PRO-POOR PLANNING: A Tool for Strategic Territorial Planning and a Conceptual Framework Drawn from Studies in Colombia and Costa Rica

Few planning practices in the South seem to be equipped with key concepts and technical, empirical and administrative capacities required to comprehend and visualize the phenomenon of poverty at inter- and intra-urban levels, which compromises their ability to inform decision-makers on the effects on poverty reduction of the land-based actions they design, implement and monitor. This challenge was addressed from conceptual, technical, empirical, and administrative angles, which correspond to the research objectives. As a result, the study developed a Tool for Strategic Territorial Planning, TSTP™, which – using evidence-based poverty maps – helps urban planners comprehend and visualize the effects of land-based actions on poverty reduction in order to be better equipped to inform decision-makers. A Pro-poor Planning Conceptual Framework was also developed based on the applications of the TSTP™. Particularly, the study used a spiral methodology in which experiences of planning practice were used to reflect on, conceptualise, experiment with and suggest modifications to specific aspects of planning theory, which in turns nourished the same planning practice, as follows. First, the TSTP™ was developed on the bases of observations, literature review and in-depth interviews; then, the proposed technique was tested in two case studies, in which data was collected from surveys, questionnaires and census microdata, and analysed using geographic information systems; and lastly, the reflection on, and conceptualisation of, findings was used to develop the Pro-poor Planning Conceptual Framework using structured discussions, working papers and research workshops. The study showed that the use of an evidence-based poverty map technique is of significant importance to promote pro-poor planning practice, not only as a method to visualise the geographical distribution of poverty, but also as a tool to facilitate dialogue amongst different planning stakeholders when defining indicators of poverty, when analysing and discussing the results, and when defining and prioritizing actions. On the other hand, it showed that decentralization in Latin America has been a top-down process initiated in response to systemic economic or political crisis and accompanied by external pressures (as opposed to its motor being the deepening of democracy), and that management of public resources has not improved, participation of civil society is poor, and inter-regional inequalities still persist. Hence, it argued that the causal link between decentralization and democratic development in Latin America appears to be tenuous, which helps to understand why the impact of local planning practice on poverty reduction still looks weak. Six specific findings emerged: • the combination of poverty and inequality maps help in the identification of deprived urban areas with a clearly defined territory in which to implement pro-poor land-based actions that are in line with scarce resources • social and physical public interventions need to be combined and articulated in a plan of actions in order to reduce poverty, instead of just displacing the poor • more attention is required to targeting strategies and to long-term impacts of public programmes and projects in order to effectively and efficiently combat poverty • the proposed technique is flexible enough to be used in at least four functions of urban planning: diagnostic, simulation, decision-making and monitoring • the proposed technique alone cannot cope with structural limitations of urban planning, which is why a pro-poor planning conceptual framework was developed • greater efforts are required in relation to the collection and management of statistical and cartographic data in the South

Biomarcadores cardíacos: Presente y futuro

En la actualidad, las enfermedades cardiovasculares se consideran la pandemia más significativa del siglo XXI. Dentro de ellas, la enfermedad coronaria es la más prevalente y la que más morbi-mortalidad genera; en el caso particular de Colombia, es la principal causa de muerte en individuos mayores de 45 años. La característica silenciosa de esta enfermedad ha impulsado la investigación de moléculas que permitan su diagnóstico precoz y sirvan como predictores pronóstico tanto en la fase crónica como en la aguda.Fruto de estas investigaciones, en los últimos treinta años se ha producido un avance importante en el desarrollo de biomarcadores cardiacos. Entre ellos están los recién desarrollados ensayos de troponinas ultrasensibles para diagnóstico temprano, la medición de la albúmina modificada por isquemia que cuenta con alto valor predictivo negativo para la detección de isquemia miocárdica, el ligando de CD40 soluble para la clasificación e individualización del tratamiento, la utilidad de la proteína C reactiva como marcador de riesgo de enfermedad coronaria y las diversas técnicas de alto rendimiento como la proteómica, que permite la detección de múltiples biomarcadores potenciales. A pesar de ello, aún no se dispone de evidencia suficiente para sustituir los marcadores que recomiendan las asociaciones científicas por los nuevos marcadores que se han ido desarrollando, y continúa el debate sobre qué combinación utilizar para alcanzar mayor rendimiento diagnóstico, pronostico y terapéutico. A continuación se revisan los avances actuales en biomarcadores cardiacos y su potencial integración a la práctica clínica habitual.Cardiovascular diseases are currently considered the most significant pandemic of the XXI century. Among them, coronary disease is the most prevalent and the one that generates more morbidity and mortality. In Colombia, is the main cause of death in individuals over 45 years. The silent characteristics of this disease has promoted research of molecules that allow early diagnosis and serve as predictors of prognosis both in chronic and acute phases.As result of this research, there has been significant progress in the development of cardiac biomarkers in the last thirty years. Among them are the newly developed ultrasensitive troponin assays for an early diagnosis, measurement of ischemia modified albumin, which has high negative predictive value for the detection of myocardial ischemia, soluble CD40 ligand for classification and individualization of treatment, the usefulness of CRP as a risk marker for coronary heart disease and various high-throughput techniques such as proteomics, which allow the detection of multiple potential biomarkers. Despite this, there is still insufficient evidence for replacing the markers recommended by the scientific associations by new developed markers, and the debate about what combination to use in order to achieve higher performance diagnosis, prognosis and therapy, continues Here we review current advances in cardiac biomarkers and their potential integration into daily clinical practice

El Caribe a oscuras: La crisis de Electricaribe

This article reflection aims to succinctly address a series of criticisms made to Electricaribe S.A. E.S.P, illustrate about the crisis facing the company and dismantle certain chimeras that have been woven on the problem in the provision of public energy service in the Caribbean region. Different factors are analyzed to understand this crisis that crosses the coast as an energy service, and offer some conclusions that serve to solve the problems that are experienced with the provision of energy service.Este artículo de reflexión pretende abocar de manera sucinta una serie de críticas que se le realizan a Electricaribe S.A. E.S.P, ilustrar sobre la crisis que afronta la empresa y desmontar ciertas quimeras que se han tejido sobre la problemática en la prestación del servicio público de energía en la región Caribe. Se analizan diferentes factores para entender esta crisis que atraviesa la costa en calidad de servicio energético, y ofrecer unas conclusiones que sirvan para solucionar la problemática que se vive con la prestación del servicio de energía

Impacto del marketing deportivo en el reconocimiento, posicionamiento e intención de compra de las marcas patrocinadoras de Millonarios F.C.

El presente trabajo de grado estuvo dirigido a estudiar la influencia que entre los consumidores seleccionados ha tenido el que marcas de productos y servicios patrocinen al equipo Millonarios Fútbol Club usando así el concepto de marketing deportivo de tal manera que se puede mostrar la efectividad de esta estrategia de mercadeo para las empresas que la hayan empleado y así servir de referencia para lograr perfeccionar las campañas de mercadeo que los patrocinadores están usando en el club, al tiempo que pueda servir para que los gestores de mercadeo de otras empresas en su proceso de apoyo a marcas decidan seleccionar esta alternativa. Para la ejecución del trabajo en primer lugar se estudió como el mercadeo deportivo se ha empleado en la promoción de diferentes productos y servicios tanto a nivel mundial como en Colombia, a continuación, se analizó que marcas han recurrido al patrocinio de equipos del rentado profesional colombiano de futbol y por último, se analizó la precepción que tienen los consumidores de las marcas que en la actualidad patrocinan el Millonarios Futbol Club.Resumen ejecutivo ; Introducción ; Revisión de la literatura ; Metodología ; Conclusiones ; Recomendaciones.Administrador de EmpresasPregrad

Relatorías del conversatorio: “Cartagenidad más que una palabra, más que un sentimiento”

Crear una categoría social de la ciudad: Cartagenidad, con un referente del que todos los Cartageneros y habitantes del territorio nos sintamos representados, que cuando lo escuchen, lo vean o lo sientan manifiesten ese orgullo de ser Cartageneros, que se enseñe a las nuevas generaciones obligatoriamente la catedra de Cartagenidad sería un ideal

Clinical Practice Guide for Early Detection, Diagnosis and Treatment of the Acute Intoxication Phase in Patients with Alcohol Abuse or DependencePart II : Evaluation and Management of Patients with Acute Alcohol Intoxication

