Factors associated with oral health relatedquality of life in preschoolers from an Andean community

Objetivo: Analizar el estado de salud bucal y su relación con la calidad de vida de los preescolares de una comunidad andina y vulnerable del Perú. Material y Métodos: El estudio observacional, correlacional y transversal se realizó en una muestra de 120 niños de 3 a 5 años. La caries de la primera infancia se determinó mediante el índice ceod. También se consideró la presencia y el tipo de maloclusión. El cuestionario Early Childhood Oral Health Impact Scale (ECOHIS) midió la calidad de vida relacionada con la salud bucal. Los factores y variables orales se analizaron de manera univariada y bivariada. Se realizó un análisis de correlación de Spearman y regresión lineal para identificar los factores y en qué medida explicaban la puntuación del cuestionario. Resultados: El análisis de regresión lineal múltiple por el método de mínimos cuadrados solo incluyó como significativa (p <0,05) la contribución de ceod para explicar la puntuación del cuestionario, dejando de lado variables como el sexo, la edad, la maloclusión y el índice de higiene bucal simplificado. El modelo de regresión estimado fue Puntuación del Cuestionario = 11,67 + 0,79*ceod, donde la puntuación del cuestionario aumentó en 0,79 por cada unidad ganada de ceod, y la variabilidad de las puntuaciones obtenidas se explica por el ceod en un R2 = 30% (p<0,001). Conclusiones: Existe un impacto de la caries dental en la calidad de vida de los preescolares de uma comunidade andina del Perú y sus familias

What pulmonologists think about the asthma–COPD overlap syndrome

Background: Some patients with COPD may share characteristics of asthma; this is the so-called asthma–COPD overlap syndrome (ACOS). There are no universally accepted criteria for ACOS, and most treatments for asthma and COPD have not been adequately tested in this population. Materials and methods: We performed a survey among pulmonology specialists in asthma and COPD aimed at collecting their opinions about ACOS and their attitudes in regard to some case scenarios of ACOS patients. The participants answered a structured questionnaire and attended a face-to-face meeting with the Metaplan methodology to discuss different aspects of ACOS. Results: A total of 26 pulmonologists with a mean age of 49.7 years participated in the survey (13 specialists in asthma and 13 in COPD). Among these, 84.6% recognized the existence of ACOS and stated that a mean of 12.6% of their patients might have this syndrome. In addition, 80.8% agreed that the diagnostic criteria for ACOS are not yet well defined. The most frequently mentioned characteristics of ACOS were a history of asthma (88.5%), significant smoking exposure (73.1%), and postbronchodilator forced expiratory volume in 1 second/forced vital capacity ,0.7 (69.2%). The most accepted diagnostic criteria were eosinophilia in sputum (80.8%), a very positive bronchodilator test (69.2%), and a history of asthma before 40 years of age (65.4%). Up to 96.2% agreed that first-line treatment for ACOS was the combination of a long-acting β2-agonist and inhaled steroid, with a long-acting antimuscarinic agent (triple therapy) for severe ACOS. Conclusion: Most Spanish specialists in asthma and COPD agree that ACOS exists, but the diagnostic criteria are not yet well defined. A previous history of asthma, smoking, and not fully reversible airflow limitation are considered the main characteristics of ACOS, with the most accepted first-line treatment being long-acting β2-agonist/inhaled corticosteroids

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

The global retinoblastoma outcome study : a prospective, cluster-based analysis of 4064 patients from 149 countries

DATA SHARING : The study data will become available online once all analyses are complete.BACKGROUND : Retinoblastoma is the most common intraocular cancer worldwide. There is some evidence to suggest that major differences exist in treatment outcomes for children with retinoblastoma from different regions, but these differences have not been assessed on a global scale. We aimed to report 3-year outcomes for children with retinoblastoma globally and to investigate factors associated with survival. METHODS : We did a prospective cluster-based analysis of treatment-naive patients with retinoblastoma who were diagnosed between Jan 1, 2017, and Dec 31, 2017, then treated and followed up for 3 years. Patients were recruited from 260 specialised treatment centres worldwide. Data were obtained from participating centres on primary and additional treatments, duration of follow-up, metastasis, eye globe salvage, and survival outcome. We analysed time to death and time to enucleation with Cox regression models. FINDINGS : The cohort included 4064 children from 149 countries. The median age at diagnosis was 23·2 months (IQR 11·0–36·5). Extraocular tumour spread (cT4 of the cTNMH classification) at diagnosis was reported in five (0·8%) of 636 children from high-income countries, 55 (5·4%) of 1027 children from upper-middle-income countries, 342 (19·7%) of 1738 children from lower-middle-income countries, and 196 (42·9%) of 457 children from low-income countries. Enucleation surgery was available for all children and intravenous chemotherapy was available for 4014 (98·8%) of 4064 children. The 3-year survival rate was 99·5% (95% CI 98·8–100·0) for children from high-income countries, 91·2% (89·5–93·0) for children from upper-middle-income countries, 80·3% (78·3–82·3) for children from lower-middle-income countries, and 57·3% (52·1-63·0) for children from low-income countries. On analysis, independent factors for worse survival were residence in low-income countries compared to high-income countries (hazard ratio 16·67; 95% CI 4·76–50·00), cT4 advanced tumour compared to cT1 (8·98; 4·44–18·18), and older age at diagnosis in children up to 3 years (1·38 per year; 1·23–1·56). For children aged 3–7 years, the mortality risk decreased slightly (p=0·0104 for the change in slope). INTERPRETATION : This study, estimated to include approximately half of all new retinoblastoma cases worldwide in 2017, shows profound inequity in survival of children depending on the national income level of their country of residence. In high-income countries, death from retinoblastoma is rare, whereas in low-income countries estimated 3-year survival is just over 50%. Although essential treatments are available in nearly all countries, early diagnosis and treatment in low-income countries are key to improving survival outcomes.The Queen Elizabeth Diamond Jubilee Trust and the Wellcome Trust.https://www.thelancet.com/journals/langlo/homeam2023Paediatrics and Child Healt

