El debate como estrategia metodológica para el desarrollo de las competencias genéricas del proyecto Tuning para América Latina

This work focuses on the analysis of three competences of the Tuning Project for Latin America. Its purpose is to determine to what extent does debate, used as a methodological strategy, enable the development of three generic competences of the Tuning Project for Latin America in students in the curriculum of Philosophy at the Pontifical Catholic University in Ecuador (Spanish acronym PUCE): the ability to communicate orally and in writing; the skills to search, process and analyze information from various sources; and, the ability to apply knowledge in practice. The research uses a quantitative approach, with a quasi-experimental design, based on groups of students in two courses, albeit with subgroups constituted through pairing, with a single post-test and with the assumption of a causal relationship between variables. The instrument used in the analysis and developed by the research team, is the basic questionnaire for establishing the contribution of the debate for the development of generic competences. The provisional results of the study indicate that the debate could favor the development of those analyzed competences. However, due to the size of the sample and the current state of the research, its results cannot be extrapolated to other groups and contexts, which requires further study applications.Este trabajo se centra en el análisis de tres competencias del Proyecto Tuning para América Latina. Su propósito consiste en determinar en qué medida el debate, utilizado como estrategia metodológica, permite el desarrollo de tres competencias genéricas del Proyecto Tuning para América Latina, en los estudiantes de la carrera de Filosofía de la Pontificia Universidad Católica del Ecuador: la capacidad de comunicación oral y escrita; las habilidades para buscar, procesar y analizar información procedente de diversas fuentes; y, la capacidad de aplicar los conocimientos en la práctica. La investigación aplica un enfoque cuantitativo, con un diseño cuasiexperimental, basado en grupos preexistentes de estudiantes de dos asignaturas, con subgrupos constituidos por emparejamiento, con una sola posprueba y con la presunción de una relación causal entre variables. El instrumento de análisis, elaborado por el equipo de investigación, es el “Cuestionario básico para establecer el aporte del debate para el desarrollo de competencias genéricas”. Los resultados provisionales del estudio señalan que el debate podría favorecer el desarrollo de aquellas competencias analizadas. Sin embargo, debido al tamaño de la muestra y al estado actual de la investigación, sus resultados no son extrapolables a otros grupos y contextos, por lo que se requiere ulteriores aplicaciones del estudio

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Aprendizaje de las matemáticas a través de proyectos

Pensar, Vivir y Hacer educación: visiones compartidas Vol. 2 nos introduce en el examen del hecho educativo a la luz de tres ejes inseparables: pensar, vivir y hacer. Por ello, desea recordarnos la importancia de “hacer” la educación de forma metódica y sistemática, pero sobre todo es un llamado a “vivirla” con pasión y a “reflexionar” sobre ella en sosiego. De la adecuada articulación de esos tres centros complementarios depende el futuro de la educación.

Desarrollo de las neurofunciones: implicación en la lectura y escritura en niños de la nacionalidad Waorani en Ecuador

El artículo presenta los procesos de desarrollo de las neurofunciones como un preámbulo al proceso lectoescritor en niños que pertenecen a la nacionalidad waorani del Centro Comunitario Intercultural Bilingüe (CECIB) IKA, Ecuador. Se hace un análisis de los resultados obtenidos en dos baterías de pruebas: Cuestionario de Madurez Neuropsicológica Infantil CUMANIN, y el test de inteligencia no verbal TONI 2 con estos resultados se evidencia la importancia de tomar en cuenta la relación entre desarrollo cognitivo, desarrollo de las neurofunciones y prácticas culturales a la hora de enseñar la lectoescritura de forma contextualizada

Pensar, vivir y hacer la educación: visiones compartidas (Volumen 2)

Pensar, Vivir y Hacer educación: visiones compartidas Vol. 2 nos introduce en el examen del hecho educativo a la luz de tres ejes inseparables: pensar, vivir y hacer. Por ello, desea recordarnos la importancia de “hacer” la educación de forma metódica y sistemática, pero sobre todo es un llamado a “vivirla” con pasión y a “reflexionar” sobre ella en sosiego. De la adecuada articulación de esos tres centros complementarios depende el futuro de la educación

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2