Propuesta: cuentos infantiles y autoestima en estudiantes de 5 años de la Institución Educativa N°072- Celendín 2018.

El presente trabajo de investigación, tuvo como propósito, determinar en qué medida los cuentos infantiles, influye en el desarrollo de la autoestima de los niños de 5 años de una Institución Educativa Inicial N° 392 072- Celendín. Se trabajó con una muestra de por 15 niños y niñas de 5 años de educación inicial. El diseño de investigación que se ha adoptado es el diseño pre experimental de un grupo con pre y post test, se utilizó la encuesta y la observación como técnicas de recolección de datos, asimismo se empleó el método inductivo deductivo. En los resultados se evidenció que la dimensión la dimensión de conciencia silábica, en el pre test, el 10.00% siempre omite fonemas; mientras que en el pos test el 75.00% siempre omite fonemas, mostrándose con claridad una ganancia de 65%, evidenciándose una mejora muy significativa y constructiva de la conciencia fonológica en los estudiantes de 5 años de educación inicial. La aplicación del Programa se mejoró significativamente los niveles de conciencia fonológica en todas las dimensiones evaluadas.Tesi

La violencia contra las mujeres en dos medios escritos de comunicación masiva en Guatemala.

Considerando que los medios de comunicación se encargan de informar y formar opinión pública, la investigación buscó analizar el tratamiento discursivo que dos medios escritos de comunicación dan a la información relacionada con la violencia contra las mujeres en Guatemala, con el fin de conocer sus interpretaciones del problema, las representaciones sociales que sobre las víctimas y los victimarios están generando, así como las actitudes y los patrones de conducta que están promoviendo en relación a la violencia contra las mujeres y, en particular, hacia las víctimas. Existen experiencias de monitoreo de medios de comunicación para identificar el tratamiento de los medios a este tipo de información, pero esta es una investigación que va más allá del monitoreo hemerográfico y se realizó desde el Análisis Crítico del Discurso, en su versión latinoamericana. En eso radica su importancia. Los resultados obtenidos revelan que los medios escritos de comunicación estudiados a lo largo de cuatro meses, efectivamente utilizan una serie de estrategias discursivas para trasladar la información de modo que refuerza los estereotipos y prejuicios de género, re-victimizando a las víctimas y naturalizando el problema de la violencia contra las mujeres. En última instancia, legitimando el comportamiento machista de los agresores, a partir del reforzamiento de los imaginarios sociales patriarcales que caracterizan al sentido común

Uso de métodos anticonceptivos modernos en adolescentes en los establecimientos de salud con y sin servicios diferenciados del Perú del 2014 al 2016

Se realizó el estudio descriptivo a fin de determinar el uso de métodos anticonceptivos en los establecimientos de salud con y sin servicio diferenciado para adolescentes en el Perú en los años 2014 al 2016. En los resultados obtenidos se determinó que existe una tendencia positiva en el uso de métodos anticonceptivos en adolescentes en los establecimientos de salud con servicios diferenciados respecto a los establecimientos de salud que no cuentan con servicio diferenciado de las regiones del Perú en los años 2014 al 2016. Los métodos anticonceptivos de mayor uso en adolescentes en los años 2014 al 2016 en las regiones del Perú es el inyectable trimestral seguido del método hormonal oral combinado y el condón masculino respectivamente. Las regiones que tienen mayor uso de métodos anticonceptivos en adolescentes en los años 2014 al 2016 son Lima (Lima Metropolitana), Cajamarca, La Libertad, Huánuco, Ayacucho y en Cusco

Coffee Genogram: An Analysis of the Tradition of the Rural Family in Southwest Columbia

The analysis of the family context in rural communities can provide helpful insight to promote technology appropriation processes. For this study, the family context and its influence on the coffee tradition were investigated within the framework of a proposal to build knowledge and transfer technology. To address this aim, the construction of genograms was carried out, accompanied by semi-structured interviews with coffee women from a producer’s association in the department of Huila, Colombia. Key elements around their training process as coffee growers were analyzed based on the consolidation of a tradition derived from parents and grandparents, but with unknowns regarding their continuity in future generations. The findings showed a group of women, most of whom have lived and grown around coffee farming, where their role has changed from a position of support in the home to become leading actors in the coffee production processes. Opportunities and challenges were found in the face of the possibilities in the role of woman in the coffee growing development, but important questions arise regarding the role that the following generations may have in the future

Head Position in Stroke Trial (HeadPoST)- sitting-up vs lying-flat positioning of patients with acute stroke: study protocol for a cluster randomised controlled trial

Background Positioning a patient lying-flat in the acute phase of ischaemic stroke may improve recovery and reduce disability, but such a possibility has not been formally tested in a randomised trial. We therefore initiated the Head Position in Stroke Trial (HeadPoST) to determine the effects of lying-flat (0°) compared with sitting-up (≥30°) head positioning in the first 24 hours of hospital admission for patients with acute stroke. Methods/Design We plan to conduct an international, cluster randomised, crossover, open, blinded outcome-assessed clinical trial involving 140 study hospitals (clusters) with established acute stroke care programs. Each hospital will be randomly assigned to sequential policies of lying-flat (0°) or sitting-up (≥30°) head position as a ‘business as usual’ stroke care policy during the first 24 hours of admittance. Each hospital is required to recruit 60 consecutive patients with acute ischaemic stroke (AIS), and all patients with acute intracerebral haemorrhage (ICH) (an estimated average of 10), in the first randomised head position policy before crossing over to the second head position policy with a similar recruitment target. After collection of in-hospital clinical and management data and 7-day outcomes, central trained blinded assessors will conduct a telephone disability assessment with the modified Rankin Scale at 90 days. The primary outcome for analysis is a shift (defined as improvement) in death or disability on this scale. For a cluster size of 60 patients with AIS per intervention and with various assumptions including an intracluster correlation coefficient of 0.03, a sample size of 16,800 patients at 140 centres will provide 90 % power (α 0.05) to detect at least a 16 % relative improvement (shift) in an ordinal logistic regression analysis of the primary outcome. The treatment effect will also be assessed in all patients with ICH who are recruited during each treatment study period. Discussion HeadPoST is a large international clinical trial in which we will rigorously evaluate the effects of different head positioning in patients with acute stroke. Trial registration ClinicalTrials.gov identifier: NCT02162017 (date of registration: 27 April 2014); ANZCTR identifier: ACTRN12614000483651 (date of registration: 9 May 2014). Protocol version and date: version 2.2, 19 June 2014

Statistical analysis plan for the Head Position in Stroke Trial (HeadPoST): An international cluster cross-over randomized trial

Background There is evidence to indicate that the lying flat head position increases cerebral blood flow and oxygenation in patients with acute ischemic stroke, but how these physiological effects translate into clinical outcomes is uncertain. The Head Position in Stroke Trial aims to determine the comparative effectiveness of lying flat (0°) compared to sitting up (≥30°) head positioning, initiated within 24 h of hospital admission for patients with acute stroke. Design An international, pragmatic, cluster-randomized, crossover, open, blinded outcome assessed clinical trial. Each hospital with an established acute stroke unit (cluster) site was required to recruit up to 140 consecutive cases of acute stroke (one phase of head positioning before immediately crossing over to the other phase of head positioning), including both acute ischemic stroke and intracerebral hemorrhage, in each randomized head position as a 'business as usual' policy. Objective To outline in detail the predetermined statistical analysis plan for the study. Methods All accumulated data will be reviewed and formally assessed. Information regarding baseline characteristics of patients, their process of care and management will be outlined, and for each item, statistically relevant descriptive elements will be described. For the trial outcomes, the most appropriate statistical comparisons are described. Results A statistical analysis plan was developed that is transparent, verifiable, and predetermined before completion of data collection. Conclusions We developed a predetermined statistical analysis plan for Head Position in Stroke Trial to avoid analysis bias arising from prior knowledge of the findings, in order to reliably quantify the benefits and harms of lying flat versus sitting up early after the onset of acute stroke. Trial registration ClinicalTrials.gov identifier NCT02162017; ANZCTR identifier ACTRN12614000483651

Regional variation in acute stroke care organisation

Background Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). Methods HeadPoST is an on-going international multicenter crossover cluster-randomized trial of ‘sitting-up’ versus ‘lying-flat’ head positioning in acute stroke. As part of the start-up phase, one stroke care organisation questionnaire was completed at each hospital. The World Bank gross national income per capita criteria were used for classification. Results 94 hospitals from 9 countries completed the questionnaire, 51 corresponding to MIC and 43 to HIC. Most participating hospitals had a dedicated stroke care unit/ward, with access to diagnostic services and expert stroke physicians, and offering intravenous thrombolysis. There was no difference for the presence of a dedicated multidisciplinary stroke team, although greater access to a broad spectrum of rehabilitation therapists in HIC compared to MIC hospitals was observed. Significantly more patients arrived within a 4-h window of symptoms onset in HIC hospitals (41 vs. 13%; P < 0.001), and a significantly higher proportion of acute ischemic stroke patients received intravenous thrombolysis (10 vs. 5%; P = 0.002) compared to MIC hospitals. Conclusions Although all hospitals provided advanced care for people with stroke, differences were found in stroke care organisation and treatment. Future multilevel analyses aims to determine the influence of specific organisational factors on patient outcomes

Ahora / Ara

La cinquena edició del microrelatari per l’eradicació de la violència contra les dones de l’Institut Universitari d’Estudis Feministes i de Gènere «Purificación Escribano» de la Universitat Jaume I vol ser una declaració d’esperança. Aquest és el moment en el qual les dones (i els homes) hem de fer un pas endavant i eliminar la violència sistèmica contra les dones. Ara és el moment de denunciar el masclisme i els micromasclismes començant a construir una societat més igualitària. Cadascun dels relats del llibre és una denúncia i una declaració que ens encamina cap a un món millor

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