Abordaje de contextos desde los enfoques narrativos. Departamento de Norte de Santander

Que mejor forma para adentrarse y conocer los estragos individuales, sociales y culturales que ha ocasionado el conflicto armado en el pueblo colombiano, si no es por las mismas víctimas que relatan el sufrimiento y las experiencias vividas; que mejor forma que un relato real de las víctimas que por décadas se han mantenido asechadas por el choque de intereses, que enfrentados por armas de fuego, afectan la familia, la tranquilidad, el patrimonio social e individual de los colombianos sobre un escenarios cada día más violento y deshumanizado. Aún, conociendo los eventos traumáticos de cada víctima, hay situaciones que ella misma no ha evaluado o contemplado por las características del evento, de su cognición o por desinterés, por lo tanto se proyectan unas inquietudes que podrán ser resueltas por la víctima, como método de transformación e introspección, el desarrollo y la aplicación de preguntas circulares, reflexivas o estratégicas ayudarán a la víctima a identificar esos vacíos que aún no logra comprender y que lo afectan como ser activo y social. Dichos relatos se fortalecen y se conocen también bajo ciertas herramientas de expresión como la foto voz, que permite al lector acercarse a los contextos de violencia de manera perceptiva para conocer los temores, vivencias y alcances de las comunidades, también con el objetivo de propiciar una transformación social favorable para el individuo y para la sociedad. Este proceso narrativo permite explorar las necesidades de una comunidad, para empoderarlas, ya que hay cierto desinterés por parte de los actores burocráticos hacia la solución de estas, permaneciéndose en total vulnerabilidad sin atención certera por parte del Estado colombiano. Cada experiencia de voz deja un aprendizaje, una ruta que seguir para las próximas eventualidades, permite fortalecer la persona como agente social, promotor de cambio. Por último se debe resaltar que el lenguaje de la experiencia personal, en todas sus variables o presentaciones, acercan al individuo al dolor subjetivo, de quienes han sido víctimas del conflicto armado que afectan la tranquilidad y por eso hoy en día se le reconoce necesario y se vela por una intervención integral y real.What better way to enter and learn about the individual, social and cultural ravages that the armed conflict has caused in the Colombian people, if it is not for the victims themselves who recount the suffering and experiences lived; What better way than a real story of the victims who for decades have been haunted by the clash of interests that confronted by firearms, affect the family, the tranquility, the social and individual patrimony of Colombians on a scenario that is increasingly violent and dehumanized. Still, knowing the traumatic events of each victim, there are situations that she herself has not evaluated or contemplated due to the characteristics of the event, her cognition or lack of interest, therefore some concerns are projected that can be resolved by the victim, as a method of transformation and introspection, the development and application of circular, reflective or strategic questions will help the victim to identify those gaps that they still cannot understand and that affect them as an active and social being. These stories are strengthened and are also known through certain tools of expression such as the photo you, which allows the reader to approach the contexts of violence in a perceptive way to learn about the fears, experiences, and scope of the communities, also with the aim of promoting a favorable social transformation for the individual and for society. This narrative process allows exploring the needs of a community, to empower them, since there is a certain lack of interest on the part of the bureaucratic actors towards their solution, remaining in total vulnerability without accurate attention from the Colombian state. Each experience of you does not leave a lesson, a route to follow for the next eventualities, it allows us to strengthen ourselves as a person and as a social agent, promoter of change. Finally, it should be noted that the language of personal experience, in all its variables or presentations, brings the individual closer to subjective pain, that of those who have been victims of the armed conflict, affects tranquility and that is why today we give it the necessary value. and we ensure a comprehensive and real intervention

