Review comprehensive effects of psychoanalytic psychotherapy patients attention for victims of spousal abuse

3 p.Introduction: Violence and abuse are phenomena with serious impacts on both the social structure as in everyday life and quality of life of individuals. Objectives: To describe the effects of psychoanalytic psychotherapy in the care of patients who have been victims of spousal abuse. Methodology: A comprehensive review was developed about the effects of psychoanalytic psychotherapy in the care of patients abused in the couple. A total of 13 articles were found and were subject to methodological quality review. Results: Three categories of analysis were identified: method of intervention, psychotherapeutic main objectives and psychotherapeutic achievements in patient care. Discussion: Although achievements are evident in patients victims of abuse treated with psychoanalytic psychotherapy, more research is needed in this area to support the efficacy of this treatment.Introducción: la violencia y el maltrato son fenómenos con serios impactos tanto en la estructura social como en la cotidianidad y calidad de vida de los individuos. Objetivo: describir los efectos de la psicoterapia psicoanalítica en la atención a pacientes víctimas de maltrato conyugal. Metodología: Se desarrolló una revisión de tipo exhaustivo de los efectos de la psicoterapia psicoanalítica en la atención a pacientes víctimas de maltrato a la pareja. Se encontraron 13 artículos que fueron sometidos a revisión de la calidad metodológica. Resultados: se identificaron tres categorías de análisis: método de la intervención, principales objetivos y los logros psicoterapéuticos alcanzados en la atención a pacientes. Discusión: aunque se evidencian resultados en los pacientes víctimas de maltrato tratados con psicoterapia psicoanalítica, se requiere mayor investigación en esta área para sustentar la eficacia de este tratamiento.PregradoPsicólog

Análisis de viabilidad para la creación de un centro para el envejecimiento activo en Bogotá.

El envejecimiento de la población es un fenómeno que se refleja a nivel mundial; en Colombia se prevé un crecimiento del 56% de la población mayor de 60 años para el año 2030 e incluso que para el 2050, esta población tenga el doble del tamaño que tenía en 2015. Hoy por hoy, algunos miembros de este sector de la población no gozan de una calidad de vida óptima o deseable y nos preocupa que, a falta de planificación y acciones, este panorama se continúe replicando. Por lo anterior, se concibe la reflexión de demostrar que, sin importar la edad, se puede ejercer una capacidad laboral efectiva y evolucionar con la tecnología y la sociedad a través de servicios y herramientas integrales enfocadas a la asesoría, orientación, promoción del bienestar, cuidado, activación física y mental de los adultos mayores de 60 años en centros para el envejecimiento activo. De acuerdo con esta idea, se realizó un estudio de viabilidad relacionado con la creación de un centro para el envejecimiento activo en la ciudad de Bogotá; contemplando el estudio de mercado, estudio financiero, marco legal vigente y planeación estratégica.Especialista en Gerencia en Servicios de SaludEspecializació

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

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

Review comprehensive effects of psychoanalytic psychotherapy patients attention for victims of spousal abuse

3 p.Introduction: Violence and abuse are phenomena with serious impacts on both the social structure as in everyday life and quality of life of individuals. Objectives: To describe the effects of psychoanalytic psychotherapy in the care of patients who have been victims of spousal abuse. Methodology: A comprehensive review was developed about the effects of psychoanalytic psychotherapy in the care of patients abused in the couple. A total of 13 articles were found and were subject to methodological quality review. Results: Three categories of analysis were identified: method of intervention, psychotherapeutic main objectives and psychotherapeutic achievements in patient care. Discussion: Although achievements are evident in patients victims of abuse treated with psychoanalytic psychotherapy, more research is needed in this area to support the efficacy of this treatment.Introducción: la violencia y el maltrato son fenómenos con serios impactos tanto en la estructura social como en la cotidianidad y calidad de vida de los individuos. Objetivo: describir los efectos de la psicoterapia psicoanalítica en la atención a pacientes víctimas de maltrato conyugal. Metodología: Se desarrolló una revisión de tipo exhaustivo de los efectos de la psicoterapia psicoanalítica en la atención a pacientes víctimas de maltrato a la pareja. Se encontraron 13 artículos que fueron sometidos a revisión de la calidad metodológica. Resultados: se identificaron tres categorías de análisis: método de la intervención, principales objetivos y los logros psicoterapéuticos alcanzados en la atención a pacientes. Discusión: aunque se evidencian resultados en los pacientes víctimas de maltrato tratados con psicoterapia psicoanalítica, se requiere mayor investigación en esta área para sustentar la eficacia de este tratamiento.PregradoPsicólog

Surgical site infection after gastrointestinal surgery in children : an international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45 center dot 1%) children were from high HDI, 397 (34 center dot 2%) from middle HDI and 239 (20 center dot 6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12 center dot 8% (51/397) in middle HDI and 24 center dot 7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda.Peer reviewe

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit