan siendo un tema tabú, acompañadas, además, de un gran vacío de información al respecto. El artículo comienza mostrando los tránsitos históricos de la sexualidad en pareja, pasando por la reflexión del vínculo afectivo romántico y sexual afectivo, para culminar con una disertación en torno a las diversas prácticas sexuales no monógamas. En definitiva, el artículo concluye con una invitación a entender la resignificación de la vida sexual en pareja, orientada a nuevas transformaciones, sentidos y novedosas formas de ver y experimentar el amor y la sexualidad