Manejo de la falla cardiaca aguda en urgencias: enfoque terapia farmacológica

Según la Sociedad Colombiana de Cardiología, la insuficiencia cardíaca es un síndrome que se caracteriza por alta mortalidad, hospitalizaciones frecuentes y mala calidad de vida, todo en un contexto de múltiples comorbilidades que generan, en su conjunto, un alto costo de atención, por tanto se diseñaron unas medidas farmacológicas, para el manejo de esta patología en el servicio de Urgencias, como pilar fundamental, para el personal médico cuando se enfrenta a un paciente con una crisis aguda. Se revisarán las indicaciones de las diferentes terapias, como son el uso de oxigenoterapia, diuréticos de asa, vasodilatadores, inotrópicos, vasopresores, como terapia inicial, y de otros complementarios como los opiáceos y beta-bloqueadores. El objetivo principal de este artículo es realizar una revisión bibliográfica, basándose principalmente en artículos y guías actualizadas, logrando recopilar la información, acerca del manejo ideal; identificando así, los grupos de fármacos de elección, precauciones y contraindicaciones de los mismos. (MÉD.UIS.2013;26(1):69-79).  According to Colombian society of cardiology, heart failure is a syndrome characterized by high mortality, frequent hospitalization and poor quality of life, particularly in the context of generating multiple comorbidities, overall, a high cost of care, thus pharmacological measures were designed for the management of this condition in the emergency department, as a fundamental pillar for medical staff when faced with a patient with an acute crisis. A review of the indications of different therapies, such as the use of oxygen therapy, loop diuretics, vasodilators, ionotropes, vasopressors, as initial therapy, and others such as opioids, beta-blockers. The main objective of this paper is to review literature, mainly based on articles and updated guidelines, gather information about the ideal management, this identifying the groups of drugs of choice, precautions and contraindications of these. (MÉD.UIS.2013;26(1):69-79).&nbsp

Prácticas alimentarias de las familias con niños preescolares de la escuela Carlos Martínez Silva de San Gil

Introducción: La dinámica de la familia asociada a las concepciones culturales sobre la crianza de los niños determina en muchos casos la cantidad y calidad de los alimentos que éstos reciben durante los primeros años de vida. En relación a ello el presente estudio identifica los factores y prácticas del cuidado cultural alimentario de las familias con niños en edad preescolar.Metodología: Fue un estudio descriptivo transversal realizado a 20 familias con niños de edad preescolar de la escuela Carlos Martínez Silva, a quienes se les aplicó la encuesta titulada “Prácticas del cuidado cultural alimentario en las familias con niños en edad preescolarâ€.Resultados: En cuanto a los factores sociodemográficos la ocupación de los padres fue trabajo independiente 70%, de estrato 1 y 2 el 100%, los padres son comerciantes 80%, el cuidador responsable es la madre 80%. En cuanto a los factores alimentarios se obtuvo que: los niños necesitan ayuda para comer en un 80%, los alimentos de preferencia son carne, pollo y fruta, fue posible evidencia que la fruta preferida fueron las uvas en un 35%, todos los niños reciben refrigerio, y 65% rechaza la verdura, como estrategia para el consumo de alimentos los padres acuden al premio.Conclusión: El factor principal que puede estar afectando la nutrición del niño en edad preescolar es el déficit económico por parte de los padres, lo cual impide suplir las necesidades a cabalidad del menor y afecta su desempeño escolar

Plant traits poorly predict winner and loser shrub species in a warming tundra biome

Climate change is leading to species redistributions. In the tundra biome, shrubs are generally expanding, but not all tundra shrub species will benefit from warming. Winner and loser species, and the characteristics that may determine success or failure, have not yet been fully identified. Here, we investigate whether past abundance changes, current range sizes and projected range shifts derived from species distribution models are related to plant trait values and intraspecific trait variation. We combined 17,921 trait records with observed past and modelled future distributions from 62 tundra shrub species across three continents. We found that species with greater variation in seed mass and specific leaf area had larger projected range shifts, and projected winner species had greater seed mass values. However, trait values and variation were not consistently related to current and projected ranges, nor to past abundance change. Overall, our findings indicate that abundance change and range shifts will not lead to directional modifications in shrub trait composition, since winner and loser species share relatively similar trait spaces

SARS-CoV-2 omicron (B.1.1.529)-related COVID-19 sequelae in vaccinated and unvaccinated patients with cancer: results from the OnCovid registry

