Conceptual framework for understanding the sustainability of social-ecological systems

Los índices y marcos de indicadores de desarrollo sustentable son muy utilizados para observar si un sistema es sustentable o no, aunque son insuficientes para entender por qué un sistema socioecológico puede ser in/sustentable. En este ensayo ofrecemos una propuesta teórica desarrollada a partir del concepto de resiliencia socioecológica, la cual se asume como el fundamento y propiedad de los sistemas sustentables. Así, la generación de sustentabilidad se argumenta a partir de la comprensión de conceptos como perturbación, capacidad adaptativa y cambios de estado y de régimen, que son mecanismos y elementos involucrados en la resiliencia socioecológica.Indices and frameworks of indicators on sustainable development are used for observing how sustainable a socialecological system is, though they are not appropriate to understand why these systems can be sustainable. We develop a conceptual sketch based on the concept of social-ecological resilience, which is the foundation of sustainable systems. Thus, we draw on concepts such as perturbations, adaptive capacity, and state and regime shifts, for arguing mechanisms and elements involved in generation of social-ecological resilience of systems

Marco conceptual para entender la sustentabilidad de los sistemas socioecológicos

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Concepts associated with health from the perspective of sustainable development

The concept of health is a social construction defined by the historical-cultural contexts of societies. At the moment, this context is characterized by global challenges such as climate change, energy crisis, the north-south divide, and poverty, among others. In view of these challenges, sustainable development has emerged as a proposal to cope with these drawbacks of the Western development model. In this sense, it is plausible to suppose, in accordance with a new global scenario of sustainable development, that a new conception of health is also emerging. For that reason, this paper aims at identifying this renewed concept of health, together with related concepts which are mentioned in the official documents on sustainable development originated in the world summits. Despite the fact that the concepts of health and sustainable development have been understood as being equivalent, none of the aforementioned official documents has provided societies with an explicit concept of health. It was verified that the concept of health has been associated with that of need satisfaction and preservation of ecosystems, whereas the construct of illness is associated with the concepts of poverty and high consumption levels. Finally, it is concluded that health is an intermediate goal of sustainable development and not an end in itself.El concepto de salud es una construcción social definida por los contextos histórico-culturales de las sociedades. Actualmente, dicho contexto está caracterizado por problemas como el cambio climático, la crisis energética, los desequilibrios norte-sur, y la pobreza, entre otros, que llevaron al surgimiento del desarrollo sostenible como una propuesta para afrontar estos defectos del modelo de desarrollo occidental. En ese sentido, es plausible suponer que en el marco de este escenario global con el surgimiento del desarrollo sostenible también esté emergiendo una nueva concepción de la salud. Por esa razón, en este trabajo nos propusimos identificar el concepto de salud, y los conceptos asociados a ésta, que se encuentran en los documentos oficiales del desarrollo sostenible que han surgido en las diferentes cumbres mundiales. Aunque se pudo inferir que los conceptos de salud y desarrollo sostenible son equivalentes, en ninguno de estos documentos se encontró un concepto explícito de salud. Así mismo, se observó que el concepto de salud está asociado con el de satisfacción de necesidades y cuidado de los ecosistemas, mientras que el de enfermedad está asociado a los conceptos de pobreza y elevados niveles de consumo. Finalmente, se concluye que la salud es un objetivo intermedio del desarrollo sostenible y no un fin en sí mismo

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

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

A ciência emergente da sustentaibilidade: da prática científica à da constituição de uma ciência

El término ‘ciencia de la sustentabilidad’ se ha utilizado para referirse más a la actividad científica orientada a promover el paso de las sociedades hacia trayectorias sustentables, que para hacer alusión a un conjunto de principios bajo los cuales una comunidad científica pueda construir conocimiento de forma sistemática alrededor de un objeto de estudio, que es lo que caracteriza a una ciencia. Este ensayo sostiene la tesis que en el seno de esta actividad científica está emergiendo una ciencia de la sustentabilidad en el sentido moderno y no meramente una práctica científica. Esta afirmación tiene fundamento en el hecho de que es posible definir la resiliencia socioecológica de los sistemas como objeto de estudio de la ciencia de la sustentabilidad, que es el soporte de transdisciplinas como la economía ecológica, ecología política, ética ambiental, ecología industrial, ecología cultural y la agroecología; y además, este objeto de estudio está ontológica y epistemológicamente sustentado.Peer ReviewedPostprint (published version

Marco conceptual para entender la sustentabilidad de los sistemas socioecol\uf3gicos

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Marco conceptual para entender la sustentabilidad de los sistemas socioecológicos

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Bases conceituais para uma classificação dos sistemas socioecológicos na investigação em sustentabilidade

En la investigación en sostenibilidad se estudia una gama tan amplia de sistemas socioecológicos, que el concepto de sostenibilidad con frecuencia solo tiene sentido en relación con el sistema particular de interés, dando lugar a una variedad, y a veces contradictoria, manera de entender la sostenibilidad. La investigación en sostenibilidad no podría proponer teorías sobre los sistemas sostenibles si cada investigación se ampara en un concepto diferente de sostenibilidad. En este ensayo nosotros proponemos una clasificación de los sistemas socioecológicos para demostrar cómo todos ellos pueden ser analizados bajo un mismo concepto de sostenibilidad.Peer ReviewedPostprint (published version

Marco conceptual para entender la sustentabilidad de los sistemas socioecológicos

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