Reconocimiento de voces divergentes en el marco del post conflicto colombiano: una experiencia dialógica

En medio del polémico proceso de paz que ha despertado posiciones polarizadas, a favor y en contra de la firma e implementación del acuerdo de paz, surge la inquietud por propiciar escenarios que favorezcan el reconocimiento entre las personas con voces y perspectivas divergentes frente a lo que ha sido la historia del conflicto en Colombia y las posibilidades de reconciliación social; de esta manera surge la pregunta ¿cómo, a partir del diálogo público, se puede propiciar el reconocimiento entre voces divergentes en el marco del posacuerdo colombiano? Así, se llevó a cabo un espacio de diálogo siguiendo la metodología del Proyecto de Conversaciones Públicas (PCP) (Herzig y Chasin 2001), entre personas con diferentes perspectivas frente al conflicto armado, al posacuerdo y a la reconciliación. Se realizaron cinco entrevistas a profundidad previas y cinco entrevistas posteriores para evaluar el diálogo, se hizo un análisis cualitativo del proceso, valorando las voces que emergían en el diálogo y el proceso de reconocimiento durante este. Como resultado surgieron diferentes voces que se agruparon de acuerdo a su intensidad y movimiento en el diálogo, estas son: la voz del estereotipo, de la solidaridad y la desconfianza, predominó la voz del estereotipo al comienzo del diálogo y se posicionaron en la conversación la voz de la desconfianza y la solidaridad. Como aspectos importantes de discusión se analiza la línea divisoria que históricamente ha existido entre el reconocimiento jurídico y la valoración social, y la importancia de un reconocimiento basado en la valoración social para avanzar hacia la reconciliación, así como la importancia de la mirada y la voz para un diálogo que permita el reconocimiento de la humanidad compartida. Como conclusión, se confirma la potencialidad del diálogo para promover escenarios de reconocimiento

Modelo estratégico integral para el proceso de Salud Ocupacional (SG-SST) con énfasis en gestión del conocimiento de la empresa BRITISH AMERICAN TOBACCO – San Gil

La gestión del conocimiento cumple un papel muy importante en el Sistema de Gestión de Seguridad y Salud en el Trabajo en las organizaciones ya que a través del conocimiento es donde la información es transmitida directa y potencialmente en todos los empleados para que ellos mismos sean vigías en la prevención de enfermedades, identificación de riesgos y hagan propias las medidas de seguridad que se deben tener en cuenta para evitar accidentes laborales. A través de este proyecto, se realizará mejorías a la política de SG-SST implementada en la empresa BRITISH AMERICAN TOBACCO – San Gil, integrando el modelo de conocimiento según la espiral de Nonaka y Takeuchi.Knowledge management plays a very important role in the Management System of Security and Health in the work place; this being that information is transmitted directly to employees so that they themselves can be aware of the prevention of diseases, identify risks, and independently take safety measures to prevent work related accidents. Through this project, there will be improvements to the politics of SG-SST implemented in the BRITISH AMERICAN TOBACCO company- San Gil, integrating the knowledge model according to the Noaka and Takeuchi spiral

Dislipidemias y estilos de vida de jóvenes

PublishedLa preocupación por estas alteraciones en el estilo de vida ha llevado a los entes responsables del bienestar biopsicosocial de la población, a generar estrategias en los diferentes campos del desarrollo humano, siendo una de las prioridades las instituciones educativas, como las universidades. Para esto, los lineamientos nacionales dados por el Ministerio de Salud buscan promover entornos saludables, debido a que los estudiantes universitarios son considerados la población adulto joven clave, para la promoción y prevención de la salud para las futuras generaciones

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Voluntariado en Acción Catálogo de iniciativas de voluntariado Centros de Educación para el Desarrollo.

Este catálogo compila todas las iniciativas de voluntariado que enmarcan y orientan las acciones de más de dos mil voluntarios anuales que aportan con su tiempo y conocimiento al fortalecimiento de las comunidades, sus organizaciones sociales y comunitarias que trabajan decididamente para construir una mejor sociedad. Durante los últimos tres años hemos apostado por el fortalecimiento de esta estrategia generando nuevas modalidades, diversos escenarios para el desarrollo del voluntariado, capacitando a los 19 líderes y los voluntarios en las sedes, siempre bajo la profunda convicción de que el mundo se puede cambiar cuando mucha gente pequeña, en lugares pequeños, haciendo cosas pequeñas, logran tocar la vida de las personas que más lo necesitan

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

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