Evidence of spatial clustering of childhood acute lymphoblastic leukemia cases in Greater Mexico City: report from the Mexican Inter-Institutional Group for the identification of the causes of childhood leukemia

BackgroundA heterogeneous geographic distribution of childhood acute lymphoblastic leukemia (ALL) cases has been described, possibly, related to the presence of different environmental factors. The aim of the present study was to explore the geographical distribution of childhood ALL cases in Greater Mexico City (GMC).MethodsA population-based case-control study was conducted. Children <18 years old, newly diagnosed with ALL and residents of GMC were included. Controls were patients without leukemia recruited from second-level public hospitals, frequency-matched by sex, age, and health institution with the cases. The residence address where the patients lived during the last year before diagnosis (cases) or the interview (controls) was used for geolocation. Kulldorff’s spatial scan statistic was used to detect spatial clusters (SCs). Relative risks (RR), associated p-value and number of cases included for each cluster were obtained.ResultsA total of 1054 cases with ALL were analyzed. Of these, 408 (38.7%) were distributed across eight SCs detected. A relative risk of 1.61 (p<0.0001) was observed for the main cluster. Similar results were noted for the remaining seven ones. Additionally, a proximity between SCs, electrical installations and petrochemical facilities was observed.ConclusionsThe identification of SCs in certain regions of GMC suggest the possible role of environmental factors in the etiology of childhood ALL

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

La implementación de políticas nacionales y sectoriales en el nivel regional: un análisis neoinstitucional

Identifica los principales elementos de los arreglos institucionales que posibilitan una implementación de políticas nacionales o sectoriales con un bajo nivel de conflicto intergubernamental. Dicha implementación constituye una forma de generar valor público, de acuerdo a los planteamientos del profesor Mark Moore. La tesis tiene cuatro capítulos. El primero define el marco teórico y la metodología de investigación empleada, enfatizando la relación existente entre los principales postulados de la teoría neoinstitucional y aquella correspondiente a la creación de valor público para terminar exponiendo la metodología empleada para la tesis. El segundo capítulo expone el proceso de descentralización peruano y como este se encuentra inmerso en el contexto de la teoría neoinstitucional. Se detallarán los antecedentes del actual proceso así como el diseño del proceso de descentralización vigente. El tercer capítulo revisa el marco jurídico y conceptual correspondiente a las políticas nacionales y sectoriales en el Perú, enfatizando los diferentes enfoques y la tipología existente para su caracterización, considerando el marco normativo vigente actualmente sobre la materia. El cuarto capítulo desarrolla la relevancia de la reducción del nivel de conflicto intergubernamental en la implementación de políticas nacionales y sectoriales. Para ello se expone una definición de conflicto intergubernamental así como los actores vinculados. A manera de conclusiones se incluyen reflexiones específicas sobre las materias desarrolladas, así como determinadas recomendaciones de ajuste normativo que proponemos sean consideradas para su progresiva aprobación e implementación en los procesos de mejora institucional de cada entidad subnacional.Tesi

Derecho Administrativo-DE09-201800

El curso de la especialidad en la carrera de Derecho de carácter teórico dirigido a los estudiantes del quinto ciclo busca desarrollar la competencia general comunicación escrita y la competencia específica investigación jurídica El curso abarca el estudio de la Administración Pública entelequia conceptual que engloba todas aquellas manifestaciones del Derecho por medio de las cuales el Estado y sus distintos órganos establecen relaciones jurídicas con los ciudadanos relaciones jurídicas entre instituciones y relaciones jurídicas al interior de ellos mismos.Los estudiantes podrán obtener una aproximación casuística de los efectos que la actuación de la Administración Pública puede producir en los particulares y sus implicancias para la realización de actividades económicas en general

Organización Del Estado-DE238-201700

El curso de especialidad en la carrera de Derecho es de carácter teórico dirigido a los estudiantes del cuarto ciclo busca desarrollar la competencia general ciudadanía y competencia específica perspectiva local y global ya que el estudiante conocerá sobre la realidad nacional e internacional.Se identifica y analiza las instituciones que conforman el Estado Peruano sus características y su funcionamiento así como sus mecanismos de coordinación interrelación y complementariedad además se analiza la estructura y organización del Estado Peruano a partir de preceptos contenidos en nuestro marco constitucional y la doctrina relacionada. Sobre la base de esto el estudiante podrá desempeñarse con naturalidad en cualquier entidad del Estado