Propuesta de mejora para la red de infraestructura logística del occidente de Risaralda

144 páginasEste trabajo tiene como objetivo sugerir una metodología y modelo de simulación que permita evidenciar el impacto de la inversión en la red logística y la infraestructura, en el desarrollo humano y calidad de vida de los habitantes de una región. Para hacerlo, se parte de la realización de una contextualización socioeconómica rigurosa de la zona de estudio, que en el caso este trabajo está conformada por 11 municipios del occidente de Risaralda. Luego se procede a proponer alternativas de mejora para la red logística de la región y se elige el Índice de Desarrollo Humano como variable de desempeño de la calidad de vida de un territorio, teniendo en cuenta tres dimensiones: la economía, la salud y la educación. El modelo se realiza por medio de la técnica de dinámica de sistemas, que permite simular relaciones entre las variables, que fueron establecidas por medio de la búsqueda de información en casos de estudio similares y de la realización de regresiones a partir de datos históricos del comportamiento de las dimensiones del desarrollo humano en la zona. Finalmente, se realiza una evaluación de las alternativas propuestas, simulando su efecto sobre el índice de desarrollo humano en 15 años y haciendo un análisis de sensibilidad del impacto de la inversión en diferentes rubros sobre el mismo. Como principal resultado y conclusión del trabajo, se observa como el desarrollo humano no se da, si se invierte en solo una de sus dimensiones. Es necesario invertir en corredores de transportes que impulsen la economía y conecten los recursos de una región; pero también es importante no descuidar la inversión en infraestructura de salud, educación y acceso a servicios públicos como agua, gas y energía; especialmente ante el aumento progresivo de la población, que tiende a disminuir la cobertura y el acceso a los recursos si no se ejecutan acciones para evitarlo.PregradoIngeniero(a) Industria

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