Morbilidad materna extremadamente grave y mortalidad, indicadores de calidad de la atención obstétrica.

RESUMEN La mortalidad materna es un indicador que permite evaluar el desarrollo de un país por lo que debe prestarse especial atención a la mortalidad materna extremadamente grave como alternativa para disminuir las cifras de mujeres que mueren durante la etapa de reproducción. Este estudio expone los hallazgos de la etapa de construcción teórica de una investigación sobre los indicadores de calidad en la atención obstétrica en los hospitales “Dr. Teodoro Maldonado Carbo” y “Enrique C. Sotomayor” de Guayaquil, Ecuador; se realizó una actualización epistémica a través de la hermenéutica y revisión bibliográfica que permitieron el cotejo y análisis de una abundante y variada literatura científica autorizada, con el propósito de analizar y divulgar tan valioso asunto en aras de favorecer la reducción de la mortalidad materna. Los resultados principales revelan los factores predictores de morbilidad materna extremadamente grave más frecuentes como la edad mayor de 34 años, la exclusión social y la historia previa de hemorragia postparto, entre antecedentes de complicaciones. Otro aspecto identificado fue el oportuno diagnóstico de la mortalidad materna extremadamente grave y la rápida admisión de las mujeres en las unidades de cuidados intensivos, para lo cual han de tenerse criterios propios. Palabras claves: ; ; . ABSTRACT Maternal mortality is an indicator that allows for the evaluation of the development of a country. Particular attention should be given to extremely serious maternal mortality as an alternative to reduce the number of women who die during the reproductive stage. This study exposes the findings of the theoretical construction stage of a research on quality indicators in obstetric care in hospitals "Dr. Teodoro Maldonado Carbo "and" Enrique C. Sotomayor "of Guayaquil, Ecuador. An epistemic update was made through the hermeneutics and bibliographical revision that allowed the collation and analysis of an abundant and varied authoritative scientific literature, with the purpose of analyzing and divulging such a valuable subject in order to favor the reduction of maternal mortality. The main results reveal the most frequent predictors of extremely serious maternal morbidity, such as age over 34 years, social exclusion and previous history of postpartum hemorrhage, among a history of complications. Another aspect identified was the timely diagnosis of extremely serious maternal mortality and the rapid admission of women to intensive care units, for which their own criteria must be taken into account

Extremely severe maternal morbidity and mortality, quality indicators of obstetric care

La mortalidad materna es un indicador que permite evaluar el desarrollo de un país por lo que debe prestarse especial atención a la mortalidad materna extremadamente grave como alternativa para disminuir las cifras de mujeres que mueren durante la etapa de reproducción. Este estudio expone los hallazgos de la etapa de construcción teórica de una investigación  sobre los indicadores de calidad en la atención obstétrica en los hospitales “Dr. Teodoro Maldonado Carbo” y “Enrique C. Sotomayor” de Guayaquil, Ecuador; se realizó una actualización epistémica a través de la hermenéutica y revisión bibliográfica que permitieron el cotejo y análisis de una abundante y variada literatura científica autorizada, con el propósito de analizar y divulgar tan valioso asunto en aras de favorecer la  reducción  de la mortalidad materna. Los resultados principales revelan los factores predictores de morbilidad materna extremadamente grave más frecuentes como la edad mayor de 34 años, la exclusión social y la historia previa de hemorragia postparto, entre antecedentes de complicaciones. Otro aspecto identificado fue el oportuno diagnóstico de la mortalidad materna extremadamente grave y la rápida admisión de las mujeres en las unidades de cuidados intensivos, para lo cual han de tenerse criterios propios.Maternal mortality is an indicator that allows for the evaluation of the development of a country. Particular attention should be given to extremely serious maternal mortality as an alternative to reduce the number of women who die during the reproductive stage. This study exposes the findings of the theoretical construction stage of a research on quality indicators in obstetric care in hospitals «Dr. Teodoro Maldonado Carbo «and» Enrique C. Sotomayor «of Guayaquil, Ecuador. An epistemic update was made through the hermeneutics and bibliographical revision that allowed the collation and analysis of an abundant and varied authoritative scientific literature, with the purpose of analyzing and divulging such a valuable subject in order to favor the reduction of maternal mortality. The main results reveal the most frequent predictors of extremely serious maternal morbidity, such as age over 34 years, social exclusion and previous history of postpartum hemorrhage, among a history of complications. Another aspect identified was the timely diagnosis of extremely serious maternal mortality and the rapid admission of women to intensive care units, for which their own criteria must be taken into account

Modelo para la creación de emprendimientos sociales en Antioquia

En los últimos años ha crecido la creación de empresas ubicadas en el denominado cuarto sector de la economía, en el que se encuentran empresas que generan impacto social y ambiental, al tiempo que por medio de actividades comerciales, logran generación de ingresos económicos y sostenibilidad. Colombia y, específicamente Antioquia, es una región con gran potencial para este campo, debido a las problemáticas sociales que presenta y al ecosistema de innovación que se tiene, sin embargo, este tipo de emprendimientos es poco conocido, y por esta razón nace la necesidad de estructurar un modelo para la creación de emprendimientos sociales en Antioquia, enfocados en el impacto social, ambiental y económico. La presente investigación se realizó bajo un enfoque cualitativo y el tipo de estudio fue descriptivo, la unidad de análisis estuvo constituida por emprendedores y formadores de este tipo de empresas; como instrumentos de recolección de la información se utilizaron cuestionarios y entrevistas, la muestra fue intencional y se aplicó a emprendedores sociales, representantes del sistema de innovación y la academia.The born of enterprises located at the named fourth sector of the economy has increased In the last years, in this sector are located business generating social and environmental impact, at the time that through commercial activities, achieve economic revenue and sustainability. Colombia and, specifically Antioquia, is a high potential region for this field, due to the social troubles and their innovation ecosystem, but nevertheless, this kind of business are almost unknown, and because that born the need of design a model for the creation of social entrepreneurships in Antioquia, focused on the social, environmental an economic impact. This research was conducted under a qualitative focus and the type of study was descriptive, the analysis unit was made up of entrepreneurs and trainers of this type of company; the tools used for collecting data were questionnaires and interviews, with an intentional sample were applied to social entrepreneurs and representatives of the innovation system and academy

Assessment strategies of palliative care development: A systematic review

Introducción. Dada la alta carga de enfermedades crónicas no transmisibles y el sufrimiento grave es importante estudiar los cuidados paliativos en los sistemas de salud pública. Objetivo. Analizar las estrategias de evaluación del desarrollo de los cuidados paliativos. Material y métodos. Se realizó una revisión sistemática de la literatura utilizando dos motores de búsqueda: pubMed y Embase, se seleccionaron artículos que evalúan el desarrollo en cuidados paliativos en al menos dos países. Se evaluó la calidad de los estudios según las fuentes de información utilizadas para la construcción de las estrategias de evaluación. Los resultados se presentan en una síntesis narrativa. Resultados. Se identificaron 15 estrategias de evaluación de los cuidados paliativos que comparten una estructura en común y se estableció una clasificación según su metodología en cuatro grupos: de registro, clasificación nominal, clasificación numérica y estrategias mixtas. Conclusiones. La clasificación de las estrategias de evaluación de los cuidados paliativos facilitará la elección del modelo más adecuado para las necesidades de cada contexto así como también la identificación de los medios necesarios para asegurar la implementación universal en los sistemas de salud.Introduction. Due to the high rate of chronic non-transmissible illnesses and the serious suffering they cause, it is important to study palliative care in public health systems. Objective. Analyze the strategies for the evaluation of the development of palliative care. Material and methods. A systematic review was made of the literature using two search engines: pubMed and Embase, and articles were selected that evaluate development in palliative care in at least two countries. The quality of the studies was evaluated according to the information source used to build the assessment strategies. The results are presented in a narrative synthesis. Results. Fifteen palliative care strategies that share a common structure were identified, and a classification was established according to their methodology in four groups: registration, nominal classification, numerical classification and mixed strategies. Conclusions. The classification of palliative care assessment strategies facilitates the choice of the most appropriate model for the needs of each context, as well as identification of the means necessary to ensure their universal implementation in health systems

Normal-Weight Obesity Is Associated with Increased Cardiometabolic Risk in Young Adults

