El turismo comunitario y su aporte al desarrollo de la Comunidad de San Clemente del cantón Ibarra

Esta investigación tiene como propósito el visibilizar la situación de la comunidad San Clemente en cuanto al desarrollo sostenible en todas sus dimensiones, busca obtener: ¿cuál es el aporte de la práctica de turismo comunitario en el desarrollo de la comunidad?, basado en las prácticas sociales, culturales, ambientales y las actividades económicas que realizan los habitantes de la comunidad, identificando las principales fuentes de empleo e ingresos y el uso de sus recursos naturales. En el Ecuador el turismo comunitario es una actividad emergente, que se desarrolla en las cuatro regiones: Amazonía, región insular, costa y callejón interandino. Además, ha llegado a convertirse en una actividad estratégica para el desarrollo social, económico y cultural. El presente trabajo propone un análisis de la conceptualización teórica y la aplicación en el estudio de campo, referido a la práctica del turismo comunitario como una actividad de desarrollo, en primer momento abordando un marco conceptual sobre desarrollo sostenible, gestión social sus componentes y objetivos y el turismo comunitario en Ecuador. En un segundo momento, en trabajo de campo se analizan datos relacionados con la comunidad San Clemente, con la identificación de las características particulares (sociales, culturales, económicas) y las fuentes del dinamismo socioeconómico, con el fin de conocer el aporte del turismo comunitario en el desarrollo de la comunidad. En lo referente al diseño metodológico se establecieron tres etapas: muestreo, recolección de datos con la aplicación de encuestas en el área de estudio y procesamiento de la información, consecuentemente los resultados obtenidos en esta investigación, arrojaron datos que permitieron comprobar la participación de la comunidad en el turismo comunitario, como una alternativa económica emergente que podría beneficiar a la comunidad y al cantón para su desarrollo, a partir del diseño de políticas públicas tanto locales como nacionales que sean sostenibles en el tiempo, relacionadas con la práctica de turismo comunitario, que sea consciente e inclusivo

Comparison of single-incision mini-slings (Ajust) and standard transobturator midurethral slings (Align) in the management of female stress urinary incontinence: A 1-year follow-up

AbstractObjectiveTo investigate the effectiveness and safety of a new single-incision mini-sling (SIMS)—Ajust—compared with the standard transobturator midurethral sling (SMUS)—Align—for the treatment of female stress urinary incontinence (SUI).Materials and MethodsA retrospective cohort study was conducted between January 1, 2010 and August 31, 2012. Women with SUI who underwent either SMUS-Align or SIMS-Ajust were recruited. The primary outcomes included operation time, estimated operative blood loss, postoperative pain, and complications. The secondary outcomes included subjective and objective success, defined as an International Consultation on Incontinence Questionnaire (ICIQ) score of 0 or improvement as felt by the patient and a long-term complication, such as dyspareunia and mesh erosion after 6 months and 12 months of follow-up.ResultsA total of 136 patients were enrolled, including 76 receiving SMUS-Align and 60 receiving SIMS-Ajust. Baseline characteristics of the patients in both groups were similar, without a statistically significant difference. Primary outcomes between both groups were similar, except that women treated with SIMS-Ajust had statistically significantly shorter operation time (p = 0.003), less intent to treat (p < 0.05), and earlier postoperative discharge (p = 0.001) than women treated with SMUS-Align. Secondary outcomes were similar without a significant difference between the two groups (93% vs. 88% success rate in each group).ConclusionOur results showed that SIMS-Ajust was not inferior to SMUS-Align with respect to success rate, and might have a slight advantage in early discharge. A long-term follow-up or prospective study is needed to confirm the above findings

Development of a core set of outcome measures for OAB treatment

© 2017, The Author(s). Introduction and hypothesis: Standardized measures enable the comparison of outcomes across providers and treatments giving valuable information for improving care quality and efficacy. The aim of this project was to define a minimum standard set of outcome measures and case-mix factors for evaluating the care of patients with overactive bladder (OAB). Methods: The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group (WG) of leading clinicians and patients to engage in a structured method for developing a core outcome set. Consensus was determined by a modified Delphi process, and discussions were supported by both literature review and patient input. Results: The standard set measures outcomes of care for adults seeking treatment for OAB, excluding residents of long-term care facilities. The WG focused on treatment outcomes identified as most important key outcome domains to patients: symptom burden and bother, physical functioning, emotional health, impact of symptoms and treatment on quality of life, and success of treatment. Demographic information and case-mix factors that may affect these outcomes were also included. Conclusions: The standardized outcome set for evaluating clinical care is appropriate for use by all health providers caring for patients with OAB, regardless of specialty or geographic location, and provides key data for quality improvement activities and research

Urogynecologic conditions: pelvic organ prolapse.

Chronic pelvic pain is a commonly encountered condition that often is multifactorial. Etiologies include gynecologic, urologic, gastrointestinal, and neurologic conditions. Laboratory tests, imaging, and surgical intervention are not always helpful in identifying the etiology of pelvic pain. For appropriate management of this complex disease process, a detailed history and physical examination, and a multidisciplinary approach are needed. Pelvic pain may be caused by endometriosis, pelvic inflammatory disease, adenomyosis, interstitial cystitis/painful bladder syndrome, or other factors. Evaluation may include keeping a pain diary; laboratory tests, such as a pregnancy test, urinalysis, or tests for sexually transmitted infections; ultrasonography of abnormalities detected on physical examination; and laparoscopy. Specific first-line treatments include nonsteroidal anti-inflammatory drugs and oral contraceptives for endometriosis; progestins, gonadotropin-releasing hormone analogs, aromatase inhibitors, or hysterectomy for adenomyosis; and education, food avoidance, and behavioral modifications for interstitial cystitis/painful bladder syndrome. Surgical options include nerve transection procedures, laparoscopic uterosacral nerve ablation, and presacral neurectomy, although data on effectiveness are limited

Diagnosis and surgical treatment of stress urinary incontinence.

Stress urinary incontinence (SUI) is a major problem affecting more than 20% of the nation\u27s female population, with increasing prevalence as our population continues to age. Incontinence places a great burden on individuals, and the economic effect is large. Stress urinary incontinence occurs when there is involuntary leakage of urine during coughing, laughing, sneezing, or physical activity. It can be diagnosed during physical examination and by using low-cost office diagnostics. Although nonsurgical treatments provide some benefit, surgical interventions have demonstrated superiority with respect to subjective and objective cure and better long-term improvement. Corrective surgeries for SUI can be grouped into four categories: 1) slings (midurethral slings and slings placed at the ureterovesical junction), 2) retropubic urethropexy, 3) urethral bulking agents, and 4) artificial sphincters. The success and failure of each approach needs to be assessed in the context of individual patients and their circumstances. Slings and retropubic urethropexy are considered first-line surgical options. Since the advent of minimally invasive retropubic midurethral slings such as the tension-free vaginal tape, transobturator tension-free vaginal tape, and single-incision sling, retropubic urethropexy have fallen out of favor. Warnings about mesh use may contribute to a resurgence of retropubic urethropexy procedures such as the Burch procedure. A Burch procedure should still be considered for patients who have an aversion to mesh or if they are undergoing concurrent abdominal approach surgery. Urethral bulking agents are usually reserved for patients with a fixed, nonmobile urethra who cannot tolerate an operative experience or have failed previous antiincontinence procedures. Artificial sphincters should be considered an operation of last resort