Alternativas de financiamiento y su incidencia en la rentabilidad de la empresa constructora AMAFE Contratistas Generales SAC – año 2020

El objetivo de la investigación fue determinar de qué manera las alternativas de financiamiento inciden en la rentabilidad de la empresa Constructora Amafe Contratistas Generales SAC. El Tipo de investigación fue descriptivo y el método o enfoque del estudio cualitativo. El diseño de la investigación es no experimental y transversal. La Muestra probabilística aleatoria utilizando la fórmula del tamaño muestra finita se determinó 33 sujetos informantes. Se aplicó la técnica análisis de contenido y un cuestionario con preguntas que esta codificado en una escala de tipo Likert (Totalmente en desacuerdo, en desacuerdo, neutral, de acuerdo y totalmente de acuerdo). El estudio concluye que las Alternativas de Financiamiento inciden en la Rentabilidad de la empresa Constructora Amafe Contratistas Generales SAC. Además, se concluye que las alternativas de financiamiento (interno y externo) inciden en la rentabilidad económica, financiera y social de la empresa Constructora Amafe Contratistas Generales SAC

Vacunación contra SARS-CoV-2 en pacientes con esclerosis sistémica en Argentina: preferencias, acceso y adherencia al plan de vacunación

Introducción: en pacientes con enfermedades reumatológicas autoinmunes se recomienda la aplicación sistemática y secuencial de una serie de vacunas para la prevención de enfermedades transmisibles. El objetivo de este estudio fue estimar la proporción de pacientes con esclerosis sistémica (ES) que recibieron vacunación contra el coronavirus (SARS-CoV-2). Materiales y métodos: se envió una encuesta anónima por correo electrónico o contacto por WhatsApp desde mayo a septiembre de 2021, con preguntas para evaluar la adherencia al esquema de vacunación recomendado en pacientes con enfermedades reumatológicas, así como temores, preferencias y adherencia al esquema de vacunación contra el SARS-CoV-2

Evaluation of fertility and subfertility in adult alpacas and tuis using ultrasonography, endometrial cytology and bacterial isolation

The objective of this study was to compare the uterine health between fertile, sub-fertile alpacas and tuis using transrectal ultrasonography, endometrial cytology and bacterial isolation. A total 10 tuis (young mature females without breeding with average age of 1.5 years) and 20 adult alpacas of the Suri breed were used. In turn, the adult females were divided into two groups of 10 animals each according to their reproductive history: fertile group (parturition every year) and sub-fertile group (1 to 2 years without pregnancy). In all females, the thickness of the cervix and uterine horns was determined by transrectal ultrasonography. On the other hand, endometrial cytology and bacterial isolation were performed from samples obtained by uterine flushing. A Kruskal-Wallis and a Chi-square tests were used to compare ultrasonography and cytology groups. A greater thickness of the cervix and both uterine horns (p 5% PMN. The bacteria isolated were: Bacillus lechiniformis and Escherichia coli in the three groups studied, Staphylococcus saprophyticus and Bacillus cereus in tuis and fertile alpacas, Staphylococcus aureus in tuis and sub-fertile, Bacillus spp. and Micrococcus spp. in fertile and sub-fertile alpacas, Bacillus lactic acid, Staphylococcus epidermidis and Citrobacter spp. in fertile alpacas, Enterococcus spp., Bacillus subtilis and Klebsiella spp. in sub-fertile and Enterobacter spp. in tuis. The low percentage of PMN in endometrial cytology in sub-fertile alpacas would indicate the absence of endometritis at the time of the study. However, the lower thickness of the cervix and uterine horns observed in sub-fertile alpacas suggest that it would be necessary to perform uterine biopsies in order to evaluate if there is any association between the thickness of the uterine wall and the presence of degenerative and/or inflammatory changes observed on histopathological examination.El objetivo de este estudio fue comparar la salud uterina entre alpacas fértiles, sub-fértiles y tuis mediante ultrasonografía transrectal, citología endometrial y aislamiento bacteriano. Se utilizaron 10 tuis (hembras jóvenes maduras sin empadre con edad promedio de 1,5 años) y 20 alpacas adultas de raza Suri. A su vez las hembras adultas se dividieron en dos grupos de 10 animales cada uno según su historial reproductivo: grupo fértil (parto todos los años) y grupo sub-fértil (1 a 2 años sin preñez). En todas las alpacas se determinó el espesor del cérvix y cuernos uterinos mediante ultrasonografía transrectal. Por otra parte, se realizó citología endometrial y aislamiento bacteriano a partir de muestras obtenidas por lavaje uterino. Se utilizaron las pruebas de Kruskal-Wallis y Chi-cuadrado para comparar los grupos de ultrasonografía y citología. Se observó un mayor espesor del cérvix y de ambos cuernos uterinos (p˂0,05) en las alpacas fértiles con respecto a las sub-fértiles y tuis. El porcentaje de PMN en tuis y alpacas sub-fértiles fue 5% de PMN. Las bacterias aisladas fueron: Bacillus lechiniformis y Escherichia coli en los tres grupos estudiados, Staphylococcus saprophyticus y Bacillus cereus en tuis y en alpacas fértiles, Staphylococcus aureus en tuis y subfértiles, Bacillus spp. y Micrococcus spp. en alpacas fértiles y sub-fértiles, Bacilo ácido láctico, Staphylococcus epidermidis y Citrobacter spp. en alpacas fértiles, Enterococcus spp., Bacillus subtilis y Klebsiella spp en sub-fértiles y Enterobacter spp. en tuis. El bajo porcentaje de PMN en la citología endometrial en las alpacas sub-fértiles indicarían ausencia de endometritris al momento del estudio. Sin embargo, el menor espesor del cérvix y cuernos uterinos observados en las alpacas sub-fértiles sugieren que sería necesario realizar biopsias uterinas con el objetivo de evaluar si existe alguna asociación entre el espesor de la pared del útero y la presencia de cambios degenerativos y/o inflamatorios observados al examen histopatológico.Fil: Perez Guerra, Uri Harold. Universidad Nacional del Altiplano; PerúFil: Perez Durand, Manuel Guido. Universidad Nacional del Altiplano; PerúFil: Limache Mamani, Lourdes. Universidad Nacional del Altiplano; PerúFil: Condori Villegas, Vilma Hilaria. Universidad Nacional del Altiplano; PerúFil: Macedo Sucari, Rassiel. Universidad Nacional del Altiplano; PerúFil: Condori Chuchi, Eloy Amador. Universidad Nacional del Altiplano; PerúFil: Orós Butrón, Oscar. Universidad Nacional del Altiplano; PerúFil: Espinoza Molina, Saul. Universidad Nacional del Centro del Perú; PerúFil: Carretero, Maria Ignacia. Universidad de Buenos Aires. Facultad de Ciencias Veterinarias. Instituto de Investigacion y Tecnología en Reproducción Animal; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Diagnóstico Comunitario - ME168 - 202101

