la perspectiva de los/as delegados/as

Tesis (Magíster en Intervención Socio-jurídica en Familia)Esta tesis indaga en las percepciones de los/as delegados/as de la Región Metropolitana respecto de sus intervenciones profesionales en la ejecución de la sanción de Libertad Asistida Especial. Se utiliza una metodología cualitativa de carácter exploratorio-descriptivo y basándose en la teoría fundamentada. La muestra de la investigación, fue intencionada y corresponde a un grupo de delegados/as que ejecuta la sanción de Libertad Asistida Especial, de las cuatro instituciones colaboradoras del SENAME. Se reflexionó sobre el ejercicio profesional de los/as delegados/as, considerando que debe prevalecer el contexto frente al estricto cumplimiento de la sanción LAE con jóvenes infractores/as de ley, con el fin de levantar información de factores que influyen en la intervención social y, por ende, en el proceso de reinserción. A partir de las áreas que constituyen la red local y los programas y estrategias de reinserción social se reflexiona también en torno a los significados que otorgan los/as delegados/as a las orientaciones técnicas definidas por el SENAME y concretadas por las propias instituciones colaboradoras. Se identifican las fortalezas y debilidades del ejercicio profesional, en torno al trabajo que se desarrolla con el/la joven, la familia y la red local y, finalmente, se singularizan algunas experiencias de intervención, considerándolas buenas prácticas. Todo ello con el objetivo final de poder generar nuevos insumos que informen la mejora de las políticas de sanción a jóvenes infractores/as en el medio libre. Finalmente, cabe mencionar que dentro de los principales hallazgos se encuentra la falta de recursos y coordinación con la red, la ausencia de capacitación permanente hacia los/as profesionales por parte de las instituciones colaboradoras y del propio Servicio, deficiencias técnicas en los/as delegados/as respecto a las metodologías de intervención y escasa claridad del Servicio respecto del enfoque y/o paradigma que quiere instalar en los programas, además del desgaste profesional ante la ausencia de instancias de autocuidado.This thesis investigates in the perceptions of the delegates of the Metropolitan Region regarding their professional interventions in the execution of the sanction of Special Assisted Freedom. A qualitative exploratory-descriptive methodology is used and based on grounded theory. The sample of the investigation was intentional and corresponds to a group of delegates of the sanction of Special Assisted Freedom, of the four collaborating institutions of the SENAME. Reflecting on the professional practice of the delegates, considering that the context must prevail against the strict compliance with the LAE sanction with young offenders, in order to raise information on factors that influence social intervention And, therefore, in the process of reintegration. From the areas that make up the local network and the programs and strategies for social reintegration, we also reflect on the meanings given by the delegates to the technical orientations defined by SENAME and defined by the collaborating institutions themselves. The strengths and weaknesses of the professional practice are identified, based on the work developed with the young person, the family and the local network, and finally, some intervention experiences are singled out as good practices. All this with the final objective of being able to generate new inputs that inform the improvement of the policies of sanction to young offenders in the free environment. Finally, it should be mentioned that the main findings are the lack of resources and coordination with the network, the lack of permanent training for the professionals by the collaborating institutions and the Service itself, technical deficiencies in the delegates With respect to the intervention methodologies and poor clarity of the Service regarding the approach and / or paradigm that it wants to install in the programs, besides the professional wear and tear in the absence of instances of self-care

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

Estudio sobre la eficacia del plan de intervención individual como herramienta para cumplir la finalidad de la sanción de libertad asistida especial, en jóvenes infractores de ley que se encuentran ejecutando condenas por delito de robo con intimidación

Tesis (Trabajador Social)La investigación tiene por finalidad establecer la efectividad de los planes de intervención respecto de la sanción de LIBERTAD ASISTIDA ESPECIAL, en el caso de dos jóvenes infractores de Ley de 17 años que han cometido delitos de robo con intimidación en la comuna de Pudahuel e Independencia, que se encuentran condenados a dichas sanciones y cumpliéndolas en los centros “Corporación A” y “Fundación B”. Con el objeto de saber si se logra el cumplimiento de la finalidad de la sanción, se pretende indagar, a través de los distintos actores involucrados en la ejecución de la sanción impuesta, qué es lo que pasa, qué es lo que hay y finalmente cómo opera el funcionamiento de estos planes de intervención. A través de la información recopilada se describirá la misma y se interpretará la información con el propósito de verificar si se cumplen los objetivos de la sanción “LIBERTAD ASISTIDA ESPECIAL”. En relación a la metodología de investigación, se realizará un estudio cualitativo, el cual tiene por finalidad obtener la información necesaria de los distintos actores involucrados, que participan en la ejecución de la sanción de los dos casos que se pretende describir y analizar. Finalmente, se pretende adoptar una postura frente al análisis de la información, para corroborar si efectivamente el plan de intervención individual en los casos de la sanción “LIBERTAD ASISTIDA ESPECIAL” cumple con su finalidad, en los términos del artículo 20 de la Ley de Responsabilidad Penal Adolescente