Percepción cultural del “embarazo y parto”, en las comunidades campesinas del distrito Ayaviri-Puno

Native and Amazonian communities have this tendency to consider pregnancy and childbirth as a cultural and historical process of self-determination. This section deals with traditional knowledge in relation to pregnancy and childbirth, which is still revalued and put into practice in rural areas, however, this knowledge is being displaced by modernity. The objective of the research is aimed at reassessing the cultural perception of "pregnancy and childbirth", linked to customs, beliefs, cultural tradition, the role of midwives and symbolic representations, as a millenary cultural manifestation; This study is qualitative, using the ethnographic design and inductive method. The results describe the customs and beliefs in relation to pregnancy and childbirth associated with food beliefs and importance of supernatural beings and deities; as well as, the popular tradition expressed in celebrations at the family and collective level; The role of midwives is also developed in the therapeutic treatment with plants, minerals and animals, and ultimately the ritual acts related to pregnancy and childbirth are analyzed, as a product of an ancestral cultural heritage still valued in the district's communities. from Ayaviri-Puno.Las comunidades nativas y amazónicas tienen esa tendencia en considerar el embrazo y parto, como un proceso cultural e histórico de libre determinación. El presente apartado trata sobre los conocimientos tradicionales en relación al embarazo y parto, los cuales aún son revalorados y puestos en práctica en las zonas rurales, sin embargo, estos conocimientos están siendo desplazados por la modernidad. El objetivo de la investigación esta orientado en revalorar la percepción cultural del “embarazo y parto”, vinculados a las costumbres, creencias, tradición cultural, la función de las parteras y representaciones simbólicas, como una manifestación cultural milenaria; es estudio es de corte cualitativo, se utiliza el diseño etnográfico y método inductivo. En los resultados se describe las costumbres y creencias en relación al embarazo y parto asociadas a las creencias alimentarias e importancia seres sobrenaturales y deidades; así como, la tradición popular expresado en celebraciones a nivel familiar y colectivo; se desarrolla tambien la función de las parteras en el tratamiento terapéutico con plantas, minerales y animales, y en última instancia se analiza los actos rituales relacionados al embarazo y parto, como producto de una herencia cultural ancestral aún puesta en valor en las comunidades del distrito de Ayaviri-Puno

Factores contributivos del programa Pensión 65 y su relación con el bienestar del adulto mayor

Aging leads to the physical and mental deterioration of the person, it is a stage of maximum fragility, so the presence of social assistance programs that promote a decent stay at this stage is dispensable. For this reason, the Pension 65 program emerges, whose purpose is to ensure the well-being of the elderly living in poverty. Therefore, the objective of the research was to determine the contributory factors of the Pension 65 program and its relationship with the well-being of the elderly in the district of Pilcuyo, province of El Collao. The study was framed within the quantitative approach of the correlational type, non-experimental design. The sample consisted of 196 elderly beneficiaries. The results showed that there is a relationship between: household targeting (r=0.903**) and affiliation criteria, non-contributory pension (r=0.875**) and access to basic services, and between social assistance (r=0.890* *) and social satisfaction. In conclusion, the contributory factors of Pension 65 are significantly related (+0.891**, p<0.05) with the well-being of the elderly.El envejecimiento conlleva al deterioro físico y mental de la persona, es una etapa de máxima fragilidad, por lo que se hace prescindible la presencia de programas de asistencia social que fomente una estadía digna en esta etapa. En razón a ello, emerge el programa Pensión 65 cuyo propósito es asegurar el bienestar de las personas de la tercera edad en situación de pobreza. Por ende, el objetivo de la investigación fue determinar los factores contributivos del programa Pensión 65 y su relación con el bienestar del adulto mayor en el distrito de Pilcuyo, provincia de El Collao. El estudio se enmarcó dentro del enfoque cuantitativo del tipo correlacional, diseño no-experimental. La muestra estuvo conformada por 196 adultos mayores beneficiarios. Los resultados evidenciaron que existe relación entre: focalización de hogares (r=0,903**) y criterios de afiliación, pensión no contributiva (r=0,875**) y acceso a los servicios básicos, y entre la asistencia social (r=0,890**) y satisfacción social. En conclusión, los factores contributivos de Pensión 65 se relacionan de forma significativa (+0,891**, p<0,05) con el bienestar del adulto mayor

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