Mejorar las condiciones de salud de las comunidades constituye el objetivo principal de las actividades de salud pública y para lograrlo se requiere, antes que nada, conocer el estado de salud de sus habitantes, así como los determinantes sociales que son causa de sus desigualdades sanitarias; este conocimiento es un proceso permanente que deben realizar los establecimientos de salud a todo nivel, tan importante es que un Ministro de Salud conozca la situación de salud del país, como que un Director Regional de Salud tenga un diagnóstico de la problemática de su región o un jefe de un Centro de Salud conozca lo que ocurre en las comunidades a su cargo; esta tarea es fundamental para poder, a partir de este diagnóstico, diseñar los planes e intervenciones necesarias para mejorar la salud de la población en dichas comunidades. Para realizar el diagnóstico de la situación de salud de una población, se utiliza la información de los registros habituales de los establecimientos de salud así como de otras fuentes como censos, encuestas y estudios especiales, pero un buen diagnóstico no sería completo y adecuado si no se involucra en su elaboración a los actores sociales de la comunidad quienes viven, conocen e interpretan la realidad local. El curso de Diagnóstico Comunitario proporciona al estudiante de medicina las habilidades necesarias para el conocimiento y priorización de los problemas de salud de la comunidad, a través de la interacción con personas clave de una población, con la finalidad de generar evidencias, diseñar y ejecutar intervenciones en salud acordes con la realidad local. Diagnóstico Comunitario es un curso de especialidad del nivel 9 en la carrera de medicina, de carácter teórico- práctico y que precede al curso de Intervención en Comunidad del nivel 10. El curso busca desarrollar las siguientes competencias: Competencia general de Ciudadanía, nivel 3, con las siguientes dimensiones: - Razonamiento ético: Evalúa el sentido ético presente en las acciones humanas. - Responsabilidad: Evalúa la importancia de responder por sus acciones y decisiones en la interacción con los demás. - Pluralismo: Incorpora una perspectiva pluralista en la elaboración de un trabajo académico. - Respeto y diálogo: Evalúa la importancia del respeto y diálogo para la solución de problemas y la búsqueda de acuerdos en la interacción con otros - Perspectiva solidaria: Evalúa la importancia de la perspectiva solidaria para la interacción con otros. - Reconocimiento de deberes y derechos ciudadanos: Evalúa el ejercicio de los derechos y deberes ciudadanos en la sociedad actual y en el marco de un Estado democrático de Derecho Competencia específica de Práctica de Salud Pública, nivel 2, en la siguiente dimensión: - Análisis de Situación de Salud, Vigilancia y Control de Riesgos y Daños: el estudiante analiza, prioriza los problemas de salud de la población e identifica medidas de control frente a riesgos, daños y emergencias sanitaria

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI &lt;18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI &lt;2 SD below the median of the WHO growth reference) and obesity (BMI &gt;2 SD above the median). Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. Funding: UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union