Evaluación de la calidad bacteriológica de agua de consumo almacenada, de los pobladores de los pobladores del sector los Marenco, Comunidad Marvin Corrales, municipio de San Marcos, Carazo Noviembre 2021

El agua potable es un recurso indispensable debido que influye directamente en la salud, consumir agua no potable o con deficiencias higiénico-sanitarias puede ocasionar transmisión de enfermedades. En el sector Marvin Corrales de San Marcos, Carazo se ubica el barrio Los Marencos; este barrio cuenta con un pozo perteneciente a la empresa ENACAL, pero no cuenta con un sistema de tuberías que facilite el abastecimiento a cada vivienda; por esta circunstancia los pobladores viajan hasta el pozo para obtener el agua y deben almacenarla durante días. Se realizó un estudio descriptivo de corte transversal, con el objetivo de evaluar la calidad bacteriológica del agua de consumo almacenada de la población en estudio mediante el método de NMP. La muestra estuvo comprendida por 40 muestras de agua (correspondiente al 58% del universo) procedentes de 40 viviendas y 2 muestras extraídas del pozo utilizadas como control. Obteniéndose los siguientes resultados: El 75 % de las muestras tenían un pH 7.0 considerado óptimo, el 17.5% tenían pH 6.0 considerado fuera del rango aceptable y 7.5 % restante un pH 8.0 considerado aceptable. El 97.5 % de las muestras analizadas tenían presencia de coliformes totales debido a factores ambientales y condiciones higiénico sanitarias deficientes. Así mismo, un 95% de las muestras estaban positivas para el indicador coliformes fecales y en relación a la presencia de Escherichia coli se obtuvo que un 65 % tenían presencia. Se logró evaluar la calidad bacteriológica del agua en estudio evidenciando que existe contaminación de esta, ligada a las condiciones de acarreo y almacenamiento, en donde intervienen hábitos higiénico sanitarios inadecuados que pueden favorecen la transmisión de enfermedades por patógenos intestinales. Por tanto, nuestras recomendaciones principales son para ENACAL y Ministerio de Salud, brindarle a la comunidad capacitación sobre cloración del agua, así mismo gestionar proyecto para implementar el sistema de tuberías para agua potable a cada viviend

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

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

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

Turkey age : escuela de teatro

El trabajo obtuvo un Premio Tomás García Verdejo a las buenas prácticas educativas en la Comunidad Autónoma de Extremadura para el curso 2020/2021. Modalidad BSe describe un proyecto llevado a cabo en el IES Bioclimático y el IES San Roque, ambos de Badajoz, cuyo objetivo principal era atender al alumnado de altas capacidades o con talento/alto rendimiento, mediante la creación de una escuela de teatro en inglés. Otros objetivos de la iniciativa fueron: fomentar el interés por la investigación e innovación utilizando las nuevas tecnologías de la información y comunicación; estimular el potencial de aprendizaje del alumnado participante para el enriquecimiento común contribuyendo al fomento de la igualdad entre hombres y mujeres; aprovechar el teatro como una forma innovadora para el aprendizaje del inglés; ofrecer procedimientos para la mejora del rendimiento escolar y el éxito educativo, la integración social y la reducción de la tasa de fracaso escolar y abandono escolar de estos alumnos; fomentar la investigación, la lectura y la escritura en lengua inglesa; facilitar espacios colaborativos; contribuir a la adquisición de valores como la responsabilidad, la solidaridad, etc. y promover la participación de la comunidad educativaExtremaduraES

