Sostenibilidad de la agricultura familiar: el caso del cultivo de granadilla (Passiflora ligularis Juss) en la provincia de Oxapampa, Pasco, Perú

Universidad Nacional Agraria La Molina. Escuela de Posgrado. Doctorado en Agricultura SustentableEl cultivo de granadilla (Passiflora ligularis Juss.) tiene importancia socio-económica y ambiental en la Provincia de Oxapampa - Perú. Este estudio tuvo como objetivo caracterizar, tipificar, evaluar la sostenibilidad y realizar un análisis económico del sistema productivo de granadilla, en un contexto de agricultura familiar. La caracterización se realizó a través del ACP y la tipificación de acuerdo al análisis cluster. Para la evaluación de la sostenibilidad se utilizó dos metodologías; el marco metodológico MESMIS y el Análisis Multicriterio de Sarandón. Se analizó rendimiento y precio mediante el modelo AMMI con la finalidad de medir la escala temporal del sistema. La caracterización y tipificación de las fincas permitió identificar cuatro Componentes Principales. El análisis cluster permitió tipificar tres grupos de fincas que difieren entre sí, pero que de acuerdo al tamaño de parcela se clasifican como pequeños agricultores. Los valores de Sostenibilidad de acuerdo al método MESMIS es Moderadamente Sostenible con un valor de 4.6, mientras que el ISGen de acuerdo a Sarandón, es Potencialmente Sostenible con un valor de 6.2. Adicionalmente, la producción de granadilla es rentable a tres tazas de actualización (8%, 12% y 14%), tiene un Punto de Equilibrio (P.E.) igual a 4 151 kg (346 cajones/ha), y un B/C> 1 de 1.25, 1.21 y 1.20. Para la campaña 2017-2018 se registró un total de 1520 ha de granadilla cosechadas, con un rendimiento promedio de 12 t/ha. El análisis AMMI corrobora la sostenibilidad del sistema productivo en un periodo de 18 años e indica la inestabilidad de precios, alta adaptabilidad y rendimiento del cultivo de granadilla frente a los cultivos complementarios. Este estudio demuestra que el cultivo de granadilla, es rentable, equitativo, resiliente, con debilidades en la parte ambiental, que requiere nuevas innovaciones tecnológicas para lograr la sostenibilidad del cultivo.In the Province of Oxapampa – Peru, passionfruit (Passiflora ligularis Juss) is of socioeconomic and environmental importance. The objective of the present study was characterizing, typify, evaluate sustainability and perform an economic analysis of the production system of passionfruit, in a context of family farming. To characterize the passionfruit production system an Analysis of Main Components was applied, as well as a cluster analysis. The used methodology to evaluate the production system´s sustainability is based on two methods, being the MESMIS framework and Sarandon’s Multicriteria Analysis. To complete the evaluation of the system´s sustainability and make the time-scale operational, data of production and prices was used, as well as an (economic) stability analysis (AMMI). The characterization of the farms allowed the identification of four Main Components. Although the cluster analysis allowed typifying three types of farms, based on the plot size all farms are considered as small. By applying the two methods it was found that the passionfruit production system is Moderately Sustainable, with a SGen value (MESMIS) of 4.6 and a General Sustainability Indicator ISGen (Sarandon) value of 6.2, qualifying the system as Potentially Sustainable. Furthermore, the economic analysis confirms that passionfruit cultivation is profitable at three discount rates (8%, 12% and 14%), with a break-even point (production) of 4 151 kg/ha (346 boxes), and a benefit cost ratio of 1.25, 1.21 and 1.20. For the period 2017-2018 the passionfruit crop in the study area measured a total of 1520 hectares harvested, with an average yield of 12 t/ha. The economic analysis was backed by the AMMI model, which showed that over a period of 18 years, crop sale prices were unstable and passionfruit was more profitable than the other crops. This study shows that the passionfruit production system is economically profitable, socially just, and resilient. However, there were a number of downfalls on the environmental side. At present, the system requires technological innovations, and should mitigate negative environmental aspects for the system to be sustainable.Tesi

Plan Andaluz de Cuidados Paliativos, 2008-2012

Publicado en la página web de la Consejería de Igualdad, Salud y Políticas Sociales: www.juntadeandalucia.es/salud (Consejería de Igualdad, Salud y Políticas Sociales / Ciudadanía / Quiénes somos / Planes y Estrategias)YesEste plan nace con el objetivo de proporcionar una atención integral que dé una respuesta adecuada a las necesidades de diversa índole -físicas, emocionales, sociales y espirituales,.- que presentan las personas que se hallan en una situación terminal, así como a sus familiares, procurándoles el máximo grado de bienestar y calidad de vida posibles, siempre dentro del respeto a la dignidad y voluntad personal en el que es su último periodo vita

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research