Fundamentación de un sistema de acciones de educación ambiental en el Parque Nacional Guanahacabibes, Cuba

In the interest of basing a system of actions to promote community environmental education in a sector of Guanahacabibes National Park, measuring instruments such as surveys and interviews they were applied to diagnose the state of awareness on environmental issues in their area of impact and determine those issues that needed to be highlighted in terms of expanding frameworks of positive environmental action in public spaces of the Park. The results could confirm that the level of knowledge reflected an advanced stage of incidences of the work of the administrators of the National Park; all could support a strengthened system of actions being implemented in the eastern part of the Guanahacabibes National Park.Con el interés de fundamentar un sistema de acciones para potenciar la educación ambiental comunitaria en un sector del Parque Nacional Guanahacabibes, se aplicaron instrumentos de medición como encuestas y entrevistas a fin de diagnosticar el estado de percepción sobre problemáticas ambientales en su área de incidencia y determinar aquellas temáticas que requerían ser destacadas en función de ampliar marcos de actuación ambiental positiva en espacios de uso público del Parque. Los resultados pudieron constatar que el nivel de conocimientos reflejó un estado avanzado de incidencias de la labor de los administradores del Parque Nacional; todo ello pudo sustentar un fortalecido sistema de acciones a aplicar en el sector oriental del Parque Nacional Guanahacabibes

Frequency of breast cancer with hereditary risk features in Spain: Analysis from GEICAM “El Álamo III” retrospective study

Purpose: To determine the frequency of breast cancer (BC) patients with hereditary risk features in a wide retrospective cohort of patients in Spain. Methods: a retrospective analysis was conducted from 10, 638 BC patients diagnosed between 1998 and 2001 in the GEICAM registry “El Álamo III”, dividing them into four groups according to modified ESMO and SEOM hereditary cancer risk criteria: Sporadic breast cancer group (R0); Individual risk group (IR); Familial risk group (FR); Individual and familial risk group (IFR) with both individual and familial risk criteria. Results: 7, 641 patients were evaluable. Of them, 2, 252 patients (29.5%) had at least one hereditary risk criteria, being subclassified in: FR 1.105 (14.5%), IR 970 (12.7%), IFR 177 (2.3%). There was a higher frequency of newly diagnosed metastatic patients in the IR group (5.1% vs 3.2%, p = 0.02). In contrast, in RO were lower proportion of big tumors (> T2) (43.8% vs 47.4%, p = 0.023), nodal involvement (43.4% vs 48.1%, p = 0.004) and lower histological grades (20.9% G3 for the R0 vs 29.8%) when compared to patients with any risk criteria. Conclusions: Almost three out of ten BC patients have at least one hereditary risk cancer feature that would warrant further genetic counseling. Patients with hereditary cancer risk seems to be diagnosed with worse prognosis factors

Co-infections and superinfections complicating COVID-19 in cancer patients: A multicentre, international study

Background: We aimed to describe the epidemiology, risk factors, and clinical outcomes of co-infections and superinfections in onco-hematological patients with COVID-19. Methods: International, multicentre cohort study of cancer patients with COVID-19. All patients were included in the analysis of co-infections at diagnosis, while only patients admitted at least 48 h were included in the analysis of superinfections. Results: 684 patients were included (384 with solid tumors and 300 with hematological malignancies). Co-infections and superinfections were documented in 7.8% (54/684) and 19.1% (113/590) of patients, respectively. Lower respiratory tract infections were the most frequent infectious complications, most often caused by Streptococcus pneumoniae and Pseudomonas aeruginosa. Only seven patients developed opportunistic infections. Compared to patients without infectious complications, those with infections had worse outcomes, with high rates of acute respiratory distress syndrome, intensive care unit (ICU) admission, and case-fatality rates. Neutropenia, ICU admission and high levels of C-reactive protein (CRP) were independent risk factors for infections. Conclusions: Infectious complications in cancer patients with COVID-19 were lower than expected, affecting mainly neutropenic patients with high levels of CRP and/or ICU admission. The rate of opportunistic infections was unexpectedly low. The use of empiric antimicrobials in cancer patients with COVID-19 needs to be optimized

