Transmisión generacional de valores y principios para la convivencia con la Madre Tierra del pueblo Miskitu de la comunidad de Tuapi

This study reflects the main practices for the conservation of Good Living and the generational transmission mechanisms for the management, care, use, and conservation of Mother Earth. The methodology used was the Cultivation and Breeding of Wisdom and Knowledge (CCRISAC). The sample consisted of 30 community members who participated in interviews and focus groups.The research describes that Tuapi community, from the Autonomous Region of the Northern Caribbean Coast, has a tropical rainforest ecosystem with forest species and fauna as resources for food, health, and housing construction. Its communal organization is traditional and representative of the Miskitu people, and it is recognized for being a peaceful and united community. The dialogue with the community members reflects that the elders are concerned that the generational transmission of values, and therefore practices, are being lost due to the constant contact with other cultural practices, which produces an accelerated process of transculturation. As a consequence, there is a high level of cultural consumerism, which is causing profound changes in the way the community heritage is used. The main identified problems have to do with the loss of values that begins at home, the lack of security in the community, poor management of natural resources, weakness of the leaders in making decisions for the well-being of Mother Earth. The vision for the future of the elders consists of promoting the recovery of community values and principles, through the generational transmission of knowledge and practices associated with the harmonious coexistence with Mother Earth.El presente estudio refleja las principales prácticas para la conservación del Buen Vivir y los mecanismos de transmisión generacional para el manejo, cuido, uso y conservación de la Madre Tierra. La metodología utilizada fue el Cultivo y Crianzas de Sabidurías y Conocimientos (CCRISAC). La muestra estuvo conformada por 30 comunitarios (as) que participaron en entrevistas y grupos focales. La investigación realizada describe que la comunidad de Tuapi, Región Autónoma de la Costa Caribe Norte, dispone de un ecosistema de bosque tropical húmedo con especies forestales y fauna que son fuente de recursos para alimentación, salud y construcción de viviendas. Su organización comunal es tradicional, representativa del pueblo Miskitu y reconocido por ser una comunidad pacífica y unida.El diálogo con los comunitarios refleja que los ancianos están preocupados puesto que la transmisión generacional de valores, y por ende las prácticas se van perdiendo debido al constante contacto con otras prácticas culturales, lo que produce un proceso acelerado de transculturación. Como consecuencia, se genera un alto consumismo cultural, hecho que está provocando cambios profundos en la forma de aprovechamiento del patrimonio comunitario.  De ahí los principales problemas identificados tienen que ver con la pérdida de valores que inicia desde el hogar, la falta de seguridad en la comunidad, mal manejo de los recursos naturales, debilidad de los líderes en la toma de decisiones para el bienestar de la Madre Tierra. La visión de futuro de las ancianas y ancianos consiste en promover la recuperación de valores y principios comunitarios, a través de la transmisión generacional de conocimientos, prácticas asociadas a la convivencia armoniosa con la madre tierr

Acute otitis externa: Consensus definition, diagnostic criteria and core outcome set development.

OBJECTIVE: Evidence for the management of acute otitis externa (AOE) is limited, with unclear diagnostic criteria and variably reported outcome measures that may not reflect key stakeholder priorities. We aimed to develop 1) a definition, 2) diagnostic criteria and 3) a core outcome set (COS) for AOE. STUDY DESIGN: COS development according to Core Outcome Measures in Effectiveness Trials (COMET) methodology and parallel consensus selection of diagnostic criteria/definition. SETTING: Stakeholders from the United Kingdom. SUBJECTS AND METHODS: Comprehensive literature review identified candidate items for the COS, definition and diagnostic criteria. Nine individuals with past AOE generated further patient-centred candidate items. Candidate items were rated for importance by patient and professional (ENT doctors, general practitioners, microbiologists, nurses, audiologists) stakeholders in a three-round online Delphi exercise. Consensus items were grouped to form the COS, diagnostic criteria, and definition. RESULTS: Candidate COS items from patients (n = 28) and literature (n = 25) were deduplicated and amalgamated to a final candidate list (n = 46). Patients emphasised quality-of-life and the impact on daily activities/work. Via the Delphi process, stakeholders agreed on 31 candidate items. The final COS covered six outcomes: pain; disease severity; impact on quality-of-life and daily activities; patient satisfaction; treatment-related outcome; and microbiology. 14 candidate diagnostic criteria were identified, 8 reaching inclusion consensus. The final definition for AOE was 'diffuse inflammation of the ear canal skin of less than 6 weeks duration'. CONCLUSION: The development and adoption of a consensus definition, diagnostic criteria and a COS will help to standardise future research in AOE, facilitating meta-analysis. Consulting former patients throughout development highlighted deficiencies in the outcomes adopted previously, in particular concerning the impact of AOE on daily life