15 research outputs found

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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    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

    Las ciencias del comportamiento en la reducción de la pobreza rural feminizada : una aproximación al caso del Quindío

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    En esta investigación, se exploran las barreras y catalizadores que inciden en la capacidad de toma de decisiones de las mujeres rurales del Quindío de participar o no en programas gubernamentales, incidiendo en el resultado de las políticas públicas. Esto con el propósito de contribuir a procesos de innovación pública, a través de una primera aproximación a la aplicación de las ciencias del comportamiento en el diseño, implementación y evaluación de las políticas públicas en Colombia que buscan reducir las desigualdades de género. Para ello, se propone como punto de partida las experiencias y lecciones aprendidas en la materia en diferentes países de Latinoamérica, así como las tendencias y patrones hallados en las entrevistas realizadas en esta investigación a 10 mujeres rurales del Quindío. Los principales resultados sugieren que efectivamente hay una incidencia en la capacidad de toma de decisiones de las mujeres rurales por parte de barreras conductuales asociadas a las normas sociales de género y los roles de género, así como de otras barreras estructurales, lo cual incide sobre el resultado de las políticas públicas implementadas evidenciando a su vez que no han sido tan efectivas como se plantearon. Además, se identifican oportunidades en algunos programas implementados en el Quindío que pueden fortalecerse aplicando un enfoque conductual. Finalmente, se dan una serie de recomendaciones de política pública basadas en estudios realizados por el BID y el Banco Mundial, así como en los requerimientos o necesidades expresadas por las mujeres rurales entrevistadas, que pueden contribuir a reducir la pobreza feminizada en el Quindío y mejorar la eficacia y los resultados de otras políticas en el departamento y otras regiones del país.This research explores the barriers and catalysts that affect the decision-making capacity of rural women in Quindío to participate or not in governmental programs, influencing the outcome of public policies. The purpose is contributing to public innovation processes, through a first approach to the application of behavioral sciences in the design, implementation, and evaluation of public policies in Colombia that seek to reduce gender inequalities. To this end, it is proposed as a starting point the experiences and lessons learned in the field in different countries of Latin America, as well as the trends and patterns found in the interviews conducted in this research with 10 rural women from Quindío. The main results suggest that there is indeed an impact on the decision-making capacity of rural women due to behavioral barriers associated with social norms of gender and gender roles, as well as other structural barriers, which affects the result of the public policies implemented, showing in turn that they have not been as effective as they were proposed. In addition, opportunities are identified in some programs implemented in Quindío that can be strengthened by applying a behavioral approach. Finally, a series of public policy recommendations are given based on studies conducted by the IDB and the World Bank, as well as on the requirements or needs expressed by the rural women interviewed, which can contribute to reducing feminized poverty in Quindío and improve the effectiveness and results of other policies in the department and other regions of the country.Magíster en Políticas PúblicasMaestrí

    La Biopolítica de la Deuda: Relación Acreedor-deudor

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    La  sociedad actual está inmersa en la economía de la deuda, entendida ésta en palabras de Lazzarato (2013),  como una promesa de reembolso en un futuro más o menos lejano pero siempre imprevisible. “El crédito o deuda y su relación acreedor-deudor constituyen una relación de poder específica que implica modalidades específicas de producción y control de la subjetividad (una forma particular de homo oeconomicus, el “hombre endeudado”)” (Lazzarato, 2013, p. 36).Los préstamos   se han convertido en la  acceder una formación profesional, en la nueva forma de financiación de sus carreras, Biopolitica de la gestión de su fuerza productiva  pues  ya "Michel Foucault, a través del concepto de biopolítica, nos había anunciado desde los años setenta lo que hoy día va haciéndose evidente: la "vida" y lo "viviente" son los retos de las nuevas luchas políticas y de las nuevas estrategias económicas. En la actualidad los créditos universitarios se han configurado como la principal fuente de financiación de los estudios profesionales, siendo el endeudamiento la nueva realidad en la vida de los jóvenes. “La llamada “financiación” constituye no tanto una modalidad de financiamiento de las inversiones, sino un enorme dispositivo de gestión de la deudas privadas y públicas y, por ende, de la relación acreedor-deudor, gracias a las técnicas de titulización” (Lazzarato, 2013, p. 28-29). Palabras Claves: Biopolítica, Acreedor – Deudor,  Pedagogía de la deuda, subjetividad

    Verdad y afectaciones a la infraestructura petrolera durante el conflicto armado

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    Durante cinco meses, la Fundación Ideas para la Paz (FIP)* con el apoyo de la Consultoría para los Derechos Humanos y el Desplazamiento, CODHES, recogió y analizó el impacto que dejaron los atentados a la infraestructura petrolera en Colombia por más de tres décadas, así como a las comunidades que viven en el entorno de los oleoductos. Resultado de esa investigación, se construye el informe, el cual describe las acciones armadas y afectaciones a la infraestructura petrolera en Colombia en el marco del conflicto armado a lo largo de treinta años. Su propósito es brindar herramientas analíticas a la Comisión para el Esclarecimiento de la Verdad, la Convivencia y la No Repetición para el cumplimiento de su mandato. De igual forma, presenta y analiza datos sobre hechos contra la infraestructura petrolera entre el 1 de mayo de 1986 y el 24 de noviembre de 2016 a nivel nacional, con un énfasis en las áreas de influencia de los oleoductos Caño Limón-Coveñas y Trasandino. Para el efecto, se describen tendencias, responsables, modalidades de ataques y consecuencias diferenciadas de los actos contra la infraestructura petrolera. Igualmente, y como forma de destacar las consecuencias humanas de estos eventos, el informe recoge las historias de vida de diez personas y los impactos individuales, familiares, sociales y laborales que éstas sufrieron como consecuencia de los hechos violentos contra las principales infraestructuras petroleras del país
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