31 research outputs found
Conciencia moral ambiental desde el colegio, transformando actitudes para la sustentabilidad
105 P?ginasRecurso Electr?nicoLa preocupaci?n creciente por el aumento de los efectos del deterioro ambiental, la explotaci?n insostenible de recursos naturales no renovables, las desigualdades humanas en las condiciones de bienestar y acceso a dichos recursos desde la sostenibilidad, entre otros aspectos; cuestionan la pertinencia y eficacia de la educaci?n ambiental y determinan la urgencia de implementar estrategias y acciones que conduzcan a cambios sociales, pol?ticos, econ?micos y finalmente, culturales para afrontar la situaci?n. Esta tarea ha sido asumida tradicionalmente por la escuela con el desarrollo de competencias cognitivas y procedimentales; generando en el sujeto el conocimiento de la problem?tica y el abordaje de actividades sustentables que no forman parte de su cultura ni de su autonom?a; conoce y hace de manera inconexa, manteni?ndose incapaz de identificar su relaci?n simbi?tica con el entorno.
Al respecto, la academia tiene la responsabilidad permanente de innovar y fortalecer sus pr?cticas dirigidas al proceso de formaci?n ambiental de los j?venes. Es apremiante plantear alternativas que fortalezcan el accionar de la educaci?n ambiental, dirigida a una modificaci?n personal de actitudes que parte de autoformar el juicio moral, reconocer las propias emociones y asumir comportamientos de participaci?n proactiva con su contexto ambiental. La meta inicial es el desarrollo de autonom?a para conformar una identidad ambiental y finalmente adquirir competencias de ciudadan?a ambiental.
En este documento se detalla una propuesta de innovaci?n educativa que aborda parte del problema, mediante la b?squeda de elementos de intervenci?n que permitan integrar los avances de la educaci?n ambiental y favorezcan la formaci?n individual que permita pensar e interpretar lo ambiental de manera distinta a la que culturalmente arrastramos. Esta iniciativa incluye un dise?o de investigaci?n para la evaluaci?n de sus resultados.ABSTRACT
The growing concern about the increasing effects of environmental degradation, the unsustainable exploitation of nonrenewable natural resources, the human inequalities in welfare conditions and access to these resources from sustainability, among other things, question the relevance and effectiveness of the environmental education, and determine the urgency of implementing strategies and actions which lead to social, political, and economical and therefore, cultural changes to deal with this situation. This task has been traditionally taken on schools through the development of cognitive and procedural skills, producing in an individual the knowledge of the problem and addressing sustainable activities which are neither part of their culture nor their autonomy; he knows and does things so disjointed, being unable to identify its symbiotic relationship with the environment.
In this regard, the school has a permanent responsibility to innovate and strengthen its practices aimed at environmental education process of youth. It is urgent to propose alternatives to fortify the activities of environmental education, which lead to an individual change on attitudes of moral judgment, recognizing one's emotions and behaviors to take a proactive engagement with the environmental context. The initial goal is to develop autonomy to form an environmental identity and finally, acquire environmental citizenship skills.
This paper details an educative innovation proposal which addresses part of the problem, through the intervention elements search which lets us integrate advances in environmental education, and encourage individual training on allowing an environmental thinking and then, interpreting it differently from what culturally we drag. This initiative includes a research design for the evaluation of the results obtained.ADVERTENCIA
?El programa de Maestr?a en Educaci?n de la Universidad del Tolima, el director del trabajo de grado y el jurado calificador no son responsables de las ideas expuestas por el autor en el presente trabajo.? Art?culo 17, Resoluci?n 015 de Diciembre 18 de 1978, Reglamento de Trabajos de Grado.
Los autores CARLOS EDUARDO BALAGUERA D?VILA, Identificado con C.C. No. 91.236.962 de Bucaramanga, Santander y HENRY SANCHEZ, Identificado con C.C. No. 18.919.265 de Aguachica, Cesar; autorizan a la Universidad del Tolima la reproducci?n total o parcial de este documento, con la debida cita de reconocimiento de la autor?a y cede a la misma universidad de los derechos patrimoniales con fines de investigaci?n, docencia e institucionales, consagrados en el art?culo 72 de la Ley 23 de 1982 y las normas que lo constituyan o modifiquen.INTRODUCCI?N 15
1. DEFINICI?N DEL PROBLEMA 18
1.1 ANTECEDENTES 18
1.2 DESCRIPCI?N DEL PROBLEMA 19
1.3 FORMULACION DEL PROBLEMA 20
1.3.1 Preguntas Preliminares 20
1.3.2 Pregunta Principal 20
1.4 DELIMITACI?N TEMPORAL Y ESPACIAL 20
1.5 CONTEXTO 21
1.6 POBLACI?N 22
2. JUSTIFICACI?N 23
3. OBJETIVOS 27
3.1 OBJETIVO GENERAL 27
3.2 OBJETIVOS ESPEC?FICOS 27
4. ALCANCES Y LIMITACIONES 28
5. MARCO REFERENCIAL 30
5.1 BREVE ESTADO DE LA CUESTION 30
5.2 REFERENTE EPISTEMOL?GICO 34
8
5.2.1 El constructivismo 34
5.2.2 Complejidad ambiental 36
5.3 REFERENTE PEDAG?GICO 38
5.3.1 Educaci?n para la ciudadan?a ambiental 39
5.3.2 Ambientalizaci?n del curr?culo 40
5.3.3 La educaci?n en valores ambientales 42
5.4 REFERENTE SICOL?GICO 44
5.4.1 Desarrollo moral 44
5.4.2 Acci?n moral 48
5.4.3 Las actitudes 49
5.5 REFERENTE DID?CTICO 50
5.5.1 El m?todo Konstanz de discusi?n de dilemas 50
5.6 REFERENTE LEGAL 52
6. DISE?O METODOL?GICO 54
6.1 ENFOQUE INVESTIGATIVO 54
6.2 PROCEDIMIENTO 54
6.3 HIP?TESIS 56
6.4 POBLACI?N 56
6.5 T?CNICAS E INSTRUMENTOS DE RECOLECCI?N DE DATOS 56
6.6 T?CNICA DE AN?LISIS 57
6.7 RECURSOS 60
7. AN?LISIS DE RESULTADOS 61
9
7.1 RESULTADOS DE LA APLICACI?N PRE-TEST 61
7.2 RESULTADOS COMPARATIVOS POST-TEST 64
7.3 COMPROBACI?N DE HIP?TESIS 67
8. CONCLUSIONES 69
9. RECOMENDACIONES 70LISTA DE REFERENCIAS 71
ANEXOS 7
El presupuesto participativo como estrategia para el fortalecimiento de la gesti?n administrativa en la universidad del Tolima
114 P?ginasRecurso Electr?nicoEste trabajo revisa desde los primeros estudios y or?genes del Presupuesto participativo, con el ?nico objetivo de desarrollar una estrategia que pueda contribuir en el fortalecimiento de la gesti?n administrativa para la Universidad del Tolima, para ello el an?lisis se centra en el contexto actual de la forma como la Universidad del Tolima soportada en la tradici?n administrativa presupuestal elabora, aprueba y ejecuta un presupuesto que se debe ejecutar en el periodo de una anualidad, y paralelamente se propone un nuevo modelo de presupuesto participativo acompa?ado de un proyecto de estatuto presupuestal y financiero que contribuir?a a la estrategia que fortalecer?a la gesti?n administrativa en la Universidad, enfatizando el Presupuesto Participativo, en su naturaleza y las bondades de esta modalidad, con la participaci?n decidida e incluyente de la comunidad universitaria, fundamentada en la autonom?a universitaria, y la opini?n de un grupo de funcionarios de la universidad quienes concept?an sobre la viabilidad y aplicabilidad del presupuesto participativo en la Instituci?n.ABSTRACT. This paper reviews from the first studies and the origins of the participatory budget, with the only goal of developing a strategy that can help in strengthening the administrative management for the Universidad del Tolima. In order to reach this, the analysis focuses on the current context of how the Universidad del Tolima supported on the budget administrative tradition develops, approves and implements a budget to be run in a oneyear period, and at the same time a new model of participatory budget along with a draft budget and financial statute is proposed which would contribute to the strategy to strengthen the administrative management at the University, emphasizing the participatory budget in its nature and the benefits of this method, with committed and inclusive participation of the university community, based on university autonomy, and the opinion of a group of university officials who conceptualized on the feasibility and applicability of participatory budget in the institution.INTRODUCCI?N 11
1. PLANTEAMIENTO DEL PROBLEMA 12
1.1 EL PROBLEMA 12
1.2 JUSTIFICACI?N 13
1.3 OBJETIVOS 18
1.3.1 Objetivo General 18
1.3.2 Objetivos Espec?ficos 18
2. MARCO TE?RICO 19
2.1 DIAGN?STICO INSTITUCIONAL 19
2.1.1 La Tradici?n Presupuestal de la Universidad 43
2.1.2 Composici?n del Presupuesto 48
2.2. REFERENES TE?RICOS 55
2.2.1 Contexto Nacional 59
2.2.2 En las Universidades 61
2.3 UN PRESUPUESTO PARTICIPATIVO PARA LA UNIVERSIDAD 63
