La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia en los Departamentos de Caldas, Choco, Risaralda y Valle del Cauca.

La imagen y la narrativa como herramientas para el abordaje psicosocial en escenarios de violencia en los Departamentos de Caldas, Choco, Risaralda y Valle del Cauca.En el presente informe se tiene en cuenta la profundización de los contenidos del curso Diplomado de Profundización de Acompañamiento Psicosocial en Escenarios de Violencia, donde a partir de la revisión del material pedagógico propuesto con diferentes casos de contextos reales sobre la violencia y los hechos victimizantes que por varias regiones de nuestro territorio colombiano ha afectado a su población, debido a la guerra que se desencadeno por el conflicto armado. Estas reflexiones nos dan a conocer los actos atroces, de la violencia injustificada, de las masacres y crímenes por las que han tenido que pasar varias comunidades, dejando no solo vulnerabilidad, exclusión e indiferencia sino secuelas físicas como psicológicas, pero así mismo también a las voces de esperanza, de afrontamiento, de voluntad y ganas de salir adelante e ir superando todo lo vivido. A partir de todo esto, desde el abordaje de la narrativa y la imagen, se analizaron cada uno de los casos y desde el diagnóstico psicosocial se logra rescatar las voces de esperanza, de resiliencia, de voluntad, de reconciliación, para estas comunidades que de una y otra manea han ido transformado su entorno y los contextos a los que están expuestos. Desde nuestra formación como futuros profesionales en el área de la Psicología hemos podido analizar cada contexto y desde la intervención psicosocial hemos brindado herramientas y diferentes estrategias y acciones encaminadas al restablecimiento del tejido social y calidad de vida de estas personas que han sido víctimas de una guerra sin sentido y que llevan consigo las consecuencias como parte de sus vidas.The present report takes into account the deepening of the contents of the Diploma Course of Deepening of Psychosocial Accompaniment in Violence Scenarios, where from the revision of the pedagogical material proposed with different cases of real contexts about violence and victimizing facts that by several regions of our Colombian territory it has affected its population, due to the war that was unleashed by the armed conflict. These reflections give us to know the atrocious acts, of the unjustified violence, of the massacres and crimes for which they have had to pass several communities, leaving not only vulnerability, exclusion and indifference but physical as well as psychological sequels, but also to the voices of hope, of confrontation, of will and desire to get ahead and go overcoming everything that has been lived. From all this, from the approach of the narrative and the image, each case was analyzed and from the psychosocial diagnosis it is possible to rescue the voices of hope, of resilience, of will, of reconciliation, for these communities that both ways have transformed their environment and the contexts to which they are exposed. From our training as future professionals in the area of Psychology we have been able to analyze each context and since the psychosocial intervention we have provided tools and different strategies and actions aimed at restoring the social fabric and quality of life of these people who have been victims of a war meaningless and that carry the consequences as part of their lives

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

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research