La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Municipios Pasca Cundinamarca, Palestina Caldas, Bojayá Choco y Bogotá D.C

No aplicaEl conflicto armado en Colombia, además de dejar altas cifras de muertes, mantiene un importante número de víctimas que aun hoy sufren desplazamiento forzado y pérdida de sus tierras. En el presente trabajo seleccionamos dos casos que evidencian esta problemática del desarraigo en el país: los relatos de Ana Ligia y Peñas Coloradas. En este material se analizan los impactos psicosociales, el posicionamiento subjetivo de los actores como víctimas o sobrevivientes y los procesos de transformación que cada relato describe sobre la experiencia de la autogestión y la autoplanificación como determinantes en el logro de la resignificación de la identidad. A través del enfoque narrativo, la formulación de preguntas y la fotointervención, el grupo descubrió cómo estas herramientas facilitan la construcción de significados sobre la historia de un actor víctima de violencia y cómo la reflexión y la autobservación posibilitan la construcción de sus propias estrategias de afrontamiento y no la imposición de soluciones que vengan de agentes externos. La importancia de este trabajo radica en que, en la medida en que el psicólogo comprenda los fenómenos de violencia de nuestro país y profundice en contextos de reflexión y análisis de situaciones reales de las víctimas, facilitará los procesos de atención integral y entenderá desde la empatía el ser humano que habita en cada experiencia traumática. De esta forma, estará en capacidad de acompañar los procesos de aprendizaje y crecimiento de las comunidades vulnerables y realizará una labor enriquecedora y formativa para cada actor, como se verá en este trabajo.The armed conflict in Colombia, in addition to leaving high death tolls, has left a significant number of victims who even today suffer forced displacement and loss of their lands. In this paper we select two cases that show this problem of uprooting in the country: the stories of Ana Ligia and Peñas Coloradas. In this material we analyze the psychosocial impacts, the subjective positioning of the actors as victims or survivors and the transformation processes that each story describes on the experience of self-management and self-planning as determinants in the achievement of identity resignification. Through the narrative approach, the formulation of questions and the photo-intervention, the group discovered how these tools facilitate the construction of meanings about the history of an actor victim of violence and how reflection and self-observation make possible the construction of their own coping strategies and not the imposition of solutions coming from external agents. The importance of this work lies in the fact that, to the extent that the psychologist understands the phenomena of violence in our country and deepens in contexts of reflection and analysis of real situations of victims, he/she will facilitate the processes of comprehensive care and will understand from empathy the human being that inhabits each traumatic experience. In this way, it will be able to accompany the learning and growth processes of vulnerable communities and will carry out an enriching and formative work for each actor, as will be seen in this work

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care