La Imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia

Como futuros profesionales en Psicología, se hace necesario desarrollar habilidades y destrezas que permitan hacer un adecuado acompañamiento psicosocial en escenarios de violencia. Dichas habilidades apuntan a diseñar estrategias que promuevan en las víctimas del conflicto, el desarrollo de sus potencialidades, logrando de esta manera mitigar el dolor y ayudar en su proceso de su reconstrucción. El uso de la narrativa, permite al equipo psicosocial conocer la historia a partir de los hechos o sucesos narrados por las propias víctimas, logrando de esta manera tener acceso a la manera como éstas interpretan la realidad. La narrativa, entonces, como estrategia de abordaje psicosocial, permite trasladar eventos pasados a la actualidad, construir una historia a partir de la subjetividad, darle sentido y valor al tener en cuenta las emociones, el dolor y la desesperanza de los propios protagonistas de la historia. Para aplicar dichas técnicas, es necesario entonces que el equipo psicosocial desarrolle ciertas habilidades, dentro de las cuales se encuentra la empatía, la escucha activa, la interpretación del lenguaje no verbal, entre otras. Por esta razón es importante que la narrativa se convierta no solo en una herramienta a través de la cual el profesional conoce una historia, sino que se puedan aprovechar dichos espacios para que las victimas logre identificar, a través de la narración de experiencias pasadas, sus potencialidades, exponer y sanar el dolor y empezar a construir un nuevo proyecto de vida. Para lograr desarrollar las destrezas anteriormente mencionadas, se abordan diferentes narrativas tomadas del libro “Voces: Relatos de violencia y esperanza en Colombia”. A partir de éstas narrativas se crea un escenario de análisis y reflexión, que permiten realizar un abordaje psicosocial de atención a las víctimas del conflicto, diseñando algunas preguntas que permiten profundizar la narrativa y posteriormente diseñando algunas propuestas de acciones encaminadas a atender a los protagonistas de las historias. Posteriormente se realiza una reflexión a partir del caso Pandurí, logrando identificar los emergentes psicosociales y estableciendo algunos mecanismos de intervención psicosocial con el fin de potenciar los recursos de afrontamiento de las víctimas.As future professionals in Psychology, it is necessary to develop skills and abilities that allow adequate psychosocial accompaniment in violence scenarios. These skills aim to design strategies that promote the development of their potential in the victims of the conflict, thus mitigating the pain and helping in the process of its reconstruction. The use of narrative allows the psychosocial team to know the story from the facts or events narrated by the victims themselves, thus gaining access to the way they interpret reality. Narrative, then, as a strategy of psychosocial approach, allows past events to be transferred to the present, to build a story based on subjectivity, to give meaning and value when taking into account the emotions, pain and despair of the protagonists of the event. history. To apply these techniques, it is necessary for the psychosocial team to develop certain skills, among which is empathy, active listening, interpretation of non-verbal language, among others. For this reason, it is important that the narrative becomes not only a tool through which the professional knows a story, but that these spaces can be exploited so that the victims can identify, through the narration of past experiences, their potentialities, expose and heal the pain and start building a new life project. In order to develop the aforementioned skills, different narratives taken from the book "Voices: Stories of Violence and Hope in Colombia" are addressed. From these narratives a scenario of analysis and reflection is created, which allows us to carry out a psychosocial approach of attention to the victims of the conflict, designing some questions that allow to deepen the narrative and later designing some proposals of actions aimed at attending the protagonists of the stories. Afterwards, a reflection was made from the Pandurí case, identifying the psychosocial emergencies and establishing some psychosocial intervention mechanisms in order to enhance the coping resources of the victim

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030