Accidentes de trabajo con culpa patronal en Colombia. Revisión Sistemática:

Introduction: Introduction: Work accidents have been studied from the perspective of result indicators, quantifying the frequency and severity of those that occurred. However, work accidents continue to be a problem, in 2019 in Colombia there were 611,275. All this leads workers to file lawsuits against employers, which end in convictions by the Supreme Court of Justice in the Labor Cassation Chamber, an aspect that has been little studied.Objective: Explore the risks and non-compliance with legal regulations in workplace accidents where employers were declared at fault in Colombia during 2019 to 2020.Methods: a search was carried out for judgments evidencing employer’s fault for a work accident published in the jurisprudence system of the Supreme Court of Justice.Results: 76 sentences were selected, grouped into categories: number, year, departments, type of injury, risk class, economic activity and non-observance of legal regulations on Safety and Health at Work. Conclusion: 97% of the judgments for non-pecuniary damage show the non-compliance by employers of the legal regulations preceding the current regulations on Safety and Health at Work. They occur in risk companies IV-V (mining, construction and installation of electrical networks).Introducción: Los accidentes de trabajo han sido estudiados desde la perspectiva de los indicadores de resultado, cuantificando la frecuencia y la severidad de los ocurridos. Sin embargo, los accidentes de trabajo continúan siendo una problemática. En el 2019 se presentaron 611.275 en Colombia. Todo esto, lleva a los trabajadores a generar demandas contra empleadores los cuales terminan en condenas por la Corte Suprema de Justicia en Sala de Casación Laboral aspecto que ha sido poco estudiado. Objetivo: Explorar los riesgos y los incumplimientos de las normas legales en los accidentes de trabajo donde se declaró culpa patronal en Colombia durante 2019 a 2020. Métodos: se realizó una búsqueda de sentencias que evidenciaran culpa patronal por accidente de trabajo publicadas en el sistema jurisprudencia de la Corte Suprema de Justicia.Resultados: Se seleccionaron 76 sentencias, agrupadas en categorías: número, año, departamentos, tipo de lesión, clase de riesgo, actividad económica y la inobservancia de normatividad jurídica en Seguridad y Salud en el Trabajo. Conclusión: El 97% de las sentencias por daño moral evidencian el incumplimiento por empleadores de normatividad jurídica precedente a la normatividad actual en Seguridad y Salud en el Trabajo. Ocurren en empresas de riesgo IV-V (minería, construcción e instalación de redes eléctricas)

Los sistemas inteligentes en la prestación del servicio de salud en Colombia. Una aproximación a los aspectos procesales y sustanciales de la responsabilidad civil generada por estos sistemas en procedimientos de cirugías plásticas o reconstructivas

El presente texto es un producto de investigación y busca analizar los efectos de otorgar la calidad de persona electrónica a un sistema inteligente. Se logra con ello la construcción de un paralelo entre la forma como se determina actualmente la responsabilidad médica, cuando se trata de cirugías plásticas, y el modo en el que se debe atribuir de manera autónoma la responsabilidad jurídica a la denominada persona electrónica; por una posible mala praxis que ocasione consecuencias adversas al paciente. Esta situación crea un vacío normativo y exige la posibilidad de construir una nueva figura jurídica en Colombia, que permita adelantar el proceso judicial pertinente, sin desconocer los derechos de los demás actores involucrados en un conflicto. Para demostrarlo, esta investigación utiliza el enfoque cualitativo, a través de un alcance exploratorio; emplea los métodos hermenéutico crítico y holístico, así como las técnicas de revisión documental y de conversación con expertos, y el apoyo de las herramientas de bases de datos como Scielo, Scopus, Redalyc, entre otras

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

Accidentes de trabajo con culpa patronal en Colombia. Revisión Sistemática

Introducción: Los accidentes de trabajo han sido estudiados desde la perspectiva de los indicadores de resultado, cuantificando la frecuencia y la severidad de los ocurridos. Sin embargo, los accidentes de trabajo continúan siendo una problemática. En el 2019 se presentaron 611.275 en Colombia. Todo esto, lleva a los trabajadores a generar demandas contra empleadores los cuales terminan en condenas por la Corte Suprema de Justicia en Sala de Casación Laboral aspecto que ha sido poco estudiado. Objetivo: Explorar los riesgos y los incumplimientos de las normas legales en los accidentes de trabajo donde se declaró culpa patronal en Colombia durante 2019 a 2020. Métodos: se realizó una búsqueda de sentencias que evidenciaran culpa patronal por accidente de trabajo publicadas en el sistema jurisprudencia de la Corte Suprema de Justicia. Resultados: Se seleccionaron 76 sentencias, agrupadas en categorías: número, año, departamentos, tipo de lesión, clase de riesgo, actividad económica y la inobservancia de normatividad jurídica en Seguridad y Salud en el Trabajo. Conclusión: El 97% de las sentencias por daño moral evidencian el incumplimiento por empleadores de normatividad jurídica precedente a la normatividad actual en Seguridad y Salud en el Trabajo. Ocurren en empresas de riesgo IV-V (minería, construcción e instalación de redes eléctricas)

