El paisaje cultural en el territorio poblano-tlaxcalteca

La ponencia “El Paisaje Cultural en el Territorio Poblano-Tlaxcalteca”, presenta un avance de la investigación del mismo nombre que está en proceso de desarrollo y conclusión. La presente es una propuesta para el estudio y análisis del Paisaje Cultural, mediante la identificación y caracterización de las unidades que conforman el territorio poblano-tlaxcalteca. El trabajo de campo utiliza una ficha de registro para identificar las unidades del paisaje (lectura individual); una vez identificadas se realiza la caracterización en conjunto, para tener la lectura y el conocimiento de la situación actual del Paisaje del valle Poblano-Tlaxcalteca (problemática y tendencia). Finalmente se enlistan una serie de estrategias y propuestas para contribuir al mejoramiento y conservación de las unidades del Paisaje Cultural. La experiencia recabada nos ha permitido comprender que el paisaje cultural se conserva con sus características propias siempre que los habitantes de cada lugar participen en la construcción de su espacio, y pongan en valor lo propio: su historia, herencia y tradición, sus expresiones tangibles e intangibles y aseguren su vocación natural, siempre reconociendo y respetando la diversidad cultural, entendida como el cúmulo armónico de los elementos locales con los cuales se fortalecen sus raíces, identidad, cohesión social y participación

Defense of Puebla World Heritage by its people and communities.

Depto. de Prehistoria, Historia Antigua y ArqueologíaFac. de Geografía e HistoriaTRUEMinisterio de Economía y Competitividad (MINECO)pu

Skills for Preventive Medicine and Public Health: Proposal after a comparative and participative approach

Parte de este trabajo fue presentado en la XXXV Reunión Científica de la Sociedad Española de Epidemiología y XII Congresso da Associação Portuguesa de Epidemiologia celebrada el 6 de septiembre de 2017 en Barcelona, en formato póster, con el título «Competencias de la especialidad medicina preventiva y salud pública: una nueva visión». También en el XIX Congreso Nacional y VIII Internacional de la SEMPSPH celebrado en Valencia el 16 de mayo de 2017 fue presentado en la ponencia titulada «Pasado, presente y futuro de la formación MIR».[ES] Introducción: El desarrollo normativo de la Ley 44/2003, a través del Real Decreto 639/2014, inició el proceso de reorganización de la Formación Sanitaria Especializada (FSE). El objetivo de este trabajo es elaborar una propuesta de competencias específicas para la especialidad de Medicina Preventiva y Salud Pública mediante un análisis comparado y proceso participativo. Métodos: Cuatro fases: 1) análisis y extracción de competencias de documentación de organismos oficiales; 2) consulta dirigida a personas clave; 3) consulta abierta a residentes y personas implicadas en la FSE, y 4) difusión a la Comisión Nacional de la Especialidad y público general. Resultados: 1) Se extrajeron 543 competencias y 67 categorías de 7 fuentes primarias (Austria, Canadá, ECDC, Estados Unidos, Francia, Reino Unido y OPS). Se produjeron 126 competencias en 12 categorías. 2) Participaron 10 personas clave, 64 competencias fueron modificadas, 10 eliminadas y 9 nuevas. 3) Hubo 32 respuestas: 132 competencias en 12 categorías. Propuesta final: 145 competencias en 21 categorías, organizadas en 3 bloques: competencias genéricas, técnicas y específicas. Conclusión: La propuesta final es producto de la participación de residentes y personas implicadas en la FSE, partiendo del actual marco y del análisis del desarrollo de la especialidad en el contexto internacional. Se han incorporado conceptos presentes en países de nuestro entorno y cercanos a la práctica. [EN] Introduction: The Royal Decree 639/2014 (‘Core Curriculum’ Decree) has amongst its objectives to modify Specialist Training in Medicine Disciplines. The aim of this project is to elaborate a proposal of specific skills for the specialty of Preventive Medicine and Public Health using a comparative and participative approach. Methods: 1) Comparative analysis of documents published by official institutions; 2) consultation with key informants; 3) open consultation with residents and trainers, and 4) presentation to the National Commission of the Specialty and the general public. Results: 1) 126 competencies were found in 12 categories. 2) 10 key informants, 64 skills modified, 10 removed, and 9 added; 3) 32 responses the first draft contained 132 skills in 12 categories. The final proposal included 145 skills in 21 categories, classified into 3 areas: generic, technical, and specific skills. Conclusion: The final proposal is the product of participation of residents and individuals involved in specialised training, starting from the current framework and international context analysis. Concepts present in countries in this field and close to our professional activity have been included.S

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

Cultural Landscape; an approach to bullid security

This paper emphasizes the important role of local governments to build security through a different approach to urban design. Reconsidering the importance of developing public spaces and social capital,\ua0local governments may design its policies based on the cultural landscape approach. This approach\ua0considers different elements from landscape as a whole instead of designing projects or isolated\ua0specific interventions, contributing to create the public spaces and social capital needed to help\ua0preventing violence and crime

Switching TNF antagonists in patients with chronic arthritis: An observational study of 488 patients over a four-year period

The objective of this work is to analyze the survival of infliximab, etanercept and adalimumab in patients who have switched among tumor necrosis factor (TNF) antagonists for the treatment of chronic arthritis. BIOBADASER is a national registry of patients with different forms of chronic arthritis who are treated with biologics. Using this registry, we have analyzed patient switching of TNF antagonists. The cumulative discontinuation rate was calculated using the actuarial method. The log-rank test was used to compare survival curves, and Cox regression models were used to assess independent factors associated with discontinuing medication. Between February 2000 and September 2004, 4,706 patients were registered in BIOBADASER, of whom 68% had rheumatoid arthritis, 11% ankylosing spondylitis, 10% psoriatic arthritis, and 11% other forms of chronic arthritis. One- and two-year drug survival rates of the TNF antagonist were 0.83 and 0.75, respectively. There were 488 patients treated with more than one TNF antagonist. In this situation, survival of the second TNF antagonist decreased to 0.68 and 0.60 at 1 and 2 years, respectively. Survival was better in patients replacing the first TNF antagonist because of adverse events (hazard ratio (HR) for discontinuation 0.55 (95% confidence interval (CI), 0.34-0.84)), and worse in patients older than 60 years (HR 1.10 (95% CI 0.97-2.49)) or who were treated with infliximab (HR 3.22 (95% CI 2.13-4.87)). In summary, in patients who require continuous therapy and have failed to respond to a TNF antagonist, replacement with a different TNF antagonist may be of use under certain situations. This issue will deserve continuous reassessment with the arrival of new medications. © 2006 Gomez-Reino and Loreto Carmona; licensee BioMed Central Ltd