Development, alternatives and social change from communications perspective: A look at Observatorio Crítico from Cuba

Este artículo propone una sistematización del área de la comunicación para el desarrollo, para el cambio social y alternativa después de la segunda mitad del siglo XX. Se discuten varios enfoques teóricos, iniciativas prácticas y aproximaciones académicas relacionadas a las continuas transformaciones en esta área de la comunicación. Desde presupuestos básicos hasta tendencias actuales, se contextualiza este campo de estudios en diferentes escenarios geográficos y temporales, con énfasis en la región de América Latina. Se aborda las potencialidades que brindan plataformas y redes de trabajo como los Observatorios Sociales. Nos detenemos en el caso de Cuba, para mostrar una propuesta de cambio social impulsada desde la Red Protagónica Observatorio Crítico y cómo esa experiencia pionera fue sucedida por la conformación de proyectos alternativos de comunicación que confrontan el sistema mediático y el discurso político dominantes en la Isla.The article proposes a systematization of the area of communication for development, alternative communication, and communication for social change, after the second half of the twentieth century. Several theoretical approaches, practical initiatives and academic outlooks related to the continuous transformations in this area of communication are discussed. From basic assumptions to current trends, we aim to contextualize this field of study in different geographical and temporal settings, with emphasis on the Latin American region and the potential offered by platforms and networks such as Social Observatories. Specifically, we look at the context of Cuba, to show a proposal for social change promoted by the Red Protagónica Observatorio Crítico (Critical Observatory Network), and how that experience was followed by the creation of alternative communication projects that confront the mainstream media and the hegemonic political discourses in the Island

The Online Public Debate in Cuba: Interlocutors and Politization of Conversations on Migration in the Site Cubadebate

El artículo propone un enfoque integrador de los espacios conversacionales online y su dimensión política, a partir de la articulación de diversos actores institucionales y mediáticos que intervienen en el desarrollo el debate público en Cuba. Para tanto, se aborda el concepto de politización de conversaciones online, a fin de destacar la interrelación entre dimensiones del contexto y discurso en las interacciones. Así, se analizan las conversaciones sobre migración en Cubadebate entre 2013 y 2017; complementando el análisis con entrevistas realizadas a directores y periodistas del medio. De esa forma, evidenciamos cómo ese espacio comunicativo funciona simultáneamente cómo foro de discusión, canal de comunicación con el gobierno y vehículo de discusión de la pauta noticiosa del medio. Por fin, observamos que la conversación online puede politizarse también a partir de su entrelazamiento con experiencias offline y de la reelaboración discursiva de la existencia de los sujetos que conversan.The article proposes an integrative approach to online conversational spaces and their political dimension, based on the articulation of various institutional and media actors involved in the development of public debate in Cuba. Therefore, the concept of politicization of online conversations is discussed, in order to highlight the interrelation between dimensions of context and discourse in those interactions. Thus, we analyze conversations on migration issues in Cubadebate between 2013 and 2017; complementing the analysis with interviews made to directors and journalists of the site. In this way, we show how this communicative space functions simultaneously as a discussion forum, a channel of communication with the government and a vehicle for discussing the news agenda of the media. Finally, we observe that the online conversation can also be politicized from its intertwining with offline experiences and from the discursive reconfiguration of subjects existence

Desarrollo, alternativas y cambio social desde la comunicación: una mirada al Observatorio Crítico de Cuba

ResumenEste artículo propone una sistematización del área de la comunicación para el desarrollo, para el cambio social y alternativa después de la segunda mitad del siglo XX. Se discuten varios enfoques teóricos, iniciativas prácticas y aproximaciones académicas relacionadas a las continuas transformaciones en esta área de la comunicación. Desde presupuestos básicos hasta tendencias actuales, se contextualiza este campo de estudios en diferentes escenarios geográficos y temporales, con énfasis en la región de América Latina. Se aborda las potencialidades que brindan plataformas y redes de trabajo como los Observatorios Sociales. Nos detenemos en el caso de Cuba, para mostrar una propuesta de cambio social impulsada desde la Red Protagónica Observatorio Crítico y cómo esa experiencia pionera fue sucedida por la conformación de proyectos alternativos de comunicación que confrontan el sistema mediático y el discurso político dominantes en la Isla

Lo glocal y el turismo. Nuevos paradigmas de interpretación.

El estudio del turismo se realiza desde múltiples escalas y enfoques, este libro aborda muchos temas que es necesario discutir desde diversas perspectivas; es el caso de la reflexión sobre la propia disciplina y sus conceptos, así como los asuntos específicos referidos al impacto territorial, los tipos de turismo, las cuestiones ambientales, el tema de la pobreza, la competitividad, las políticas públicas, el papel de las universidades, las áreas naturales protegidas, la sustentabilidad, la cultura, el desarrollo, la seguridad, todos temas centrales documentados y expuestos con originalidad y dominio del asunto. Lo multiescalar es básico para la comprensión del sistema turístico, sistema formado de procesos globales, regionales y locales. El eje de discusión del libro es lo glocal, esa interacción entre lo nacional y local con lo global

Transformaciones y retos de la educación en las artes y los diseños (tomo 2)

394 páginas.Libro con diversas muestras de la labor, el pulso, las formas y caminos resolutivos que asumieron los docentes frente a contextos de complejidad en el marco de la educación superior en las artes y los diseños, que buscó la profesionalización de los estudiantes frente a la emergencia de la pandemia Covid-19 yendo más allá y proponiendo mecanismos de creatividad, flexibilidad académica, colaboración y motivación educativa. Aparecen en las investigaciones no solo respuestas y experiencias, sino nuevos planteamientos para una perspectiva futura, necesarios en las transformaciones para las próximas décadas que deberán vivirse en los planes y programas de estudio, los sistemas de evaluación, la formación docente, el perfil y las competencias digitales de los estudiantes, entre otros aspectos. Y a propósito de estas reflexiones, también se plantea un escenario sobre ¿a dónde queremos o debemos llegar en la educación en artes y diseño? Cabe señalar que los aportes de estos textos provienen del ámbito de la educación superior pública en México, que se rige bajo los principios generales de libertad de cátedra para los docentes, y este factor resulta fundamental para poder observar justamente la toma de decisiones, adecuaciones, movilidad y flexibilidad para las adecuaciones curriculares y también en los procesos de enseñanza- aprendizaje que se exponen, resultando un componente central para pensar en contextos de emergencia y complejidad y en los escenarios futuros de la educación en las artes, diseños y en todos los ámbitos del conocimiento.Coordinadoras: Alma Elisa Delgado Coellar, Juana Cecilia Angeles Cañedo & Daniela Velázquez Ruí

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

EDUCACIÓN AMBIENTAL Y SOCIEDAD. SABERES LOCALES PARA EL DESARROLLO Y LA SUSTENTABILIDAD

Este texto contribuye al análisis científico de varias áreas del conocimiento como la filosofía social, la patología, la educación para el cuidado del medio ambiente y la sustentabilidad que inciden en diversas unidades de aprendizaje de la Licenciatura en Educación para la Salud y de la Maestría en Sociología de la SaludLas comunidades indígenas de la sierra norte de Oaxaca México, habitan un territorio extenso de biodiversidad. Sin que sea una área protegida y sustentable, la propia naturaleza de la región ofrece a sus visitantes la riqueza de la vegetación caracterizada por sus especies endémicas que componen un paisaje de suma belleza

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group