2.3.1 Fase 1 66
2.3.2 Fase 2 68
2.3.3 Fase 3 69
2.3.4 Fase 4 70
2.3.5 Fase 5 70
3. METODOLOG?A 82
4. RESULTADOS 85
5. CONCLUSIONES 92
RECOMENDACIONES 95
REFERENCIAS 9
Propuesta de aplicaci?n del Vendor Managed Inventory, como pol?tica de gesti?n de inventarios en una empresa concesionaria de gas natural en el sector dom?stico en Lima Metropolitana y Callao
La presente Tesis tiene como objetivo explorar conceptos relacionados con el modelamiento de est?ndares y buenas pr?cticas a trav?s de herramientas como el modelo de referencia SCOR y conceptos claves como VMI y an?lisis financiero, con el fin de realizar una propuesta de mejora en la cadena de suministro para una empresa concesionaria de gas natural. La propuesta se enfoca en la reducci?n de los d?as de inventario y la optimizaci?n del costo en sus operaciones sin afectar el nivel de servicio. La tesis tiene como referente a una empresa concesionaria de gas natural que opera en Lima Metropolitana y Callao, la cual tiene un contrato de concesi?n del sistema de distribuci?n de gas natural por un periodo de 33 a?os, susceptibles de pr?rroga, a trav?s de un contrato de concesi?n, que incluye todas las etapas necesarias para poner en marcha el servicio
Gas Dynamics and Star Formation in the Galaxy Pair NGC1512/1510
(abridged) Here we present HI line and 20-cm radio continuum data of the
nearby galaxy pair NGC1512/1510 as obtained with the Australia Telescope
Compact Array. These are complemented by GALEX UV-, SINGG Halpha- and Spitzer
mid-infrared images, allowing us to compare the distribution and kinematics of
the neutral atomic gas with the locations and ages of the stellar clusters
within the system. For the barred, double-ring galaxy NGC1512 we find a very
large HI disk, about 4x its optical diameter, with two pronounced spiral/tidal
arms. Both its gas distribution and the distribution of the star-forming
regions are affected by gravitational interaction with the neighbouring blue
compact dwarf galaxy NGC1510. The two most distant HI clumps, at radii of about
80 kpc, show signs of star formation and are likely tidal dwarf galaxies. Star
formation in the outer disk of NGC1512 is revealed by deep optical- and
two-color ultraviolet images. Using the latter we determine the properties of
about 200 stellar clusters and explore their correlation with dense HI clumps
in the even larger 2XHI disk. The multi-wavelength analysis of the NGC1512/1510
system, which is probably in the first stages of a minor merger having started
about 400 Myr ago, links stellar and gaseous galaxy properties on scales from
one to 100 kpc.Comment: accepted in MNRAS (please find the high-resolution pdf file and
further information at http://www.atnf.csiro.au/people/bkoribal/ngc1512
Azimuthal anisotropy at the relativistic heavy ion collider: The first and fourth harmonics
We report the first observations of the first harmonic (directed flow, v(1)) and the fourth harmonic (v(4)), in the azimuthal distribution of particles with respect to the reaction plane in Au+Au collisions at the BNL Relativistic Heavy Ion Collider (RHIC). Both measurements were done taking advantage of the large elliptic flow (v(2)) generated at RHIC. From the correlation of v(2) with v(1) it is determined that v(2) is positive, or in-plane. The integrated v(4) is about a factor of 10 smaller than v(2). For the sixth (v(6)) and eighth (v(8)) harmonics upper limits on the magnitudes are reported
Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019
Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Global burden of 87 risk factors in 204 countries and territories, 1990�2019: a systematic analysis for the Global Burden of Disease Study 2019
Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk�outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk�outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk�outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51�12·1) deaths (19·2% 16·9�21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12�9·31) deaths (15·4% 14·6�16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253�350) DALYs (11·6% 10·3�13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0�9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10�24 years, alcohol use for those aged 25�49 years, and high systolic blood pressure for those aged 50�74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Asociaci?n entre caracter?sticas cl?nicas e ?ndices de oxigenaci?n con el ingreso a uci, requerimiento de ventilaci?n invasiva y mortalidad en pacientes con COVID-19 en 2 IPS de Ibagu?, 2020-2021.
123 p.INTRODUCCION: La actual pandemia ha sido una experiencia ?nica para cada uno de nosotros, desde lo personal y lo profesional ha representado un desaf?o, para diciembre de 2019 en la mayor?a de nosotros era impensable que el surgimiento del nuevo coronavirus SARS Cov-2 se transformara en una pandemia que pusiera en jaque la salud y la econom?a global. En el transcurso de los ?ltimos meses hemos visto la partida de colegas, padres, madres, hermanos y amigos, muchas familias han perdido un ser querido y las personas que no se han visto afectadas por este fen?meno que llamamos pandemia realmente son casos aislados.
Con los retos que ha representado la situaci?n actual como profesionales de la salud nos hemos visto en la necesidad de desarrollar mecanismos que nos permitieran adaptarnos a la nueva realidad, con miras a la necesidad apremiante de entregar lo mejor de nosotros a nuestros pacientes, desde lo humano y lo cient?fico, buscando motivaci?n desde lo primero para buscar respuestas en la mejor evidencia cient?fica disponible, se ha podido ver un trabajo colaborativo sin precedentes entre los diferentes niveles t?cnicos y cient?ficos para lograr intervenciones efectivas que permitan mitigar la carga de la pandemia; por ejemplo, el desarrollo de la vacuna contra el SARS Cov-2 es una de ellas.
OBJETIVO: Describir las caracter?sticas sociodemogr?ficas, cl?nicas, ?ndices de oxigenaci?n y de laboratorio y establecer su asociaci?n con el ingreso a la unidad de cuidado intensivo, requerimiento de intubaci?n orotraqueal y muerte en pacientes confirmados con COVID-19 en 2 IPS de la ciudad de Ibagu?, entre abril de 2020 y enero de 2021.
DISE?O Y METODOS: Estudio epidemiol?gico anal?tico longitudinal de asociaci?n con una cohorte retrospectiva de pacientes admitidos en dos IPS de Ibagu? con diagn?stico de COVID-19 confirmada por ant?geno o RT-PCR, que requirieron manejo en unidad de cuidados intensivos, en quienes se medir?n variables en tres momentos, primero, al momento del ingreso a la IPS, segundo, en las primeras 24 horas de la atenci?n, y tercero, entre el 4? y 7? d?a de la atenci?n, se incluyeron al estudio todos los paciente que requirieron atenci?n en unidad de cuidados intensivos en 2 IPS de Ibagu?, reportes base de datos pruebas diagn?sticas SISMUESTRAS, reportes SIVIGILA de las instituciones de salud y la ciudad de Ibagu?, con diagn?stico cl?nico y molecular (RT-PCR y ant?geno de SARS Cov-2) de COVID-19, entre abril de 2020 y enero 2021,
RESULTADOS: se obtuvieron los datos de 410 atenciones de pacientes cr?ticos para realizar el c?lculo. Con un nivel de confianza del 95% y una frecuencia esperada del 20,6% de acuerdo con estudios en otros contextos, se calcul? una muestra de 156 pacientes, de ellos se evidencio una mediana de edad de 66 a?os, el paciente m?s joven atendido tuvo 24 a?os y el m?s longevo 93 a?os, la mediana del peso es 60kg con una mediana en la talla de 1 metro con 55 cent?metros, la mediana en el IMC reportado es 21,7 estando clasificado como normal, el paciente m?s obeso obtuvo un IMC en 46,6 clasificado como obeso, de los 227 pacientes tratados la media muestra oxigenaci?n al ingreso de la consulta en 85% demostrando un trastorno de oxigenaci?n leve a moderado, y requiriendo soporte de ox?geno complementario.
En el caso de la mortalidad como desenlace, se puede apreciar una asociaci?n estad?sticamente significativa entre los valores de SAFI y fallecer, mucho mayor en el tercer momento de medici?n
Al analizar los grupos de pacientes por sexo, analizando tiempo de supervivencia al evento muerte, se observa que del total de 227 pacientes del estudio la mayor proporci?n correspondi? a hombres con 153 casos (67,40%), de estos, 60,78% tuvieron desenlace fatal (93 casos), la mediana a la mortalidad desde el inicio de s?ntomas fue de 18 d?as (valor p = 8,082
Algo parad?jico sucede con la curva de supervivencia de pacientes con COVID 19 que cursan con una infecci?n adicional a la neumon?a viral o bacteriana. La mediana de supervivencia de los pacientes que no tienen infecciones asociadas es de 20 d?as desde el inicio de s?ntomas, vs 26 d?as de aquellos que, si cursan con fungemias, bacteriemias o infecciones urinarias (p= 0.007).
Palabras Claves: Covid 19, Pandemia, Falla ventilatoria.INTRODUCTION: The current pandemic has been a unique experience for each of us, personally and professionally, it has represented a challenge. By December 2019, it was unthinkable for most of us that the emergence of the new SARS Cov-2 coronavirus would transform in a pandemic that put health and the global economy in check. In recent months we have seen the departure of colleagues, fathers, mothers, brothers and friends, many families have lost a loved one and the people who have not been affected by this phenomenon that we call a pandemic are really isolated cases.
With the challenges that the current situation has represented as health professionals, we have seen the need to develop mechanisms that allow us to adapt to the new reality, with a view to the pressing need to deliver the best of ourselves to our patients, from the human and scientific, seeking motivation from the first to seek answers in the best available scientific evidence, it has been possible to see an unprecedented collaborative work between the different technical and scientific levels to achieve effective interventions that allow mitigating the burden of the pandemic; for example, the development of the SARS Cov-2 vaccine is one of them.
OBJECTIVE: To describe the sociodemographic, clinical, oxygenation and laboratory indices and to establish their association with admission to the intensive care unit, orotracheal intubation requirement and death in patients confirmed with COVID-19 in 2 IPS in the city of Ibagu?. , between April 2020 and January 2021.
DESIGN AND METHODS: Longitudinal analytical epidemiological study of association with a retrospective cohort of patients admitted to two IPS in Ibagu? with a diagnosis of COVID-19 confirmed by antigen or RT-PCR, who required management in an intensive care unit, in whom variables will be measured. in three moments, first, at the time of admission to the IPS, second, in the first 24 hours of care, and third, between the 4th and 7th day of care, all patients who required care were included in the study in an intensive care unit at 2 IPS in Ibagu?, SISMUESTRAS diagnostic test database reports, SIVIGILA reports from health institutions and the city of Ibagu?, with clinical and molecular diagnosis (RT-PCR and SARS Cov-2 antigen) of COVID-19, between April 2020 and January 2021,
RESULTS: Data from 410 critical care patients were obtained to perform the calculation. With a confidence level of 95% and an expected frequency of 20.6% according to studies in other contexts, a sample of 156 patients was calculated, of which a median age of 66 years was evidenced, the youngest patient attended was 24 years old and the oldest was 93 years old, the median weight is 60kg with a median height of 1 meter 55 centimeters, the median reported BMI is 21.7 being classified as normal, the most obese patient obtained a BMI at 46.6 classified as obese, of the 227 patients treated, the average shows oxygenation at the entrance of the consultation in 85% demonstrating a mild to moderate oxygenation disorder, and requiring complementary oxygen support.
In the case of mortality as an outcome, a statistically significant association can be seen between SAFI values and death, much greater at the third time of measurement When analyzing the groups of patients by sex, analyzing survival time to the death event, it is observed that of the total of 227 patients in the study, the highest proportion corresponded to men with 153 cases (67.40%), of these, 60.78% had a fatal outcome (93 cases), the median mortality from the onset of symptoms was 18 days (p value = 8.082
Something paradoxical happens with the survival curve of patients with COVID 19 who have an additional infection to viral or bacterial pneumonia. The median survival of patients who do not have associated infections is 20 days from the onset of symptoms, vs 26 days for those who, if they present fungemia, bacteremia or urinary infections (p = 0.007).
Keywords: Covid 19, Pandemic, Ventilatory failure