Normal-weight obesity (NWO) has been shown to be associated with cardiometabolic dysfunction. However, little is known regarding this potential relationship in early adulthood. The aim of this study was to investigate the associations between NWO and cardiometabolic risk factors in a large population of Colombian young adults. A cross-sectional study was conducted on 1354 subjects (61% women), aged from 18 to 30. Anthropometric data, including body mass index (BMI) and waist circumference (WC), were estimated, and the percentage of fat mass was measured through bioelectrical impedance analysis (BIA). Muscular fitness was determined by using a handgrip strength test and normalized grip strength (NGS = handgrip (kg)/body mass (kg)). A cardiometabolic risk Z-score was derived by assessing WC, triglycerides, high-density lipoprotein cholesterol (HDL-C) cholesterol, fasting glucose, and systolic blood pressure. NWO was defined by the combination of excess %BF (over 25.5% for men and 38.9% for women) and a BMI < 25 kg/m2 . The overall prevalence of NWO was 29.1%. Subjects with NWO have an increased risk of cardiometabolic risk compared to the normal-weight lean group (OR = 3.10). Moreover, NWO was associated with an increased risk of presenting low HDL-C (OR = 2.34), high abdominal obesity (OR = 7.27), and low NGS (OR = 3.30), p < 0.001. There is a high prevalence of NWO in American Latin young adults and this condition is associated with an increased cardiovascular risk, high blood pressure, low HDL-C, high abdominal obesity, and low muscular strength early in life. Screening for adiposity in subjects with a normal BMI could help to identify young adults at a high risk of cardiometabolic abnormalities.This study was part of the project entitled “Body Adiposity Index and Biomarkers of Endothelial and Cardiovascular Health in Adults” (Code N FIUR DN-BG001), Institución Universitaria Antonio José Camacho (Code N 111-02.01.48/16), Universidad Santo Tomás (Code N 2013004), Universidad Manuela Beltrán (Code N FT201204), and Universidad de Boyacá (Code N RECT 60). M.I. is funded in part by a research grant PI17/01814 of the Ministerio de Economía, Industria y Competitividad de España (ISCIII, FEDER). A.G.-H. is a Miguel Servet Fellow (Instituto de Salud Carlos III—CP18/0150). R.R.-V. is funded in part by a Postdoctotal fellowship grant ID 420/2019 of the Universidad Pública de Navarra, Spain. The funder had no role in the study design, data collection, data analysis and interpretation, preparation of the manuscript, or decision to publish

Comportamiento sedentario en estudiantes universitarios

Objetivo: Determinar el comportamiento sedentario enestudiantes universitarios.Materiales y M&eacute;todos: Estudio de tipo descriptivo decorte transversal en 2203 estudiantes de pregrado desiete instituciones de educaci&oacute;n superior. Se aplic&oacute; unaencuesta que midi&oacute; las variables sociodemogr&aacute;ficas: sexo,edad y &aacute;rea de conocimiento donde el estudiante est&aacute;matriculado; el comportamiento sedentario a trav&eacute;s delinterrogante: &iquest;cu&aacute;ntas horas al d&iacute;a emplea usted frenteal televisor, computador, videojuego u otra pantalla? Elan&aacute;lisis de los datos se realiz&oacute; en el programa estad&iacute;sticoSPSS versi&oacute;n 24. Se determin&oacute; la relaci&oacute;n entre el tiempofrente a pantallas y el sexo y rango de edad de los sujetosestudio mediante la prueba t de Student. Igualmente, conel &aacute;rea de conocimiento mediante la Prueba de an&aacute;lisis devarianza de una v&iacute;a (ANOVA).Resultados: El 50,1% de los estudiantes son hombres.El rango de edad predominante fue menor de 26 a&ntilde;os(90,1%). Los estudiantes gastan m&aacute;s horas frente al celular(7,5&plusmn;5,6 horas) y al computador (3&plusmn;2,5 horas). Existendiferencias significativas (p&lt;0,05) entre el rango deedad y uso del computador, en los mayores el promedioes 3,8&plusmn;2,4 horas. Los de menor edad gastan frente al celular6,6&plusmn;3,8 horas. Los estudiantes de ciencias sociales enpromedio gastan 7,1&plusmn;4 horas al d&iacute;a.Conclusiones: Los estudiantes universitarios gastan m&aacute;sde 2 horas diarias frente a pantallas como el celular y elcomputador principalmente. Por lo anterior, es necesarioimplementar intervenciones que se enfoquen en establecerh&aacute;bitos saludables en los universitarios

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Implementación de la identidad desde el diseño de la comunicación gráfica para la empresa Técnicostura Ltda

Este trabajo plantea la realización de la implementación gráfica de la nueva identidad corporativa de Tencicostura Ltda. Con esta implementación se aprovecha una oportunidad táctica de mercadeo la cual es que la competencia no hace esfuerzos de comunicación logrando así, que la empresa proyecte su marca ante los clientes actuales y futuros, cuyo objetivo conlleve a la fidelización de los mismos. Se ha tomado como base el desarrollo de una estrategia de comunicación que se soporta sobre planteamientos teóricos requeridos por el mercado y la articulación con el departamento de comunicación de Tencicostura Ltda., que es fundamental en la consultoría de implementación comunicacional tanto interna como externa de la empresa. Las piezas que se seleccionaron por medio de la estrategia, son piezas gráficas que no se contemplaron dentro del manual de identidad corporativo de la empresa y que la empresa para las cosas específicas de la estrategia comunicacional debía implementar su marca para cumplir con el objetivo propuesto por la empresa para llevar a cabo su cometido comunicacionalPasantía institucional (Diseñador de la Comunicación Gráfica)-- Universidad Autónoma de Occidente, 2012PregradoDiseñador(a) de la Comunicación Gráfic