4 research outputs found
La inclusión educativa de niños con necesidades educativas especiales en edad preescolar en la ciudad de Cuenca
El Estado ecuatoriano a partir de la puesta en vigencia del currículo de educación básica 2010, declara la obligatoriedad de la inclusión educativa para las personas con Necesidades Educativas Especiales (NEE).
Este proceso de inclusión requiere de un nivel adecuado de preparación, de compromiso, de aceptación, de un bagaje de conocimientos técnicos y metodológicos, un nivel de sensibilidad hacia las personas con necesidades especiales y, en particular,a los niños y niñas que lo padecen.
En Ecuador la educación especial ha trabajado durante muchos años en el empeño de potencializar y asegurar condiciones educativas adecuadas para los niños y niñas que presentan NEE, en su mayor parte derivadas de una discapacidad, quienes a lo largo de la historia han sido víctimas de actitudes y acciones de discriminación tanto en el ámbito social, educativo y laboral
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
Propuesta Operativa para la Inclusión Educativa de Niños y Niñas con Necesidades Educativas Especiales derivadas de la Discapacidad Física de 3 a 5 años de edad en los Centros de Desarrollo Infantil Municipales de la Ciudad de Cuenca 2012
El presente estudio investigativo contiene una fundamentación teórica de la Educación Inicial e Inclusiva, las Necesidades Educativas Especiales, Adaptaciones Curriculares y la Discapacidad Física. El objetivo central de la investigación desarrolla un Manual Operativo para la Inclusión Educativa de niños y niñas con Discapacidad Física de 3 a 5 años, constituyéndose en un instrumento básico que orientará a profesoras, profesores y a todas las personas involucradas con la educación inclusiva inicial a llevar con éxito este proceso. La construcción de esta propuesta, basada en un contexto real de las Necesidades Educativas Especiales derivadas de la Discapacidad y considerando la exigibilidad de sus derechos, trascenderá en el desarrollo y atención integral de las niñas y niños en edades iniciales