Tratamientos psicológicos para la esquizofrenia: análisis de la terapia familiar

La esquizofrenia es un síndrome crónico y altamente discapacitante que altera el proyecto vital de gran número de personas jóvenes y de sus familias. En las tres últimas décadas, y gracias a los proceso de desinstitucionalización se han configurado nuevas relaciones terapéuticas entre familiares y el personal de atención en salud mental. En la actualidad es de suponer que el interés por el abordaje multidisciplinar de la esquizofrenia se encuentre aumentado debido a la evidencia científica que apunta a identificar este tipo de intervenciones como las de mayor eficacia; por otro lado, un tratamiento basado exclusivamente en la farmacoterapia privaría a los pacientes de rehabilitar aspectos importantes pero no siempre evidentes como la autoestima, capacidad de insight y capacidad cognitiva. En el presente trabajo se revisaron los estudios de corte experimental o cuasi experimental que tenían como objetivo evaluar la eficacia terapéutica de la terapia familiar. Las bases de datos seleccionadas fueron medline, psycinfo, psicothema y embase, las palabras utilizadas para la búsqueda fueron, terapia familiar aplicada a la esquizofrenia, con este criterio de búsqueda se hallaron un total de 467 citas, de las cuales se seleccionaron solo los estudios experimentales con grupo control y grupo experimental y asignación aleatoria. Se concluye que las intervenciones que exponen mejores resultados son las que combinan tratamiento farmacológico estándar con terapia familiar

Aplicación del modelo SERVQUAL para la determinación de los factores que inciden en la satisfacción de los usuarios en los hogares infantiles de Chibolo, Magdalena.

Introduction: Early childhood is the life cycle that allows the development of the individual as a person. Despite this, there are components that have negatively affected the satisfaction of the users in the Community Welfare Homes-ICBF that work in favor of the infants, due to this, the SERVQUAL model emerges as a solution that allows the measurement of the quality of the service, to know the perceptions and expectations of the customers, and to identify the factors that affect the quality of the service.Objective: The purpose of this study is to determine the factors that affect the satisfaction of users in children's homes, through the application of a SERVQUAL model.Method: The article consists of 3 phases: Collection of information relevant to the case under study, Evaluation of the importance, expectation and perception of the user against the components of quality and Determination of quality components that affect user satisfaction.Results: The complete application of the statistical model was obtained, obtaining that the components "health and nutrition" are the ones that most affect the perception of the service quality, followed by the factors "Family community, pedagogical process and human talent" that also have an important index of incidence.Conclusions: The company is in continuous improvement, however, it is necessary to work responsibly to attend to the components that influence the perception of its service, to obtain a higher quality index.Introducción: La primera infancia es el primer ciclo de vida de gran importancia que permite el desarrollo del individuo como persona. Pese a ello, existen componentes que han afectado negativamente la satisfacción de los usuarios en los Hogares Comunitarios de Bienestar-ICBF que trabajan en pro de los infantes, debido a esto, surge el modelo SERVQUAL como una solución que permite la medición de la calidad del servicio, conocer las percepciones y expectativas de los clientes, e identificar los factores que afectan la calidad del servicio. Objetivo: El presente estudio tiene como finalidad la aplicación del modelo SERVQUAL para la determinación de los factores que inciden en la satisfacción de los usuarios en los hogares infantiles. Metodología:  El articulo consta de 3 fases: Recolección de información relevante al caso en estudio, Evaluación de la importancia, expectativa y percepción del usuario frente a los componentes calidad y Determinación de los componentes de calidad que inciden en la satisfacción de los usuarios. Resultados: Se logró la aplicación completa del modelo estadístico, obteniéndose que los componentes “salud y nutrición” son los que más afectan la percepción de la calidad del servicio, seguidos por los factores “Familia comunidad, proceso pedagógico y talento humano” que también tienen un importante índice de incidencia. Conclusiones: La empresa se encuentra en mejoramiento continuo, sin embargo, se hace necesario trabajar responsablemente para atender los componentes que influyen en la percepción de su servicio, para la obtención de un mayor índice de calidad

Aplicación del modelo SERVQUAL para la determinación de los factores que inciden en la satisfacción de los usuarios en los hogares infantiles de Chibolo, Magdalena.

Introducción: La primera infancia es el primer ciclo de vida de gran importancia que permite el desarrollo del individuo como persona. Pese a ello, existen componentes que han afectado negativamente la satisfacción de los usuarios en los Hogares Comunitarios de Bienestar-ICBF que trabajan en pro de los infantes, debido a esto, surge el modelo SERVQUAL como una solución que permite la medición de la calidad del servicio, conocer las percepciones y expectativas de los clientes, e identificar los factores que afectan la calidad del servicio. Objetivo: El presente estudio tiene como finalidad la aplicación del modelo SERVQUAL para la determinación de los factores que inciden en la satisfacción de los usuarios en los hogares infantiles. Metodología: El articulo consta de 3 fases: Recolección de información relevante al caso en estudio, Evaluación de la importancia, expectativa y percepción del usuario frente a los componentes calidad y Determinación de los componentes de calidad que inciden en la satisfacción de los usuarios. Resultados: Se logró la aplicación completa del modelo estadístico, obteniéndose que los componentes “salud y nutrición” son los que más afectan la percepción de la calidad del servicio, seguidos por los factores “Familia comunidad, proceso pedagógico y talento humano” que también tienen un importante índice de incidencia. Conclusiones: La empresa se encuentra en mejoramiento continuo, sin embargo, se hace necesario trabajar responsablemente para atender los componentes que influyen en la percepción de su servicio, para la obtención de un mayor índice de calidad.Introduction− Early childhood is the pert of life that determines the development of the individual as a per-son. Undoubtedly, experiences influence the development of children. This paper analyzes the factors that have af-fected negatively the satisfaction index of the ICBF Com-munity Welfare Homes users of the that work in favor of the infants, due to this, the SERVQUAL model emerges as a solution that allows the measurement of the quality of the service, to know the perceptions and expectations of the customers, and to identify the factors that affect the quality of the service.Objective−The purpose of this study is to determine the factors that affect the satisfaction of users in chil-dren’s homes, through the application of a SERVQUAL model.Methodology−The article consists of 3 phases: Collection of information relevant to the case under study, Evaluation of the importance, expectation and perception of the user against the components of quality and Determination of quality components that affect user satisfaction.Results− The complete application of the statistical model was obtained, obtaining that the components “health and nutrition” are the ones that most affect the perception of the service quality, followed by the factors “Family community, pedagogical process and human talent” that also have an important index of incidence.Conclusions−The company is in continuous improve-ment, however, it is necessary to work responsibly to at-tend to the components that influence the perception of its service, to obtain a higher quality index

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe