Including students with visual impairment in a colombian state university: a descriptive case study

Muchas organizaciones alrededor del mundo, así como el gobierno colombiano, tienen el compromiso de proveer a todos los estudiantes educación de calidad, lo cual implica garantizar una educación inclusiva real. El propósito de este estudio de caso descriptivo cualitativo fue explorar qué se pudo observar en términos de educación inclusiva, en un programa de enseñanza de lengua Inglesa en una universidad pública colombiana, para un estudiante con discapacidad visual, y analizar las percepciones de este estudiante y siete de sus docentes en relación a este proceso de educación inclusiva. Estas percepciones fueron recolectadas a través de entrevistas y recuerdos estimulados para su posterior análisis. Los hallazgos revelan que la universidad en la cual este estudio fue realizado carece de una arquitectura y una infraestructura adecuadas para facilitar la movilidad de personas con discapacidad visual. Además, los siete docentes entrevistados no tienen una formación formal acerca de educación inclusiva, y no reciben ningún apoyo por parte de dicha universidad para enseñarle a un estudiante con discapacidad visual de una manera adecuada. Por otra parte, la falta de conocimiento de los docentes y los compañeros estudiantes acerca de las necesidades de las personas invidentes, hace el proceso de inclusión de este estudiante aún más laborioso

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

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 middle-income 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 low-income 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 low-income, 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

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

Abordaje rehabilitador de la deglución en adultos mayores con enfermedades neurodegenerativas: Revisión sistemática

The present review was proposed in order to compile the existing evidence on the rehabilitative approach in older adults with neurodegenerative diseases, since these treatments directly influence the health of patients. The search methods were implemented under an ordered systematic review process under the Preferred Reporting Items for Systematic Reviews, PRISMA model, in which information is collected chronologically on the scientific evidence of a particular topic. Descriptors such as: Adult, Neurodegenerative, Dysphagia; Rehabilitation. Twenty-one articles were included in the systematic review, including studies and reviews on the treatments used in neurodegenerative diseases. In the findings it is evident inter-transdisciplinary intervention, modification of the environment, use of drugs as a means to mitigate mainly motor symptoms, surgical procedures; in addition, swallowing, compensatory, rehabilitative maneuvers, among others. Some alternatives require the participation of the speech pathologist because in most people suffering from neurodegenerative diseases the oral and / or pharyngeal phase of swallowing is affected, triggering dysphagia in different degrees of severity and directly compromising food intake. due to the risk of aspiration, pneumonia and / or death and, in turn, the quality of life, This systematic review allows us to identify the need to make more proposals for therapeutic options, studies that show their efficacy and that above all generate significant changes in those who suffer described diseases.La presente revisión se planteó con el fin de recopilar la evidencia existente sobre el abordaje rehabilitador de la disfagia en adultos mayores con enfermedades neurodegenerativas, con la intención de encontrar propuestas de tratamientos que influyan de manera positiva en la salud de los pacientes. Los métodos de búsqueda se implementaron bajo un proceso ordenado de revisión sistemática bajo el modelo Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a través de la cual se recolecta información de forma cronológica sobre la evidencia científica de un tema en particular. Para ello se usaron descriptores como: “Adulto; Neurodegenerativa; Disfagia; Rehabilitación”. En la revisión sistemática se incluyeron 21 artículos, entre estos se mencionaron estudios y revisiones sobre los tratamientos empleados en las enfermedades neurodegenerativas. En los hallazgos es evidente la intervención multidisciplinar, modificación del entorno, uso de fármacos como medio para mitigar síntomas principalmente motores, procedimientos quirúrgicos; además, maniobras deglutorias, compensatorias, rehabilitadoras, entre otras. Algunas alternativas requieren de la participación del Fonoaudiólogo/Logopeda debido a que en la mayoría de personas que padecen enfermedades neurodegenerativas se ve afectada la fase oral y/o faríngea de la deglución, desencadenando disfagia en diferentes grados de severidad y comprometiendo de forma directa la ingesta de alimentos debido al riesgo de aspiración, neumonía y/o muerte y a su vez, la calidad de vida. Esta revisión sistemática permite identificar la necesidad de realizar más propuestas terapéuticas, estudios que evidencien su eficacia y que, sobre todo, generen cambios significativos en quienes padecen las enfermedades descritas