De la prevención a la promoción cultural: acciones pedagógicas en contextos de consumo problemático de drogas

La mejor forma de prevenir el abuso de las drogas es no ocuparse de las drogas en sí, sino de todo lo demás: el hueco social en que la droga se instala señalando con su presencia otras carencias. Este corrimiento conceptual, desde la droga hacia lo que subyace al consumo en la persona y su grupo social, es el punto de partida de la prevención como promoción, como elemento constitutivo de la educación social. Así, como educadores, es posible tomar distancia de la prevención y proponer acciones de promoción de conductas saludables; de desarrollo de capacidades autónomas; de construcción de sentidos de pertenencia; de rescate de lazos de solidaridad. Alentando la participación con miras a producir cambios de comportamientos y hábitos que posibiliten un mejor nivel de vida. El problema no es sólo de los que consumen, sino que se requiere una lectura que exceda el marco de lo individual para referenciarlo en las condiciones sociohistóricas en las que el consumo se produce. Este trabajo pretende dar cuenta de una propuesta de acción pedagógica en el campo de la articulación educación no formal – educación formal, en tanto refiere a la capacitación docente en la temática de las problemáticas sociales, específicamente, del uso problemático de drogas. El trabajo toma como antecedente directo la práctica profesional que desarrollo en el tema y reflexiona críticamente sobre esa práctica e intenta mejorarla y superarla, elaborando un dispositivo integral en el abordaje de la temática, desde la mirada de la Pedagogía Social. En este marco, presentamos una propuesta de acción pedagógica desarrollada desde la Dirección de Coordinación Institucional y Planificación de la Superintendencia de Investigaciones de Drogas Ilícitas del Ministerio de Justicia y Seguridad de la Provincia de Buenos Aires. No cabe duda de la importancia que tienen las grandes políticas que deben abordar esta problemática, pero tanto o más importantes son aquellos esfuerzos que se llevan a cabo día a día en las distintas instituciones, para evitar el desenganche de aquellos que están en relación con el uso problemático de drogas. Se torna ineludible, una mirada que asuma la necesidad y la especificidad de la acción pedagógica en esta problemática y la torne relevante en contextos educativos. Docentes, agentes escolares y extraescolares, construyen cotidianamente acciones como pueden y hasta donde les resulta posible, abriéndose paso entre el mandato redentor y la opción de no ver.Facultad de Humanidades y Ciencias de la Educació

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit