La mirada de la escuela a la interculturalidad: el cimiento de la ciudadanía

Un total de noventa y un inmigrantes que han pasado por el sistema educativo español nos cuentan cómo ha sido su experiencia y para qué les ha servido la escuela.  En base a esto se puede decir que es muy importante que la mirada en la escuela sea cercana, abierta a lo nuevo y con proyección de futuro, ya que en ella se educan hoy a los ciudadanos del mañana. El papel que en esta labor asume el docente es fundamental, por lo que deben incorporarse en su formación conceptos como el de hibridación cultural o el de pedagogía de la hibridación

Nivel de eficiencia del uso de recursos por las organizaciones públicas. Caso: sistemas sanitarios españoles

Objectives: This paper seeks to detect, in the Spanish health system, which health services are efficient, and which are not, as well as propose corrective measures that allow inefficient health services to achieve efficiency. Methods: This paper applies the Data Envelopment Analysis (DEA) methodology, which allows obtaining natural and managerial efficiencies, as well as deviations from inefficient units in relation to efficient ones and proposing corrective measures that imply only budgetary (natural) modifications or changes in the policies of resource management (management). Results: Through the efficiencies, or the lack of them, the health services of the 17 Spanish autonomous communities are classified into four groups: With high, medium-high, medium-low or low natural or managerial efficiency. Conclusions: The lack of natural efficiency can be corrected with a greater budgetary endowment and the lack of managerial efficiency with a budget cut and changes in resource management policies. This tendency contrary to the adjustments is precisely what gives this work of interest and novelty with respect to others that apply the DEA in different sectors such as those that study the impact on the environment of resource consumption. Another important aspect of this study is the possibility of applying it to other countries with similar political structures.Objetivos: Con este trabajo se persigue detectar, en el sistema sanitario español, que servicios sanitarios son eficientes y cuáles no, así como proponer medidas correctoras que permitan a los servicios sanitarios ineficientes alcanzar la eficiencia. Metodología: Este trabajo aplica la metodología del análisis envolvente de datos (DEA), que permite obtener las eficiencias natural y gerencial, así como las desviaciones de las unidades ineficientes con relación a las eficientes, y proponer medidas correctoras que impliquen únicamente modificaciones presupuestarias (natural) o cambios en las políticas de gestión de recursos (gerencial). Resultados: A través de las eficiencias, o la falta de ellas, los servicios sanitarios de las 17 comunidades autónomas españolas se clasifican en cuatro grupos: Con eficiencia natural o gerencial alta, media-alta, media-baja o baja. Conclusiones: La falta de eficiencia natural puede corregirse con una mayor dotación presupuestaria, la falta de eficiencia gerencial con un recorte presupuestario y cambios en las políticas de gestión de recursos. Esta tendencia contraria de los ajustes es precisamente la que dota este trabajo del interés y novedad con respectos a otros que aplican el DEA en sectores diferentes como aquellos que estudian el impacto en el medioambiente de los consumos de recursos. Otro aspecto importante de este estudio es la posibilidad de aplicarlo a otros países con estructuras políticas similares

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

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

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Aula de innovación educativa

El artículo forma parte de la sección dedicada a la acción comunitaria.Se tratan los retos que ha de enfrentar la educación social en el futuro, tanto en la escuela como en la sociedad, desde la experiencia del colegio público CEIP Prácticas nõ 1 de Málaga. Se sientan las bases para el trabajo en red mediante el proyecto 'Juntos trabajamos en red' y la acción llevada a cabo por parte de las dos educadoras sociales con las que cuenta el centro. La implicación de diversas organizaciones, entidades e instituciones han contribuido a lograr la revitalización del centro. Se destaca la importancia de la educación social como el conjunto de actividades no formales que deben ser reconocidas y practicadas en el sistema educativo actual para conseguir el desarrollo completo del alumnado..CataluñaConsejería de Educación, Ciencia e Investigación. Biblioteca; Av. de la Fama, 15; 30006 Murcia; Tel. +34968279685; Fax +34968279835; [email protected]

La mirada de la escuela a la interculturalidad: el cimiento de la ciudadanía

A total of 91 immigrants who have passed through the Spanish educational system tell us about their experience at school and how it has served them. We could say that it is important that our schools are open to new things and to the future because we are educating today the citizens of tomorrow. The teacher�s role is paramount, so his/her training must nurture concepts such as cultural hybridization and the pedagogy of hybridization.Un total de noventa y un inmigrantes que han pasado por el sistema educativo español nos cuentan cómo ha sido su experiencia y para qué les ha servido la escuela. En base a esto se puede decir que es muy importante que la mirada en la escuela sea cercana, abierta a lo nuevo y con proyección de futuro, ya que en ella se educan hoy a los ciudadanos del mañana. El papel que en esta labor asume el docente es fundamental, por lo que deben incorporarse en su formación conceptos como el de hibridación cultural o el de pedagogía de la hibridación

The importance of schools regarding interculturality: The foundation of citizenship

Un total de noventa y un inmigrantes que han pasado por el sistema educativo español nos cuentan cómo ha sido su experiencia y para qué les ha servido la escuela. En base a esto se puede decir que es muy importante que la mirada en la escuela sea cercana, abierta a lo nuevo y con proyección de futuro, ya que en ella se educan hoy a los ciudadanos del mañana. El papel que en esta labor asume el docente es fundamental, por lo que deben incorporarse en su formación conceptos como el de hibridación cultural o el de pedagogía de la hibridación.A total of 91 immigrants who have passed through the Spanish educational system tell us about their experience at school and how it has served them. We could say that it is important that our schools are open to new things and to the future because we are educating today the citizens of tomorrow. The teacher’s role is paramount, so his/her training must nurture concepts such as cultural hybridization and the pedagogy of hybridization.Universidad de Granada. Grupo de Investigación "Desarrollo Educativo de las Didácticas en la Comunidad Andaluza" (HUM742)