Introducción: El alcohol es la segunda sustancia psicotrópica más usada en el mundo y el tercer factor de riesgo para muerte prematura y discapacidad. Su uso nocivo es un problema de salud pública mundial, dado su impacto personal, laboral, familiar, económico y social. Es de suma importancia la identificación de intoxicación aguda por alcohol, el síndrome de abstinencia alcohólica y sus complicaciones, como delirium tremens y encefalopatía de Wernicke, para garantizar de esta manera un tratamiento oportuno para estos pacientes. Este artículo busca presentar la evidencia encontrada para el abordaje y el tratamiento de estas presentaciones clínicas. Método: Revisiones sistemáticas de la evidencia disponible y se evaluaron las guías pertinentes identificadas en la literatura, para decidir, en cada pregunta, si se adopta o se adapta a una recomendación ya existente, o bien, si se desarrollan recomendaciones de novo. Para las recomendaciones de novo y aquellas adaptadas, se realizó una síntesis de la evidencia, se elaboraron tablas de evidencia y se formularon las recomendaciones basa-das en evidencia. Resultados: Se encuentra evidencia y se realizan recomendaciones para abordaje y tratamiento pertinente de intoxicación alcohólica aguda, síndrome de abstinencia, delirium tremens y encefalopatía de Wernicke.Q4Artículo original805-825Introduction: Worldwide, alcohol is the se-cond most-used psychotropic substance and the third risk factor for early death and disability. Its noxious use is a world public health problem given its personal, labor, family, economic and social impact. The identification of acute alcohol intoxication is extremely important, as well as the alcohol withdrawal syndrome and its complications, such as delirium tremens and Wernicke’s encephalopathy in order to grant a timely treatment for those patients. This article introduces the evidence found so as to face and treat these clinic manifestations. Methodology: Systematic revision of the evidence available together with an evaluation of pertinent guidelines found in literature so as to decide whether to adopt or adapt the existing recommendation for each question or to develop de novorecommendations. For de novo recommendations as well as those adapted, it was carried out an evidence synthesis, together with evidence tables and formulation of recommendations based on the evidence. Results:Evidence was found and recommendations were made for the diagnosis and treatment of acute alcohol intoxication, withdrawal syndrome, delirium tremens and Wernicke’s encephalopathy

Clinical practice guide for early detection, diagnosis and treatment of the acute intoxication phase in patients with alcohol abuse or dependence part I : screening, early detection and risk factors in patients with alcohol abuse or dependence

Resumen Introducción El alcohol es la segunda sustancia psicotrópica más usada en el mundo y el tercer factor de riesgo para muerte prematura y discapacidad. Su uso nocivo es un problema de salud pública mundial, dado su impacto personal, laboral, familiar, económico y social. Hasta el 70 % de las personas en riesgo de tener problemas con el alcohol no se detectan en la práctica médica, lo que hace pensar que se requieren medidas de tamizaje específicas que permitan la detección temprana y lleven a un tratamiento oportuno. Este artículo presenta la evidencia encontrada en tamización de abuso y dependencia de alcohol y en tamización e identificación de factores de riesgo; también presenta la evidencia relacionada con síndrome de abstinencia, delirium tremens y encefalopatía de Wernicke, con el fin promover una de detección temprana y un tratamiento oportuno. Método Revisiones sistemáticas de la evidencia disponible y evaluación de las guías pertinentes identificadas en la literatura, para decidir, en cada pregunta, si se adopta o se adapta a una recomendación ya existente, o si se desarrollan recomendaciones de novo. Para las recomendaciones de novo y aquellas adaptadas, se realizó una síntesis de la evidencia, se elaboraron tablas de evidencia y se formularon las recomendaciones basadas en evidencia. Resultados Se encuentra evidencia y se realizan recomendaciones para tamización pertinente y búsqueda de factores de riesgo, con el fin de realizar un diagnóstico y un manejo oportuno de abuso y dependencia a alcohol y sus complicaciones: síndrome de abstinencia, delirium tremens y encefalopatía de Wernicke.Q4787-804Introduction Worldwide, alcohol is the second most-used psychotropic substance and the third risk factor for early death and disability. Its noxious use is a world public health problem given its personal, labor, family, economic and social impact. 70 % of people under risk of having alcohol problems go undetected in medical practice, a fact that underlines the need for specific screening measures allowing early detection leading to timely treatment. This article presents evidence gathered by alcohol abuse and dependence screening as well as by risk factor identification and screening. It also presents evidence concerning withdrawal symptoms, delirium tremens and Wernicke's encephalopathy in order to promote early detection and timely treatment. Methodology Systematic revision of the evidence available together with an evaluation of pertinent guidelines found in literature so as to decide whether to adopt or adapt the existing recommendation for each question or to develop de novo recommendations. For de novo recommendations as well as those adapted, it was carried out an evidence synthesis, together with evidence tables and formulation of recommendations based on the evidence. Results Evidence was found and recommendations were made for the pertinent screening and search of risk factors, in order to perform a diagnosis and carry out a timely management of alcohol abuse, dependence and ensuing complications: withdrawal syndrome, delirium tremens and Wernicke's encephalopathy