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

Fundamentos de la Gerencia - AD144 - 202200

Descripción: El curso de Fundamentos de la Gerencia es un curso teórico general, que apertura en el estudiante el conocimiento de la Administración mediante conceptos y metodologías básicas, que le permitirán comprender el trabajo de los gerentes en las organizaciones, utilizando para ello el proceso de la administración, dentro de un enfoque técnico y a la vez humano, que son los elementos principales de la competitividad en el siglo XXI. El contenido del curso representa primero, el punto de partida para los cursos de ciclos siguientes dentro de la línea de Negocios, y segundo, la formación de la base para los criterios futuros que requiere un profesional de Administración para manejar situaciones. Propósito: El curso de Fundamentos de la Gerencia contribuye directamente al desarrollo de las competencias específicas de Pensamiento Estratégico y Desarrollo de Personas en el Nivel 1, para cada una de ellas. Los cursos pre requisitos, dependiendo de la carrera, son Comprensión y Producción del Lenguaje o Introducción a los Negocios. Está diseñado para la Facultad de Negocios

Introducción A Los Negocios-AD179-201701

Descripción: El curso Introducción a los Negocios es de especialidad en la carrera de Administración y Finanzas de carácter teórico-práctico dirigido a los estudiantes de primer ciclo que le permitirá conocer los conceptos fundamentales sobre cómo se conforma una empresa a través de la comprensión de los tipos de empresas y de las áreas funcionales y de apoyo en una organización. Para este fin se desarrollan temas como: el emprendimiento los tipos de empresas sectores empresariales así como la composición y funcionamiento de las diferentes áreas que la conforman (operaciones marketing logística finanzas y áreas de apoyo).Propósito: El curso busca desarrollar la competencia general "Pensamiento innovador" en un nivel 1 y la competencia específica "Planificación y control" en nivel 1. Cabe mencionar que no tiene prerrequisitos

Fundamentos de la Gerencia - AD144 - 202100

Descripción: El curso de Fundamentos de la Gerencia es un curso teórico general, que apertura en el estudiante el conocimiento de la Administración mediante conceptos y metodologías básicas, que le permitirán comprender el trabajo de los gerentes en las organizaciones, utilizando para ello el proceso de la administración, dentro de un enfoque técnico y a la vez humano, que son los elementos principales de la competitividad en el siglo XXI. El contenido del curso representa primero, el punto de partida para los cursos de ciclos siguientes dentro de la línea de Negocios, y segundo, la formación de la base para los criterios futuros que requiere un profesional de Administración para manejar situaciones. Propósito: El curso de Fundamentos de la Gerencia contribuye directamente al desarrollo de las competencias específicas de Pensamiento Estratégico y Desarrollo de Personas en el Nivel 1, para cada una de ellas. Los cursos pre requisitos, dependiendo de la carrera, son Comprensión y Producción del Lenguaje o Introducción a los Negocios. Está diseñado para la Facultad de Negocios

Fundamentos De La Gerencia-AD144-201900

Descripción:El curso de Fundamentos de la Gerencia es un curso teórico general que apertura en el estudiante el conocimiento de la Administración mediante conceptos y metodologías básicas que le permitirán comprender el trabajo de los gerentes en las organizaciones utilizando para ello el proceso de la administración dentro de un enfoque técnico y a la vez humano que son los elementos principales de la competitividad en el siglo XXI. El contenido del curso representa primero el punto de partida para los cursos de ciclos siguientes dentro de la línea de Negocios y segundo la formación de la base para los criterios futuros que requiere un profesional de Administración para manejar situaciones.Propósito:El curso de Fundamentos de la Gerencia contribuye directamente al desarrollo de las competencias específicas de Pensamiento Estratégico y Desarrollo de Personas en el Nivel 1 para cada una de ellas. Los cursos pre requisitos dependiendo de la carrera son Comprensión y Producción del Lenguaje o Introducción a los Negocios. Está diseñado para la Facultad de Negocios Facultad de Hotelería y Administración Facultad de Derecho Facultad de Psicología y la Carrera de Comunicación Audiovisual y Medios Interactivos

Impactos en seguridad social, económico y político de las migraciones laborales, de manera global y en el marco de los acuerdo bilaterales

El mundo moderno, caracterizado por globalización, acuerdos regionales de libres mercados presenta una enorme población de migración, las naciones Unidas han calculado, para 2005, en 192 millones al total de la población migrante internacional con su correspondiente conjunto de migrantes laborales, personas que buscan mejorar oportunidades de empleo. Tal fenómeno de migraciones laborales tienen repercusiones e impactos en la vida de las naciones originales y receptoras de estos migrantes. El trabajo de investigación presentado, aborda y analiza las implicaciones en seguridad social, económicas y políticas para Colombia y los países receptores de migrantes laborales, en el contexto de nuestros acuerdos