Relación entre la gestión administrativa de la seguridad interna y la satisfacción laboral de los trabajadores del Palacio Municipal de la Municipalidad Metropolitana de Lima, 2013

La presente investigación tiene por objetivo determinar la relación entre la Gestión Administrativa de la seguridad interna y la satisfacción laboral de los trabajadores del palacio municipal de la Municipalidad Metropolitana de Lima, 2013. El tipo de investigación es básica, el nivel de investigación descriptivo, el diseño de la investigación es No experimental – Tipo transversal correlacional y el enfoque es cuantitativo. La muestra fue no probabilística estuvo constituida por 60 trabajadores del palacio municipal. El instrumento de recolección de datos utilizado, fue un cuestionario encuesta validada por la junta de expertos de la Universidad Cesar Vallejo, que fue aplicada en una sola vez. Los resultados obtenidos con la prueba indican que existe relación significativa entre las variables de estudio, así también con las dimensiones planificación, estrategia y ejecución. Se concluye que la Gestión Administrativa de seguridad interna contribuye a lograr satisfacción laboral en los trabajadores del palacio municipal de la Municipalidad de Metropolitana de Lima

La eficiencia y eficacia de la prueba anticipada a través de la Cámara Gesell

El objetivo general del presente estudio, titulado " La eficiencia y eficacia de la prueba anticipada a través de la Cámara Gesell", fue evaluar la utilidad de la entrevista única de Cámara de Gesell a un menor de edad como Prueba Anticipada en el Delito de Violación Sexual como soporte de la Solicitud de Detención Preventiva. La tipología de estudio fue fundamental, utilizando la teoría fundamentada, técnica cualitativa y diseño fenomenológico. La población se halló formada por un conjunto de profesionales conocedores de la trama de estudio. Se empleó el enfoque de entrevista y la guía de entrevista fue el instrumento. Siempre que se realice conforme a la ley especial y a la normativa procesal penal, se ha demostrado que la entrevista única de Cámara Gesell a una menor puede ser valorada efectivamente como prueba, lo que permite al tribunal valorar la afirmación de la menor involucrada en el delito de violación sexual que el Ministerio Público presentó como prueba para sustentar la solicitud de prisión preventiva

Diversidad vegetal silvestre y cultivada y su aporte a la sustentabilidad del sistema agrario del Distrito de Cajatambo, Lima

Universidad Nacional Agraria La Molina. Escuela de Posgrado. Doctorado en Agricultura SustentableLa presente investigación tuvo como objetivo evaluar la diversidad vegetal silvestre y cultivada en el distrito de Cajatambo, Lima, a fin de aportar en la sustentabilidad del sistema agrario. Los registros fueron hechos durante los años 2015 y 2016 mediante 44 transectos de 30 metros, en 9 formaciones vegetales del mosaico de parches determinado por fotointerpretación: campo agrícola, bosque de eucalipto, bosque de Polylepis, matorral, pajonal, césped, bofedal, gravilla y juncal. Se determinó un total de 355 especies, correspondientes a 211 géneros y 64 familias, siendo las más importantes Asteraceae, Poaceae, Fabaceae, Caryophyllaceae, Lamiaceae y Solanaceae. Se encontró 32 especies en alguna categoría de amenaza, algunas presentes sólo en un lugar como en Ocopata, IscuViconga, Huaylashtoclanca y en el cerro San Cristóbal, siendo matorrales, campos agrícolas, pajonales y bosque de Polylepis, formaciones vegetales en donde se ha registrado más la presencia de especies amenazadas. La diversidad vegetal en las zonas agrícolas como Parientana, Urpaycocha y el césped de Tizapampa fueron muy variables en el tiempo, pero con poca diversidad vegetal, mientras que los matorrales cerca de la cantera y de la mina y los pajonales de Tocanca y camino a Viconga menos variables y con mayor diversidad. El grado de intervención antrópica estaría determinando este comportamiento. De las especies seleccionadas como potencialmente clave, 12 tendrían un posible patrón de refugio, mientras que 4 especies un posible patrón de hot-sposts móvil y fijo. La ubicación de refugios permite planificar acciones de conservación y explotación sostenida de estos recursos. El conocimiento de la distribución poblacional en el tiempo de especies que son usadas como forraje, como Trifolium repens, Medicago polymorpha, Medicago sativa y Cenchrus clandestinus, y otras que mayormente son colectadas y utilizadas, como Ambrosia arborescens, Chuquiraga spinosa, Tetraglochin cristatum y Austrocylindropuntia subulata, contribuye a una gestión sostenible de las mismas. La presencia de ciertas plantas en épocas secas y que son muy utilizadas por los pobladores del lugar proporcionan recursos vegetales para la subsistencia en momentos donde la poca disponibilidad de agua hace más difícil la obtención de recursos. El uso de estas plantas silvestres y arvenses constituye una estrategia importante en la sustentabilidad de sistema agrario de Cajatambo.The objective of the research was to evaluate the wild and cultivated plant diversity in the district of Cajatambo, Lima, in order to contribute to the sustainability of the agricultural system. The records were made during the years 2015 and 2016 through 44 transects of 30 meter in 9 plant formations in the patchwork mosaic determined by photointerpretation: agricultural field, eucalyptus forest, Polylepis forest, scrubland, grassland, lawn, bofedal, gravel and juncal. A total of 355 species, corresponding to 211 genera and 64 families were determined, being Asteraceae, Poaceae, Fabaceae, Caryophyllaceae, Lamiaceae and Solanaceae the families best represented. Thirty-two species were found in some category of threat, some present only in one place such as Ocopata, Iscu-Viconga, Huaylashtoclanca and in San Cristobal Hill, being scrublands, agricultural fields, grasslands and Polylepis forest, vegetal formations where the presence of threatened species has been registrered more. Vegetal diversity in agricultural areas such Parientana, Urpaycocha and Tizapampa grasses was highly variable over time, but with little plant diversity, while the scrublands near the quarry and mine and the Tocanca and Viconga grasslands were less variable and more diverse. The degree of anthropic intervention would determine this behavior. Of the species selected as potentially key, 12 would have a possible shelter pattern, while 4 species a possible pattern of mobile and fixed hot-sposts. The location of shelters allows planning of conservation and sustained exploitation of these resources. Knowledge of the population distribution over time of species that are used as forage, such as Trifolium repens, Medicago polymorpha, Medicago sativa and Cenchrus clandestinus, and others that are mostly collected and used, such as Ambrosia arborescens, Chuquiraga spinosa, Tetraglochin cristatum and Austrocylindropuntia subulata, contributes to their sustainable management. The presence of certain plants in dry season and which are widely used by local residents provide plant resources for subsistence at times when the scarce availability of water makes it more difficult to obtain resources. The use of these wild plants and weeds constitutes an important strategy in the sustainability of the Cajatambo´s agricultural syste

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially