Relaciones intergubernamentales y factores contextuales: un estudio comparativo de tres municipios: un análisis de la implementación de la Política Pública de Atención Integral a la Primera Infancia

El presente trabajo describe y analiza cómo los factores contextuales inciden en las relaciones intergubernamentales (RIG) y cómo los distintos tipos de estas relaciones viabilizan u obstruyen el desarrollo de una política pública, en este caso la de atención integral a la primera infancia -- Los factores contextuales constituyen el trasfondo total de un entorno, son elementos fundamentales, para este estudio comparado se tomaron factores como la capacidad técnica, financiera y del Estado -- Este trabajo partió de la hipótesis de que los factores contextuales inciden en los tipos de RIG, produciendo variaciones en los tipos de relación intergubernamental que pueden sostener los municipios con otros niveles de gobierno, para lo cual se revisaron tres casos que fueron seleccionados a través del método Milliano de máxima diferencia -- Este análisis mostró que cuando los factores contextuales ya mencionados, tienen niveles críticos o bajos producen un tipo de RIG conocida como Donante-Receptor, en la que los recursos y el diseño de los programas dependen del nivel central, pero la capacidad de gestión está determinada por los factores contextuales del mismo municipio -- Por el contrario, el caso del municipio con niveles contextuales altos mostró que el tipo de RIG encontrado fue el de dispersión ya que se encontraron situaciones como la existencia de iniciativas superpuestas en relación a las del nivel central -- En ambos casos, se puede ver un modelo delegativo que se encuentra en la mayoría de municipios de Colombia, el cual implica que los resultados de una política dependen de la implementación local, con lo cual son los factores contextuales de los mismos municipios, los determinantes en el desarrollo de una política pública ante la existencia de RIGs delegativa

Inappropriate antibiotic use in the COVID-19 era: Factors associated with inappropriate prescribing and secondary complications. Analysis of the registry SEMI-COVID

Background: Most patients with COVID-19 receive antibiotics despite the fact that bacterial co-infections are rare. This can lead to increased complications, including antibacterial resistance. We aim to analyze risk factors for inappropriate antibiotic prescription in these patients and describe possible complications arising from their use. Methods: The SEMI-COVID-19 Registry is a multicenter, retrospective patient cohort. Patients with antibiotic were divided into two groups according to appropriate or inappropriate prescription, depending on whether the patient fulfill any criteria for its use. Comparison was made by means of multilevel logistic regression analysis. Possible complications of antibiotic use were also identified. Results: Out of 13,932 patients, 3047 (21.6%) were prescribed no antibiotics, 6116 (43.9%) were appropriately prescribed antibiotics, and 4769 (34.2%) were inappropriately prescribed antibiotics. The following were independent factors of inappropriate prescription: February-March 2020 admission (OR 1.54, 95%CI 1.18-2.00), age (OR 0.98, 95%CI 0.97-0.99), absence of comorbidity (OR 1.43, 95%CI 1.05-1.94), dry cough (OR 2.51, 95%CI 1.94-3.26), fever (OR 1.33, 95%CI 1.13-1.56), dyspnea (OR 1.31, 95%CI 1.04-1.69), flu-like symptoms (OR 2.70, 95%CI 1.75-4.17), and elevated C-reactive protein levels (OR 1.01 for each mg/L increase, 95% CI 1.00-1.01). Adverse drug reactions were more frequent in patients who received ANTIBIOTIC (4.9% vs 2.7%, p < .001). Conclusion: The inappropriate use of antibiotics was very frequent in COVID-19 patients and entailed an increased risk of adverse reactions. It is crucial to define criteria for their use in these patients. Knowledge of the factors associated with inappropriate prescribing can be helpful

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care