Los estudios del territorio en perspectiva de la geografía escolar

“Los estudios del territorio en perspectiva de la geografía escolar”, título del presente libro donde se recogen algunos de los textos presentados en la IV Convención Nacional de Educación Geográfica, organizada por la Universidad de Córdoba y la Universidad de Antioquia. Evento académico en el cual se dio el encuentro de docentes de geografía y ciencias sociales para conversar sobre los retos de la educación geográfica en el país y en particular acerca de las reflexiones y experiencias dadas en los procesos de enseñanza de esta disciplina escolar.Presentación 15Capítulo 1. Territorialidades educativas y educaciones geográficas 23Capítulo 2. Desarrollos recientes de las didácticas críticas para una geografía escolar comprometida socialmente: reflexiones desde una práctica pedagógica. 43Capítulo 3. El espacio de la educación: cuatro proposiciones desde el pensamiento clásico 67Capítulo 4: El enfoque cualitativo en la innovación de la didáctica de la geografía 91Capítulo 5: Resistência, território e ensino de Geografia: um debate sobre práticas e saberes escolares fundamentados no engajamento social 115Capítulo 6: Lectura del territorio con líderes comunitarios. Oportunidades de una ciudadanía territorial 139Capítulo 7. Imágenes mentales del territorio en la formación docente de ciencias sociales 161Capítulo 8. Perspectivas dialécticas sobre: territorio usado, lugar y espacio público – privado; categorías de análisis indispensables en la enseñanza de la geografía escolar 185Capítulo 9. Educación geográfica para los futuros profesionales en Planeación y Desarrollo Social y su quehacer desde la perspectiva territorial 205Capítulo 10. Implicaciones del discurso de la paz territorial para la educación 227Capítulo 11. Del necesario abordaje ético del territorio en el trabajo con comunidades víctimas del conflicto armado 245Capítulo 12. Otra mirada al paisaje en la educación rural 277Capítulo 13. Percepciones de las transformaciones paisajísticas dadas en las ciénagas del municipio de San Carlos a partir de la cartografía social. 295Capítulo 14. El paisaje, más allá de la imagen: apuestas para generar valores éticos y estéticos en la enseñanza de la geografía 319Capítulo 15. La imagen en la enseñanza de la geografía escolar y la construcción del pensamiento crítico 345Capítulo 16. La metamorfosis del paisaje desde un barrio mirador. Posibilidad de aprender y enseñar la ciudad en lo cotidiano 359Capítulo 17. Estudio del paisaje en La Mojana desde la percepción de las comunidades. Aportes para la enseñanza de la geografía. 379Capítulo 18. Las Olimpiadas Universitarias del Conocimiento del área de Geografía en la Universidad Nacional Autónoma de México 393Capítulo 19. Los aportes de la cartografía social a la educación para la paz en las instituciones educativas. 421Capítulo 20. Formar pensamiento crítico desde la enseñanza de la geografía mediante el estudio del medio geográfico rural. 441Capítulo 21. Formación en didáctica de la geografía desde el semillero de investigación 463Capítulo 22. Geografía escolar una pedagogía de la memoria 483Capítulo 23. Monumentos con pies: la interacción en el Centro de la ciudad 505Capítulo 24. La ciudad y su ambiente. Un abordaje a partir de la salida de campo 52

3er. Coloquio: Fortalecimiento de los Colectivos de Docencia

Las memorias del 3er. Coloquio de Fortalecimiento de Colectivos de Docencia deben ser entendidas como un esfuerzo colectivo de la comunidad de académicos de la División de Ciencias y Artes para el Diseño, en medio de la pandemia COVID-19, con el fin de: • Analizar y proponer acciones concretas que promuevan el mejoramiento de la calidad docente en la División. • Proponer acciones que permitan continuar fortaleciendo los cursos con modalidad a distancia (remotos). • Ante un escenario que probablemente demandará en el mediano plazo, transitar del modelo remoto a un modelo híbrido, proponer acciones a considerar para la transición de los cursos. • Planear y preparar cursos de nivelación de conocimientos, para cuando se transite a la impartición de la docencia de manera mixta o presencial, dirigidos a los alumnos que no hayan tenido oportunidad de desarrollar actividades relevantes para su formación, como prácticas de talleres y laboratorios, visitas, o alguna otra actividad relevante

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

Risk of COVID-19 after natural infection or vaccinationResearch in context

Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health