Conviviendo en Positivo: Educación en salud, Atención Consciente, Compasión activa y Resiliencia

Proyecto de innovación docente enfocado en valores nucleares y convivencia en una sociedad serodiscordante, es continuidad del P89/2018, titulado “competencias intra e interpersonales, sexo consciente, fármacos y mindfulness”. Durante el primer semestre, desde el paradigma de aprendizaje cooperativo, basado en resolución de proyectos, se desarrolló la investigación documental, reflexión y debate sobre estos centros de interés: valores nucleares & VIH: abordaje de la seropositividad; adherencia terapéutica; estudio PARTNER indetectable es igual a intransmisible; profilaxis pre-exposición (PrEP); convivir en serodiscordancia; encuestas sobre estigmatización y discriminación social y sanitaria; riesgos globales de la discriminación terapéutica; relaciones interpersonales y emociones aflictivas; mindfulness y compasión basado en la evidencia; psicología positiva y resiliencia. En el segundo semestre, durante la fase cero del estado de alerta sanitaria, se desarrolló una intervención psicoeducativa, dirigida a facilitar estrategias que ayudasen a gestionar mejor el impacto emocional generado por la incertidumbre, la restricción de movilidad territorial, el confinamiento, y el miedo al contagio de la COVID-19. Perpetuar el estigma ante VIH, es una violación de los derechos humanos. Como antídoto a la indiferencia, se integró en nuestra intervención el fomento de la compasión activa, entendida como un sentido básico de cuidado, sensibilidad y apertura hacia el sufrimiento propio y de los demás, y la intención genuina de intentar aliviarlo y prevenirlo. La pandemia generada por el SARS-CoV-2 es una oportunidad para entender que ante este virus, aquí y ahora, la única opción es prevenirlo, detectarlo mediante pruebas y confinarlo, es decir no transmitirlo y no reinfectarse. Si de forma transversal somos capaces de interiorizarlo y normalizar la convivencia en serodiscordancia, si normalizamos las pruebas diagnósticas rutinarias, podremos entre todas y todos reducir hasta un 90% la transmisión activa otra pandemia de la que hoy no se habla, del VIH, de este modo conseguiríamos minimizar la aparición de nuevos casos, frenar su avance y vencer definitivamente al SIDA

La convivencia en los centros educativos de educación básica en Iberoamérica

La presente aportación recoge la visión de 46 especialistas de quince países iberoamericanos sobre las formas de entender y promover la convivencia escolar en los centros educativos de los distintos países. Sus aportaciones son un conjunto de descripciones, experiencias y valoraciones significativas y en relación al contexto considerado. Las aportaciones no buscan tanto radiografiar la temática a nivel teórico como presentar lo más significativo de cada realidad y las propuestas que, al respecto, se realizan. La orientación es claramente organizativa, si consideramos que una parte común de todas las aportaciones tiene que ver con las políticas de convivencia escolar, programas aplicados, aspectos organizativos a nivel de institución, experiencias significativas y retos para la mejora. Se cubre así y de nuevo un propósito fundamental de la Red AGE, como es el de fomentar el intercambio de experiencias, la promoción del conocimiento sobre administración y gestión educativa y la reflexión sobre la práctica de la gestión. La finalidad última es la de mejorar el funcionamiento de los centros educativos (y, a través de ellos, de los sistemas educativos), procurando sean de calidad y un instrumento para el cambio profesional y social

Material docente para la aplicación del Derecho internacional y el Derecho penal

El presente proyecto de innovación tiene como propósito el desarrollo de materiales de enseñanza, aprendizaje y evaluación del Derecho internacional y del Derecho penal, al mismo tiempo busca promover una comunidad académica colaborativa.Depto. de Derecho Procesal y Derecho PenalFac. de DerechoFALSEsubmitte

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit