Exigencias laborales y daños en la salud en dos universidades Latinoamericanas: México y Argentina

Studying job demands, also known as requirements, mental load or psychosocial risk factors, is increasingly important in the world of work. These workplace conditions refer to situations that, due to their magnitude, intensity and frequency, could damage physical and mental health. The concept of job demands is used here to refer to job requirements that can cause such damage, including domestic work, which is analyzed as an additional demand. The objective was to carry out a comparative analysis of work demands and damage to health at the Universidad Nacional de Mar del Plata (UNMdP) and the Universidad Autónoma Metropolitana (UAM-X). Two cross-sectional studies were carried out. Job variables and some disorders of interest were measured. The X2 statistic was used, with p<0.05 and 95% CI. Informed consent was obtained. More women (63%) participated at the UNMdP and more men at the UAM-X (57.8%). The demands reported at both universities were: working more than 48 hours per week, computer use, and doing work on non-working days. At the UAM, the perception that work is causing damage to health was nearly twice as prevalent (P.R. 1.9; P<0.003). Depression and fatigue had a higher prevalence at the UNMdP (1.7 and 1.6). Diversity, multiple tasks, and long workdays are affecting the health of university staff. A rethinking about their work and the conditions under which it is carried out is required.El estudio de las exigencias laborales, también conocidas como demandas, carga mental o factores de riesgo psicosocial, ha cobrado relevancia en el mundo laboral. Estas condiciones de trabajo se refieren a las situaciones que, debido a su magnitud, intensidad y frecuencia, podrían causar daños a la salud física y mental. Aquí se utiliza el concepto de exigencia laboral para dar cuenta de aquellos requerimientos laborales que pueden ocasionar esos daños y se analiza el trabajo doméstico como una demanda adicional. El objetivo fue realizar un análisis comparativo de las exigencias laborales y los daños a la salud en la Universidad Nacional de Mar del Plata (UNMdP) y la Universidad Autónoma Metropolitana (UAM-X). Se realizaron dos investigaciones transversales. Se estudiaron variables del trabajo y algunos trastornos de interés. Se utilizó la X2, con p<0.05 e IC al 95%. Se solicitó consentimiento informado. Hay una mayor participación de mujeres (63%) en la UNMdP y de hombres en la UAM-X (57.8%). Las exigencias reportadas en ambas universidades fueron jornadas laborales mayores a 48 horas semanales, uso de computadora y trabajar en días de descanso. En la UAM se halló una percepción duplicada de que el trabajo está ocasionando un daño en la salud (RP. 1.9 P<0.003). La depresión y la fatiga presentaron mayor prevalencia en la UNMdP (1.7 y 1.6). La diversidad, multiplicidad de tareas y prolongación de la jornada laboral, están permeando en la salud del personal universitario. Se requiere una reflexión sobre su quehacer y las condiciones bajo las cuales se realiza

Proyecto PREDIRCAM 2. Análisis preliminar de uso y valoración de la plataforma

En la actualidad, la prevalencia de las enfermedades no transmisibles (Non-communicable diseases NCD) y la cantidad de muertes causadas por éstas es muy elevada, en su mayoría, consecuencia del envejecimiento de la población, el aumento de la obesidad y los hábitos de vida sedentarios. En este trabajo se describen el funcionamiento y los resultados preliminares del proyecto Predircam 2, destinado al desarrollo y validación de una plataforma inteligente de tecnologías biomédicas para la monitorización, prevención y tratamiento personalizados del sobrepeso, la obesidad y la prevención de enfermedades asociadas como la diabetes, hipertensión arterial o alteraciones del metabolismo lipídico. El objetivo de este trabajo es presentar los resultados preliminares del análisis del uso de la plataforma, la evaluación de la usabilidad y la valoración de la atención recibida por los pacientes en relación a los profesionales sanitarios

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 17

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 17 de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada, de acceso abierto a todas las áreas del conocimiento, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico. Con esta colección, se aspira contribuir con el cultivo, la comprensión, la recopilación y la apropiación social del conocimiento en cuanto a patrimonio intangible de la humanidad, con el propósito de hacer aportes con la transformación de las relaciones socioculturales que sustentan la construcción social de los saberes y su reconocimiento como bien público

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

La investigación participativa como práctica Social y su aportación al mundo laboral a través del modelo obrero

Participatory research, also known as “actionoriented research” has made valuable theoretical and methodological contributions that allow us to explore and transform different social contexts: in health, education, communities, communication processes and the labor sector, among others. Its underpinnings allow thoughtful reflection on different practices by social groups, the generation of new knowledge and the acquisition of a new status for both the researcher as well as the group being researched, since both contribute to the generation and sharing of knowledge, and it includes the intent of changing practices to the benefit of a collective, as a way of achieving both immediate and long-term objectives. The articulation of actionoriented research goes through a process of recovering its enormous epistemological, political, ideological and ethical value. One example of participatory research is the Italian Worker Model, which has been implemented, at different times in history, in diverse workplaces and in different social contexts. Its use in some countries makes it still viable, although current social, political and economic conditions indicate the need to develop new proposals that allow, under the framework of participatory research, the generation of a new model that is responsive to these new realities.La investigación participativa (IP), también llamada investigación-acción (IA) ha sido un aporte teórico-metodológico muy valioso para explorar y transformar diferentes contextos sociales: salud, educación, comunidades, procesos de comunicación y el sector laboral, entre otros. Sus principios implican la reflexión sobre diferentes prácticas por parte de los grupos sociales, la generación de nuevos conocimientos y la adquisición de un nuevo status tanto del investigador como del grupo “investigado”, ya que se asume la capacidad de ambos para generar y compartir conocimiento, entraña la intencionalidad de modificar dichas prácticas en beneficio de las colectividades, como una forma de alcanzar objetivos inmediatos pero también satisfactores a largo plazo. La instrumentación de la investigación-acción atraviesa por recobrar su enorme riqueza epistemológica, política, ideológica y ética. Una modalidad de la investigación participante ha sido el Modelo Obrero Italiano, el cual se ha impulsado, en diferentes momentos históricos, al interior de diversos centros de trabajo y distintos contextos sociales. Su puesta en operación en algunos países lo perfila aún como viable, aunque las actuales condiciones sociales, políticas y económicas, señalan la necesidad de la generación de propuestas que permitan, bajo la lógica de la investigación participante, generar un nuevo modelo que de respuesta a las necesidades que la realidad plantea