Distribution and genotype-phenotype correlation of GDAP1 mutations in Spain

Mutations in the GDAP1 gene can cause Charcot-Marie-Tooth disease. These mutations are quite rare in most Western countries but not so in certain regions of Spain or other Mediterranean countries. This cross-sectional retrospective multicenter study analyzed the clinical and genetic characteristics of patients with GDAP1 mutations across Spain. 99 patients were identified, which were distributed across most of Spain, but especially in the Northwest and Mediterranean regions. The most common genotypes were p.R120W (in 81% of patients with autosomal dominant inheritance) and p.Q163X (in 73% of autosomal recessive patients). Patients with recessively inherited mutations had a more severe phenotype, and certain clinical features, like dysphonia or respiratory dysfunction, were exclusively detected in this group. Dominantly inherited mutations had prominent clinical variability regarding severity, including 29% of patients who were asymptomatic. There were minor clinical differences between patients harboring specific mutations but not when grouped according to localization or type of mutation. This is the largest clinical series to date of patients with GDAP1 mutations, and it contributes to define the genetic distribution and genotype-phenotype correlation in this rare form of CMT

Ecofisiología del cultivo de la gulupa (Passiflora edulis Sims)

Este libro muestra los resultados de la investigación realizada en gulupa (Passiflora edulis Sims), la cual es una de las especies incluidas en la apuesta exportadora de Colombia en la vigencia 2019. En Colombia se cultiva en los departamentos de Risaralda, Quindío, Cundinamarca y Boyacá, entre otros. La demanda por esta fruta se ha incrementado y el sector productivo frutícola colombiano se beneficia con los precios alcanzados en la ventana de exportación cuando no se provee de otras partes del mundo. Los resultados obtenidos han permitido fortalecer un paquete tecnológico con el fin de consolidar la oferta exportadora y de comercio nacional e internacional. El libro va dirigido tanto al sector productivo como a profesionales, técnicos, estudiantes universitarios o personas interesadas en el cultivo de la gulupa

Caracterización de experiencias exitosas de negocios inclusivos en Colombia

El libro recoge un conjunto de ejemplos y modelos institucionales que sistematizan casos exitosos que propician la inclusión social bajo el enfoque de Negocios Inclusivos. Se persigue con esto evidenciar la posible relación existente entre negocios inclusivos y Responsabilidad Social Empresarial, además de señalar las ventajas de esta modalidad de desarrollo empresarial y de accionar institucional. La variedad analítica de los casos significativos contextualizados, permite entender el dinámico y cambiante mundo de la responsabilidad social empresarial en lo público y lo privado, así como el aporte de la economía del bien común y del consumo colaborativo en la vida de las personas y en los procesos de inclusión tan necesarios en una sociedad tradicional como la colombiana

Implementation of hydroponic crops as a pedagogical strategy for the promotion of research

En el presente proyecto se desarrollaron actividades pedagógicas para el fortalecimiento de los procesos educativos en la población estudiantil de la institución: Centro de Educación Básica San Valentín, en el departamento del Magdalena, a través de implementación de cultivos hidropónicos, como estrategias pedagógicas que desarrollan habilidades investigativas en infantes y jóvenes de la institución. Se trabajó bajo la metodología cualitativa con modelo de investigación acción participativa. La población estuvo conformada por estudiantes de esa institución. Se recogió la información por medio de las técnicas como relatorías individuales, institucionales, diario de campo, encuestas y observación directa. Se identificaron los contenidos curriculares del área de Biología para aplicar en los cultivos como un recurso generador de aprendizaje, con base en los cuales se realizó la planeación para las clases y el trabajo en los cultivos.In the present project, pedagogical activities were developed for the strengthening of educational processes in the student population of the San Valentín Basic Education Center, in the department of Magdalena, through the implementation of hydroponic crops as pedagogical strategies that develop investigative skills in infants and young people of the institution. We worked under the qualitative methodology with participatory action research model. The population was conformed by students of the San Valentín Basic Education Center, in Magdalena. The information was collected by means of techniques such as individual and institutional rapporteurships, field journals, surveys and direct observation. The curricular contents of the Biology area to be applied in the crops were identified as a learning instrument, based on which the planning for the classes and the work in the crops was carried out

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

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

¿Qué queda de mí?

Este libro es una reclamación a quienes hemos sido, somos o seremos docentes. A quienes no hemos respetado a las personas que se han puesto junto a nosotros y nosotras, confiando su bien más preciado: la libertad. Estas páginas denuncian cada vez que convertimos una visión en la visión, una emoción en la emoción, un saber en el saber, un comportamiento en el comportamiento. Es un grito contra la imposición, la normalización, la neutralización y la universalización de una perspectiva particular. Una pugna contra cada proceso que no se ha conectado con las vidas de los aprendices. Un texto colaborativo realizado por alumnado de Educación y Cambio Social en el Grado en Educación Infantil de la Universidad de Málaga y coordinado por Ignacio Calderón Almendros