Los sistemas de pago por servicios ambientales entre la adicionalidad y la subsidiariedad: aplicación a la belleza escénica en el pantano de San Juan, Madrid, España

A payment for environmental services (PES) based on the beauty of the San Juan dam landscape is proposed containing two innovative aspect in regard to previous PES systems: the elaboration of a diagnosis oriented to obtain a shared vision of the area based in a participative process including all relevant local stakeholders, and the integration of the PES mechanism into the regional public environmental policy. The proposed system also identifies the offer and the demand of the environmental service. It shows the main problems associated to the preservation of the service and proposes management plans oriented to its conservation. Finally, the economic viability of the system is studied comparing three different scenarios according to the grade of integration of the PES model into the regional conservation public policy. This paper shows how a PES system can be used to guarantee public investments in nature conservation through a private management.Se plantea un sistema de pago por servicios ambientales (PSA) basado en la valoración de la belleza escénica en la zona del pantano de San Juan, Madrid, con dos aspectos novedosos respecto a estudios PSA previos: la elaboración de un diagnóstico basado en un proceso participativo que involucra a todos los actores sociales locales y cuyo fin es el de obtener una visión compartida sobre el área, y la integración del mecanismo PSA en la gestión pública regional de la conservación de la naturaleza. El sistema propuesto además identifica los oferentes y demandantes del servicio ambiental, muestra los principales problemas asociados a la conservación del servicio y plantea programas de gestión orientados a contribuir a su conservación. Se estudia, por último, la viabilidad económica del sistema comparando tres escenarios hipotéticos en función del grado de integración del sistema PSA en las políticas públicas de conservación de la naturaleza regionales. El trabajo muestra como un sistema PSA puede servir para garantizar las inversiones públicas en conservación a través de la gestión privada

Características motivacionales y actitud hacia la ecoeficiencia en trabajadores de la universidad pública peruana

The investigation was aimed at establishing the association between the motivational characteristics and the eco-efficiency attitude among workers at the Peruvian public university. The study was carried out on the basis of the quantitative methodology, similarity corresponds to the type of correlational descriptive study with a sample of 148 participants. The data collection instruments included the Labor Motivation Cuestionary and the Ecoefficient Acttitud Cuestionario, composed in each case by 30 Likert-type items. According to the results, the motivational characteristics tend to favor the motivation of workers, the majority of them present a high disposition for the efficient use of resources and through the approach of Chi Cuadrado, an asymptotic (bilateral) significance is obtained below the level of significance (p<0.05). It was concluded that there is dependence between the motivational characteristic variables with the attitude towards eco-efficiency in university workers. In that sense, motivational characteristics could help predict the attitude towards eco-efficiency.La investigación se orientó a establecer la asociación entre las características motivacionales y la actitud hacia la ecoeficiencia en los trabajadores de la universidad pública peruana. El estudio se realizó en base a la metodología cuantitativa, asimismo corresponde al tipo de estudio descriptivo correlacional con una muestra de 148 participantes. Los instrumentos de recolección de datos fueron el Cuestionario de Motivación Laboral y el Cuestionario de Actitud Ecoeficiente, compuestos en cada caso por 30 ítems de tipo Likert. Según los resultados, las características motivacionales tienden a favorecer la motivación de los trabajadores, la mayoría de ellos presentan una alta disposición hacia el uso eficiente de los recursos y mediante la prueba de Chi Cuadrado se obtuvo una significación asintótica (bilateral) inferior al nivel de significancia (p<0,05). Se concluyó que existe dependencia entre las variables características motivacionales con la actitud hacia la ecoeficiencia en los trabajadores universitarios. En ese sentido, las características motivacionales podrían ayudar a predecir la actitud hacia la ecoeficiencia

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis.

A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide. To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics. Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience). In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree. Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients. In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis

International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients with Psoriasis

Importance: A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide. Objective: To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics. Design, Setting, and Participants: Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience). Main Outcomes and Measures: In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree. Results: Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients. Conclusions and Relevance: In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.