La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia. Departamentos del Atlántico, Magdalena, Bolívar y Antioquia

El conflicto armado en Colombia ha dejado a lo largo de los más de 50 años de guerras y disputas, un sinnúmero de víctimas, violentadas física, sexual, psicológica y moralmente; niños, adolescentes, jóvenes, hombre y mujeres han padecido de este flagelo que genera un impacto psicosocial importante en el bienestar y desarrollo socioemocional de los individuos. El diplomado de acompañamiento psicosocial en escenarios de violencia, busca reconocer desde el enfoque narrativo y la mirada contextualizada del conflicto, las distintas afectaciones, traumas y procesos restaurativos en poblaciones víctimas del conflicto armado en Colombia. Como cumplimiento de este objetivo, se llevaron a cabo una serie de actividades descritas en el presente trabajo; la experiencia de foto voz aplicada en los departamentos del Atlántico, Magdalena, Bolívar y Antioquia; el análisis de los relatos Carlos Arturo y Peñas Coloradas, donde se contextualizan los impactos psicosociales, las voces y significados en relación a la imagen dominante de la violencia, los posicionamientos resilientes y afrontativos ante las experiencias traumáticas en las victimas; se describen una serie de informes analíticos de los relatos, preguntas circulares, estratégicas y reflexivas del relato Carlos Arturo, y además se evidencia el diseño de estrategias psicosociales para el fortalecimiento de la comunidad Peñas Coloradas. Como conclusión se reconocen las distintas miradas y subjetividades inmersas en los escenarios de violencia, mediante el abordaje de casos y herramientas disciplinares del diplomado; orientando al estudiante de psicología en el reconocimiento del acompañamiento psicosocial a víctimas del conflicto.The armed conflict in Colombia has left throughout the more than 50 years of wars and disputes, countless victims, physically, sexually, psychologically and morally violated; children, adolescents, young people, men and women have suffered from this scourge that generates a significant psychosocial impact on the well-being and socio-emotional development of individuals. The psychosocial accompaniment course in scenes of violence, seeks to recognize from the narrative approach and the contextualized view of the conflict, the different affectations, traumas and restorative processes in populations that are victims of the armed conflict in Colombia. In order to fulfill this objective, a series of activities described in this paper were carried out; the photo voice experience applied in the departments of Atlántico, Magdalena, Bolívar and Antioquia; the analysis of the stories Carlos Arturo and Peñas Coloradas, where the psychosocial impacts, voices and meanings are contextualized in relation to the dominant image of violence, resilient and coping positions in the face of traumatic experiences in the victims; A series of analytical reports of the stories are described, circular, strategic and reflective questions of the Carlos Arturo story, and the design of psychosocial strategies for the strengthening of the Peñas Coloradas community is also evidenced. As a conclusion, the different perspectives and subjectivities immersed in the scenarios of violence are recognized, through the approach of cases and disciplinary tools of the diploma course; guiding the psychology student in the recognition of psychosocial accompaniment to victims of the conflict

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015

Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. LANCET. 2016;388(10053):1659-1724.Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd