Anteproyecto diseño arquitectónico de Centro de Desarrollo Comunitario en colonia ciudad Pacifica, San Miguel

RESUMEN: La ciudad de San Miguel presenta la necesidad de espacios donde se desarrollen actividades de esparcimiento, así como el fomento de actividades de índole cultural, de artes y de formación continua en talleres y capacitaciones para el desarrollo de la población. Por la necesidad de tales espacios se realiza la propuesta de un Centro de Desarrollo Comunitario en Colonia Ciudad Pacífica, donde se puedan realizar actividades de índole cultural, desarrollo de actividades de capacitaciones y talleres vocacionales, además del componente deportivo con el desarrollo de un Centro de Desarrollo Deportivo en las mismas instalaciones. Para la realización del anteproyecto diseño arquitectónico de Centro de Desarrollo Comunitario en Colonia Ciudad Pacífica en San Miguel, se lleva a cabo la realización del planteamiento del problema donde podremos observar las causas y consecuencias del estudio, y se explica las razones por el cual es de aporte social. Considerando que los centros de desarrollo comunitario son un lugar donde las personas de esta comunidad pueden capacitarse, superarse y tener un mejor desarrollo en el ámbito social y cultural es pertinente desarrollar la propuesta en la Colonia Ciudad Pacífica donde presenta necesidad de tales instalaciones. Como objetivo se tiene la realización del Anteproyecto Diseño Arquitectónico de Centro de Desarrollo Comunitario en Colonia Ciudad Pacífica en San Miguel, y proporcionar los instrumentos que faciliten el desarrollo del proyecto, alcances para el desarrollo son en el periodo de 6 meses calendario En la siguiente etapa se verá el crecimiento de usuarios que visitará el Centro de Desarrollo Comunitario, la cantidad de personal para su cuidado y mantenimiento, así como su respectivo espacio dentro de la propuesta en los próximos años, tiempo establecido por el crecimiento territorial de la urbanización. ABSTRACT: The city of San Miguel presents the need for spaces where recreational activities are developed, as well as the promotion of activities of a cultural nature, arts and continuous training in workshops and training for the development of the population. Due to the need for such spaces, a proposal is made for a Community Development Center in Colonia Ciudad Pacifica, where activities of a cultural nature can be carried out, development of training activities and vocational workshops, in addition to the sports component with the development of a Center for Sports Development in the same facilities. For the realization of the preliminary architectural design of the Community Development Center in Colonia Ciudad Pacifica in San Miguel, the problem statement is carried out where we can observe the causes and consequences of the study, and the reasons why it is of social contribution. Considering that the community development centers are a place where the people of this community can be trained, improve themselves and have a better development in the social and cultural sphere, it is pertinent to develop the proposal in the Ciudad Pacifica neighborhood where there is a need for such facilities. The objective is the realization of the Preliminary Architectural Design of the Community Development Center in Colonia Ciudad Pacifica in San Miguel, and to provide the instruments that facilitate the development of the project, scope for development is in the period of 6 calendar months In the next stage, the growth of users who will visit the Community Development Center will be seen, the number of personnel for its care and maintenance, as well as their respective space within the proposal in the coming years, a time established by the territorial growth of the community. urbanizatio

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research