La terapia de la risa: la perspectiva de los clowns hospitalarios y de los profesionales de la salud en la ciudad de Santiago de Cali

The objective of the present investigation was, to set forth the attitudes of the health professionals and the hospital clowns of the city of Cali, regarding the Laughter Therapy, taking it into account as an Alternative and Complementary Therapy. A qualitative study was carried out, by means of thirteen semi-structured interviews, taking as sample nine health professionals (doctors, nurses and psychologists) and four hospital clowns. It was found that Laughter Therapy is known in the field of health, as a job that hospital clowns commonly do, with the objective of ensuring the whole wellbeing of a people of different ages and in various clinical states, through laughter and humor; helping to reduce the psychological, physical, social and emotional symptoms of each person and reduce the dehumanization factor of health care. Therefore, as a conclusion, it is vital to emphasize the importance of integrating the Laughter Therapy into the health professional’s attention and considering it a supporting complement to Conventional Medicine; however, there is little interest in this topic and in general in the CAT, by the health system, the health professionals and the Colombian society. This is due to the lack of knowledge and value given to the emotional aspect of a hospitalized patient and insufficient evidence of long-term changes in patient’s health.La presente investigación tuvo como objetivo dar a conocer las actitudes de los profesionales de la salud y de los clowns hospitalarios de la ciudad de Cali frente a la Terapia de Risa, teniendo en cuenta a esta como una Terapia Alternativa y Complementaria. Se realizó un estudio de corte cualitativo, en el cual se aplicaron 13 entrevistas semiestructuradas, tomando como muestra a 9 profesionales de la salud (médicos, enfermeros y psicólogos) y a 4 clowns hospitalarios. De esta forma, se encontró que la Risoterapia es considerada en el ámbito de la salud, como aquella que es llevada a cabo por payasos hospitalarios y que tiene como objetivo velar por el bienestar integral de las personas de diferentes edades y en distintos estados clínicos, por medio de la risa y el humor; ayudando así, a la disminución de síntomas psicológicos, físicos, sociales y emocionales de cada una y a la vez, a la reducción de la deshumanización en la atención sanitaria. Por lo tanto, se hace énfasis en la importancia de integrar las bases de la Terapia de la Risa en la atención de los profesionales de la salud y de esta manera, considerar tal como un complemento a la Medicina Convencional; sin embargo, se presenta poco interés en esta por parte del sistema de salud, del personal sanitario y de la sociedad Colombiana, debido al poco conocimiento que tienen sobre las TAC, el poco valor que se le brinda a la parte emocional del paciente hospitalizado y a la falta de evidencias de cambios a largo plazo a partir de la Terapia de la Risa en la salud del paciente

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