Background COVID-19 sequelae can affect about 15% of patients with cancer who survive the acute phase of SARS-CoV-2 infection and can substantially impair their survival and continuity of oncological care. We aimed to investigate whether previous immunisation affects long-term sequelae in the context of evolving variants of concern of SARS-CoV-2. Methods OnCovid is an active registry that includes patients aged 18 years or older from 37 institutions across Belgium, France, Germany, Italy, Spain, and the UK with a laboratory-confirmed diagnosis of COVID-19 and a history of solid or haematological malignancy, either active or in remission, followed up from COVID-19 diagnosis until death. We evaluated the prevalence of COVID-19 sequelae in patients who survived COVID-19 and underwent a formal clinical reassessment, categorising infection according to the date of diagnosis as the omicron (B.1.1.529) phase from Dec 15, 2021, to Jan 31, 2022; the alpha (B.1.1.7)-delta (B.1.617.2) phase from Dec 1, 2020, to Dec 14, 2021; and the pre-vaccination phase from Feb 27 to Nov 30, 2020. The prevalence of overall COVID-19 sequelae was compared according to SARS-CoV-2 immunisation status and in relation to post-COVID-19 survival and resumption of systemic anticancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974. Findings At the follow-up update on June 20, 2022, 1909 eligible patients, evaluated after a median of 39 days (IQR 24-68) from COVID-19 diagnosis, were included (964 [ 50 center dot 7%] of 1902 patients with sex data were female and 938 [49 center dot 3%] were male). Overall, 317 (16 center dot 6%; 95% CI 14 center dot 8-18 center dot 5) of 1909 patients had at least one sequela from COVID-19 at the first oncological reassessment. The prevalence of COVID-19 sequelae was highest in the prevaccination phase (191 [19 center dot 1%; 95% CI 16 center dot 4-22 center dot 0] of 1000 patients). The prevalence was similar in the alpha-delta phase (110 [16 center dot 8%; 13 center dot 8- 20 center dot 3] of 653 patients, p=0 center dot 24), but significantly lower in the omicron phase (16 [6 center dot 2%; 3 center dot 5-10 center dot 2] of 256 patients, p<0 center dot 0001). In the alpha- delta phase, 84 (18 center dot 3%; 95% CI 14 center dot 6-22 center dot 7) of 458 unvaccinated patients and three (9 center dot 4%; 1 center dot 9- 27 center dot 3) of 32 unvaccinated patients in the omicron phase had sequelae. Patients who received a booster and those who received two vaccine doses had a significantly lower prevalence of overall COVID-19 sequelae than unvaccinated or partially vaccinated patients (ten [7 center dot 4%; 95% CI 3 center dot 5-13 center dot 5] of 136 boosted patients, 18 [9 center dot 8%; 5 center dot 8-15 center dot 5] of 183 patients who had two vaccine doses vs 277 [ 18 center dot 5%; 16 center dot 5-20 center dot 9] of 1489 unvaccinated patients, p=0 center dot 0001), respiratory sequelae (six [4 center dot 4%; 1 center dot 6-9 center dot 6], 11 [6 center dot 0%; 3 center dot 0-10 center dot 7] vs 148 [9 center dot 9%; 8 center dot 4- 11 center dot 6], p= 0 center dot 030), and prolonged fatigue (three [2 center dot 2%; 0 center dot 1-6 center dot 4], ten [5 center dot 4%; 2 center dot 6-10 center dot 0] vs 115 [7 center dot 7%; 6 center dot 3-9 center dot 3], p=0 center dot 037)

SARS-CoV-2 omicron (B.1.1.529)-related COVID-19 sequelae in vaccinated and unvaccinated patients with cancer: results from the OnCovid registry

