Aglomeraciones productivas y desarrollo regional: ¿Instrumentos eficaces para un desarrollo integral?

Los escenarios periféricos, como el latinoamericano, plantean el desafío de elaborar estrategias de desarrollo capaces de revertir los crecientes procesos de desigualdad y exclusión propiciados por la dinámica de acumulación global. En este sentido, y en consonancia con un cuerpo teórico desarrollado por un grupo de geógrafos, economistas y sociólogos que en los últimos años han posicionado a las regiones como nodos estratégicos, destacamos la necesidad de considerar las restricciones y las potencialidades que las aglomeraciones productivas de áreas periféricas poseen para actuar como inspiradoras de políticas que conduzcan a un desarrollo integral e integrador. Intentaremos aportar un enfoque más holístico para el análisis de las aglomeraciones a partir de i) la identificación de las limitaciones que presenta dicho cuerpo teórico heterogéneo para la elaboración de estrategias consistentes y ii) el análisis de las aglomeraciones en el marco de las transformaciones globales del capitalismo. Una perspectiva multiescalar es presentada como una alternativa para superar estas limitaciones

Aglomeraciones productivas y territorio: en busca de una manera más holística de entender sus contribuciones al desarrollo

En el presente trabajo se examinan las condiciones necesarias para convertir las aglomeraciones productivas en potenciales instrumentos de desarrollo, particularmente en contextos periféricos. Se presentan dos enfoques teóricos relevantes: la nueva geografía económica y los aportes que enfatizan los factores no económicos. Por último, se retoman dos contribuciones teóricas, la primera para comprender el comportamiento de las aglomeraciones productivas en la dinámica global capitalista, mientras que la segunda destaca la importancia de las trayectorias nacionales y el Estado nacional

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care