The economic burden of depression in Colombia : direct costs of intrahospital management

Introducción:En Colombia se desconoce la magnitud del impacto económico de la depresión. Objetivo: Determinar los costos directos del tratamiento hospitalario de la depresión en pacientes con trastornos depresivos de ambos géneros entre los 18 y 65 años de edad. Método: Estudio de costos directos de la enfermedad, a partir de datos consignados en 279 historias clínicas de pacientes hospitalizados por depresión en ocho instituciones de seis ciudades colombianas entre 2007-2008. Se obtuvieron medias o medianas para datos continuos y proporciones para datos categóricos, con sus respectivas medidas de dispersión. Resultados:El costo total promedio de la hospitalización por depresión se encontró en 1.680.000 pesos. La estancia representa el 74,1% del costo de la hospitalización. El costo promedio por día es 150.000 pesos. Bajo condiciones de acceso a los servicios de salud mental restringidas, el costo total directo de hospitalización por depresión severa o moderada está alrededor de 54.000 millones, en la seis ciudades, y en el país, 162.000 millones de pesos. Bajo condiciones de acceso observadas en el ámbito internacional, el costo total es de 134.000 millones de pesos en las seis ciudades y 399.000 millones en el país. Conclusiones: El presente estudio se constituye en un punto de partida hacia la cuantificación de la carga económica de la depresión en Colombia, concretamente en términos de los recursos monetarios destinados al manejo de la enfermedad en hospitales. Los hallazgos deben ser complementados con información sobre otros costos directos e indirectos de la depresión en la población adulta de Colombia.Q4Artículo original465-480Introduction: The magnitude of the econo-mic burden of depression in Colombia is unknown. Objective: To determine the direct costs of hospitalary management of male and female patients with depressive disorders aged 18 to 65. Methods: Study of the costs of the illness, using data from 279 clinical records of patients hospitalized with a diag-nosis of depression, in 2007-2008, in eight institutions of six cities in Colombia. Means or medians were estimated for continuous data and proportions for categorical data, along with dispersion measures. Results: The total average cost of hospitalization was 1,68 million Colombian pesos. Hospital stay repre-sents 74.1% of the total cost of hospitalization. The average daily cost was 150,000 pesos. Under restricted access conditions the total direct cost of hospitalization for moderate to severe depression was estimated to be around 54,000 million pesos in the six cities included in the study, and 162,000 million pesos at the national level. Under the access conditions observed at the international level, the cost is 134,000 million pesos in the six cities and 399.000 million at the national level. Conclu-sions: This study is a starting point towards the quantifi cation of the economic burden of depression in Colombia. Specifi cally, it provides information about the monetary resources used for depression management at the hospital level. These fi ndings need to be complemented with information about other direct and indirect costs related to depression in the adult population of Colombia

CA125-Guided Diuretic Treatment Versus Usual Care in Patients With Acute Heart Failure and Renal Dysfunction

Background: The optimal diuretic treatment strategy for patients with acute heart failure and renal dysfunction remains unclear. Plasma carbohydrate antigen 125 (CA125) is a surrogate of fluid overload and a potentially valuable tool for guiding decongestion therapy. The aim of this study was to determine if a CA125-guided diuretic strategy is superior to usual care in terms of short-term renal function in patients with acute heart failure and renal dysfunction at presentation. Methods: This multicenter, open-label study randomized 160 patients with acute heart failure and renal dysfunction into 2 groups (1:1). Loop diuretics doses were established according to CA125 levels in the CA125-guided group (n = 79) and in clinical evaluation in the usual-care group (n = 81). Changes in estimated glomerular filtration rate (eGFR) at 72 and 24 hours were the co-primary endpoints, respectively. Results: The mean age was 78 ± 8 years, the median amino-terminal pro-brain natriuretic peptide was 7765 pg/mL, and the mean eGFR was 33.7 ± 11.3 mL/min/1.73m2. Over 72 hours, the CA125-guided group received higher furosemide equivalent dose compared to usual care (P = 0.011), which translated into higher urine volume (P = 0.042). Moreover, patients in the active arm with CA125 >35 U/mL received the highest furosemide equivalent dose (P <0.001) and had higher diuresis (P = 0.013). At 72 hours, eGFR (mL/min/1.73m2) significantly improved in the CA125-guided group (37.5 vs 34.8, P = 0.036), with no significant changes at 24 hours (35.8 vs 39.5, P = 0.391). Conclusion: A CA125-guided diuretic strategy significantly improved eGFR and other renal function parameters at 72 hours in patients with acute heart failure and renal dysfunction