Background COVID-19 sequelae can affect about 15% of patients with cancer who survive the acute phase of SARS-CoV-2 infection and can substantially impair their survival and continuity of oncological care. We aimed to investigate whether previous immunisation affects long-term sequelae in the context of evolving variants of concern of SARS-CoV-2. Methods OnCovid is an active registry that includes patients aged 18 years or older from 37 institutions across Belgium, France, Germany, Italy, Spain, and the UK with a laboratory-confirmed diagnosis of COVID-19 and a history of solid or haematological malignancy, either active or in remission, followed up from COVID-19 diagnosis until death. We evaluated the prevalence of COVID-19 sequelae in patients who survived COVID-19 and underwent a formal clinical reassessment, categorising infection according to the date of diagnosis as the omicron (B.1.1.529) phase from Dec 15, 2021, to Jan 31, 2022; the alpha (B.1.1.7)-delta (B.1.617.2) phase from Dec 1, 2020, to Dec 14, 2021; and the pre-vaccination phase from Feb 27 to Nov 30, 2020. The prevalence of overall COVID-19 sequelae was compared according to SARS-CoV-2 immunisation status and in relation to post-COVID-19 survival and resumption of systemic anticancer therapy. This study is registered with ClinicalTrials.gov, NCT04393974. Findings At the follow-up update on June 20, 2022, 1909 eligible patients, evaluated after a median of 39 days (IQR 24-68) from COVID-19 diagnosis, were included (964 [ 50 center dot 7%] of 1902 patients with sex data were female and 938 [49 center dot 3%] were male). Overall, 317 (16 center dot 6%; 95% CI 14 center dot 8-18 center dot 5) of 1909 patients had at least one sequela from COVID-19 at the first oncological reassessment. The prevalence of COVID-19 sequelae was highest in the prevaccination phase (191 [19 center dot 1%; 95% CI 16 center dot 4-22 center dot 0] of 1000 patients). The prevalence was similar in the alpha-delta phase (110 [16 center dot 8%; 13 center dot 8- 20 center dot 3] of 653 patients, p=0 center dot 24), but significantly lower in the omicron phase (16 [6 center dot 2%; 3 center dot 5-10 center dot 2] of 256 patients, p<0 center dot 0001). In the alpha- delta phase, 84 (18 center dot 3%; 95% CI 14 center dot 6-22 center dot 7) of 458 unvaccinated patients and three (9 center dot 4%; 1 center dot 9- 27 center dot 3) of 32 unvaccinated patients in the omicron phase had sequelae. Patients who received a booster and those who received two vaccine doses had a significantly lower prevalence of overall COVID-19 sequelae than unvaccinated or partially vaccinated patients (ten [7 center dot 4%; 95% CI 3 center dot 5-13 center dot 5] of 136 boosted patients, 18 [9 center dot 8%; 5 center dot 8-15 center dot 5] of 183 patients who had two vaccine doses vs 277 [ 18 center dot 5%; 16 center dot 5-20 center dot 9] of 1489 unvaccinated patients, p=0 center dot 0001), respiratory sequelae (six [4 center dot 4%; 1 center dot 6-9 center dot 6], 11 [6 center dot 0%; 3 center dot 0-10 center dot 7] vs 148 [9 center dot 9%; 8 center dot 4- 11 center dot 6], p= 0 center dot 030), and prolonged fatigue (three [2 center dot 2%; 0 center dot 1-6 center dot 4], ten [5 center dot 4%; 2 center dot 6-10 center dot 0] vs 115 [7 center dot 7%; 6 center dot 3-9 center dot 3], p=0 center dot 037)

Plant traits poorly predict winner and loser shrub species in a warming tundra biome

Climate change is leading to species redistributions. In the tundra biome, shrubs are generally expanding, but not all tundra shrub species will benefit from warming. Winner and loser species, and the characteristics that may determine success or failure, have not yet been fully identified. Here, we investigate whether past abundance changes, current range sizes and projected range shifts derived from species distribution models are related to plant trait values and intraspecific trait variation. We combined 17,921 trait records with observed past and modelled future distributions from 62 tundra shrub species across three continents. We found that species with greater variation in seed mass and specific leaf area had larger projected range shifts, and projected winner species had greater seed mass values. However, trait values and variation were not consistently related to current and projected ranges, nor to past abundance change. Overall, our findings indicate that abundance change and range shifts will not lead to directional modifications in shrub trait composition, since winner and loser species share relatively similar trait spaces

Calidad del empleo en las Cooperativas de Trabajo Asociado : un análisis desde las dimensiones de la calidad del empleo

Aunque desde la década del ochenta se está presenciando en Colombia una reducción en las tasas de desempleo, ésta se ha logrado a costa de la calidad del empleo. Desde la década del noventa los procesos de flexibilización de los mercados de trabajo, que traen consigo desregulación, han puesto en tela de juicio la calidad de los empleos ofrecidos de manera formal en el país. Dichos procesos de desregulación han conllevado a la perdida de estabilidad de las condiciones contractuales, al crecimiento del empleo independiente \u96no regulado por relaciones laborales formales- y al crecimiento de lo que se ha denominado como empleo atípico. Empleo atípico cristalizado en su expresión más pura en las Cooperativas de Trabajo Asociado (CTA).Although the eighties from witnesses in Colombia was a reduction in unemployment rates, this has been achieved at the expense of job quality. \ud Since the nineties the process of relaxation of labor market deregulation to bring, have questioned the quality of jobs offered in a formal way in the country. Deregulation of these processes have led to loss of stability of contract terms, the growth of self employment not covered by formal labor relations and the growth of what has been termed as atypical employment. Atypical employment embodied in its most pure Cooperatives Working Association (CTA)