Consumo de açúcar e cárie na primeira infância em Cali, Colômbia

Background: The correlation between early childhood caries (ecc) and the consumption of sugar in foods and beverages in children has not yet been reported in Colombia. Objective: To investigate ecc prevalence and consumption of sugar in foods at day-care pre-schoolers. Design: A descriptive study was conducted with 124 children aged 3-4 years old attending three state funded childcare centres on weekdays and their feeding habits were recorded during 3 months and extrapolated to 1 year. The children ate an institutional determined menu at breakfast, lunch and two in between meals according to guidelines of the “Governmental Day Care Institution” that daily measure calories and classify food groups. After leaving the day-care premises and during the weekends, children feeding was a parenthood responsibility and by questionnaire, mother’s interview and programmed home visit, the dietary habits of children during the weekends was established. The International Caries Detection and Assessment System investigated ECC prevalence Results: Estimated sugar consumption of children per year was 52.20 kg which is high above of who recommendation. Even though there is an increase of eating unhealthy food and beverage intake during weekends, the amount of sugar intake during weekdays was also high and both associates with increased dmft index. Night-time feeding bottle was also associated with ecc. Toothbrush for dental plaque control of those children was also unfair. Conclusion: Excessive sugar intake and unfair toothbrush are important risk factor for ecc amongst Colombian young children. Colombia needs to develop and implement more strict nutritional policies to reduce children’s sugar consumption, and to improve efficient and regular dental plaque control at day-care institutions and at home, to reduce ecc prevalence.Introducción: la correlación entre caries de la infancia temprana y el consumo de azúcar en alimentos y bebidas no ha sido reportada en Colombia. Objetivo: investigar la prevalencia de las caries en la infancia temprana y el consumo de azúcar en alimentos dentro de un jardín de educación preescolar. Diseño: se realizó un estudio descriptivo con 124 niños con edades entre 3 y 4 años que asisten a tres entidades públicas de cuidado infantil entre semana. Se registraron sus hábitos alimenticios durante tres meses y se proyectaron hacia un año. Los niños fueron alimentados de acuerdo con un menú institucional que incluye el desayuno, el almuerzo y dos meriendas entre comidas y que se prepara siguiendo los lineamientos gubernamentales que miden las calorías y clasifican los alimentos por grupos. Luego de dejar la institución, la alimentación de los niños es responsabilidad de los padres y por esto, se les consultó, mediante un cuestionario, una entrevista y una visita domiciliaria, los hábitos alimenticios de los niños durante los fines de semana. La caries de la infancia temprana se investigó a través del sistema internacional de evaluación y detección de las caries. Resultados: por año, se estimó que el consumo de azúcar de los niños es de 52.20 kg, lo que está por encima de la recomendación de la OMS. Incluso, aunque hay un aumento en el consumo de azúcar durante los fines de semana, la cantidad de azúcar entre semana también es importante, lo que se asocia con un incremento en el índice dmft. Asímismo, se asoció el tetero de la noche con la caries de la infancia temprana y se encontró que el cepillado para el control de la placa también es insuficiente. Conclusión: el consumo excesivo de azúcar y el cepillado insuficiente son factores de riesgo importante para el desarrollo de caries de la infancia temprana en los niños colombianos. Colombia necesita promover e implementar políticas nutricionales más estrictas para reducir el consumo de azúcar de los niños y para mejorar el control de la placa dental en instituciones de cuidado y en casa para reducir la prevalencia de la caries en este momento del ciclo vital.Introdução: a correlação entre cárie na primeira infância e o consumo de açúcar em alimentos e bebidas não foi relatada na Colômbia. Objetivo: investigar a prevalência de cárie na primeira infância e o consumo de açúcar em alimentos de uma horta pré-escolar. Desenho: foi realizado um estudo descritivo com 124 crianças de 3 a 4 anos de idade que frequentam três instituições públicas de cuidados infantis durante a semana. Seus hábitos alimentares foram registrados por três meses e projetados para um ano. As crianças foram alimentadas de acordo com um cardápio institucional que inclui café da manhã, almoço e dois lanches entre as refeições, e preparado de acordo com as diretrizes do governo que medem calorias e classificam os alimentos por grupos. Após a saída da instituição, a alimentação das crianças é de responsabilidade dos pais e, por esse motivo, foram consultadas, por meio de questionário, entrevista e visita domiciliar, sobre os hábitos alimentares das crianças nos finais de semana. A cárie infantilfoi investigada através do sistema internacional de detecção e avaliação de cáries. Resultados: por ano, o consumo de açúcar infantil foi estimado em 52,20 kg, acima da recomendação da OMS. Embora exista um aumento no consumo de açúcar nos finais de semana, a quantidade de açúcar durante a semana também é importante, o que está associado a um aumento no índice dmft. Da mesma forma, a mamadeira noturna foi associada a cárie na primeira infância e a escovação para o controle da placa também foi considerada insuficiente. Conclusão: consumo excessivo de açúcar e escovação insuficiente são fatores de risco importantes para o desenvolvimento de cárie na primeira infância em crianças colombianas. A Colômbia precisa promover e implementar políticas nutricionais mais rigorosas para reduzir o consumo de açúcar das crianças e melhorar o controle da placa dentária nas instituições de saúde e em casa para reduzir a prevalência de cárie neste momento do ciclo de vida

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