Planeamiento estratégico de la industria de las bebidas alcohólicas destiladas en Colombia

La principal característica de la industria de bebidas alcohólicas destiladas en Colombia es que está compuesta en su gran mayoría por empresas de propiedad de los departamentos, dichas empresas controlan más del 85% del mercado, participación que han logrado gracias a las restricciones que sobre la producción y comercialización se han impuesto bajo el amparo del monopolio rentístico creado por la Constitución Política desde hace más de 100 años; sin embargo, a pesar del monopolio, la industria ha mantenido altos niveles de competencia entre cada uno de sus actores, lo que ha dado como resultado la consolidación de algunos productores, y casi la desaparición de otros. Desde el año 1991 y en particular durante la última década, el mercado anteriormente dominado 100% por las empresas estatales, comenzó a ser atacado por otra variedad de productos destilados importados, que paulatinamente han ganado participación. El ingreso de los destilados importados, el aumento del consumo de bebidas vínicas, así como el consumo de cervezas, son retos cada vez mayores para la industria de bebidas alcohólicas destiladas, cuyas estrategias se deben encaminar a lograr el aumento de su participación en el mercado de la bebidas alcohólicas en general, así como el desarrollo de nuevos mercados externos. Colombia ha entrado en una etapa en la cual se vienen negociando diferentes tratados de libre comercio, sin contar con los que ya están firmados y en ejecución, en donde a pesar de que se establecieron unas salvaguardas para la industria, estás no son mayores a 10 años, plazo que tiene la industria para implementar las estrategias necesarias para la consolidación y expansión de la misma, y de esta forma poder estar preparada ante estas nuevas circunstancias del mercado. Este plan estratégico plantea unos objetivos de largo plazo que buscan el fortalecimiento de la industria mediante el mejoramiento de las políticas financieras, de los procesos productivos, del desarrollo de nuevos mercados y de la expansión de los mercados existentes, del desarrollo de nuevos productos y nichos, así como la adopción de una filosofía de responsabilidad social por parte del sector. A partir de estos objetivos se plantean unas estrategias específicas, las cuales con la debida implementación y seguimiento por parte de los actores, y con el compromiso y el apoyo continuo por parte de la Asociación de Industrias Licoreras (ACIL), conducirán a la Industria de Bebidas Alcohólicas Destiladas a obtener una posición más solida en el mercado nacional, y una participación importante en los mercados mundiales, que aseguraran la existencia y rentabilidad del sector.The main feature of alcoholic beverage distilled in Colombia industry is that it is composed mostly by businesses owned departments, these companies control more than 85% of the market, participation that have been achieved thanks to the restrictions on the production and marketing have been imposed under the aegis of the ranking monopoly created by the Constitution since more than 100 years; however, in spite of the monopoly, the industry has maintained high levels of competition between each of his actors, what has resulted the consolidation of some producers, and almost the disappearance of others. Since 1991 and in particular during the last decade, market dominated 100% State owned enterprises, previously began to be attacked by another variety of imported distilled products, which have gradually gained participation. The income of imported spirits, the increase in drinking wine, as well as the consumption of beer, are challenges distilled ever increasing for the alcoholic beverage industry, whose strategies must be routed to the increase of its participation in the market for spirits in general, as well as the development of new markets. Colombia has entered a stage in which various free trade agreements, are negotiating without those who are already signed and in execution, in where while were established some safeguards for the industry, these are no older than 10 years, are term that has the industry to implement the necessary strategies for the consolidation and expansion of the Industry, and thus to be prepared under these new circumstances in the market. This strategic present some long-term goals that look forward to seeking to strengthen the industry by improving the financial policies of the production processes, development of new markets and the expansion of existing markets, the development of new products and niches, as well as the adoption of a philosophy of social responsibility by the sector. From these objectives arise about specific strategies, which with the due implementation and follow-up by the actors, and with the commitment and continuous support by liquor Industries Association (ACIL), will lead to the distilled alcoholic beverage industry to get a stronger position in the domestic market, and a major role in global markets to ensure the existence and profitability of the sector.Tesi

Consenso colombiano de enfermedad inflamatoria intestinal

La Enfermedad inflamatoria intestinal (EEI) es un término con el que se conocen varias entidades, las dos más importantes: la colitis ulcerativa idiopática (CUI) y la enfermedad de Crohn (EC), cuyo origen es multifactorial y se caracterizan por un fenómeno inflamatorio, crónico, recurrente, con diferentes grados de severidad del tubo digestivo; pero, además con afectación potencial de otros órganos. En la última década ha habido un renovado interés en dichas entidades, debido a un auge en medicamentos novedosos; a pesar de lo cual estas siguen siendo incurables. Lo anterior asociado a una incidencia creciente de dicha patología en nuestro país nos obliga tanto científica como moralmente a convocar a un panel de expertos para elaborar unos lineamientos básicos en el enfoque y manejo de la EEI. OBJETIVOS 1. Desarrollar un consenso adaptado a nuestro medio, basado en documentación científica de la mejor calidad disponible para el enfoque diagnóstico y el manejo médico y quirúrgico. 2. Publicar y difundir dichos lineamentos tanto a la comunidad científica como al público en general a través de foros especializados, y medios de comunicación de alta penetración. 3. Elaborar y divulgar el consenso en forma de suplemento de la Revista Colombiana de Gastroenterología, el 8 de diciembre de 2011, en medio del congreso de ACADI (Asociación Colombiana de Asociaciones del Aparato Digestivo); es el mejor homenaje que el panel multidisciplinario de expertos le puede rendir a dicho evento; pero más importante aún es el reconocimiento que se le hace a los pacientes que padecen de dicha patología en nuestro país, quienes en últimas son nuestra razón de ser. METODOLOGÍA 1. Se invitaron médicos especialistas (Clínicos y quirúrgicos), líderes de opinión e industria farmacéutica nacional, cuyo área de interés y de trabajo es la EEI. 2. Se separó y manejó independientemente desde el principio la CUI de la EC. A su vez, se dividió cada entidad por módulos, con base en el método de panel de Delphi, se nombró un coordinador por cada uno de ellos, el cual se encargó de analizar junto con su equipo la literatura, para extraer el nivel de evidencia clínica y así emitir unos conceptos preliminares. Posteriormente, todo el panel de expertos se reunió en varias jornadas y conjuntamente se revisó nuevamente la evidencia clínica y conclusiones de los diferentes módulos homogenizándolas y de una manera concertada se formularon las recomendaciones definitivas.Q4https://orcid.org/0000-0002-9219-4548Revista Nacional - Indexad

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Sistema de información georeferenciado

IP 7105-07-005-93LIBRO(S): Analisis de los sistemas agropecuarios del departamento de Nortede Santander / Hernando Mendez;Aldana..(et al.) -- Analisis de los sistemas agropecuariosdeldepartamento de Santander / Hernando Mendez;Aldana -- Analisis agroecologico y caracterizacion de losagroecosistemasde los departamentos de Atlantico;Bolivar, Cordoba y Sucre / Fernando Villamizar Rosas ..(etal.)'-- Analisis agroecologico y caracterizacion de;los agroecosistemas de los departamentos de Amazonas, Caqueta,Guainia, Putumayo y Vaupes / Fernando;Villamizar Rosas..(et al.) -- Analisis agroecologico y caracterizacion delos agroecosistemas de los;departamentos de Huila y Tolima / Fernando Villamizar..(etal.)'-- Analisis agroecologico y caracterizacion de;los agroecosistemas de los departamentos de Cesar, Guajiray Magdalena --Estructura de la produccion;agropecuaria de la region Tolima, Huila y Suroccidente deCundinamarca / Diego Miranda..(et. al.

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN