Guidelines for the design of actions focused on women victims in the development plans of the Alto Patía

A pesar de la firma del Acuerdo Final para la Terminación del Conflicto y la Construcción de una Paz Estable y Duradera, en la subregión del Alto Patía persiste una alta ocurrencia de hechos victimizantes que afectan de manera desproporcionada a las mujeres víctimas de la subregión. Este impacto desproporcionado hacia las mujeres se manifiesta en las numerosas facetas de género en escenarios de conflicto armado como: la agudización de los patrones estructurales de violencia y discriminación de género ya presentes en la sociedad colombiana; las afectaciones a los proyectos de vida producto de los hechos victimizantes, y los problemas y necesidades específicos de las mujeres víctimas que difieren de las mujeres no desplazadas y de los hombres desplazados. Por ello se requiere, que las entidades territoriales del Alto Patía, como primeros respondientes de la política de víctimas, apropien acciones en sus planes de desarrollo para atender a estas particularidades y con ello, propender por la paz territorial. No obstante, lo que se evidencia, es que, estos no se han manifestado en los planes de desarrollo por la ausencia de capacidades para su implementación. En consecuencia, este documento propone lineamientos para la incorporación de acciones diferenciadas para la atención de las mujeres víctimas en los planes de desarrollo territorial de las entidades del Alto Patía, mediante la incorporación de metas y estrategias, que finalmente conlleven a la paz territorial. Estos lineamientos se basan en esquemas de coordinación nación-territorio, y proponen una perspectiva de gestión de redes y gobernanza colaborativa en la que las mujeres víctimas se convierten en el principal factor transformador de los territorios.Despite the signing of the Final Agreement to End the Conflict, in the Alto Patía subregion there continues to be a high occurrence of victimizing acts that disproportionately affect the female victims who live in this region. This impact on them is manifested in the numerous gender facets to which they are subjected in scenarios of armed conflict, such as the structural patterns of violence and gender discrimination that are present in Colombian society and that are exacerbated in the conflict, the effects on life projects derived from the consequences of the victimizing acts and the specific problems and needs of the women victims as such, which are not experienced by non-displaced women or displaced men. For this reason, it is required that the territorial entities of Alto Patía, as first responders of the public policy of victims, take appropriate actions in their development plans to attend to these particularities and with this, promote territorial peace. Despite this, what is evident is that these commitments have not been manifested in a differentiated way in the local development plans, due to the lack of capacities for their implementation. Therefore, this document seeks to establish guidelines that facilitate this incorporation into local development plans, through interaction schemes based on the principles of Nation-Territory coordination, from the perspective of network management and collaborative governance, in the which women victims become the main processors of their territories.Magíster en Gobierno del Territorio y Gestión PúblicaMaestrí

Guidelines for the design of actions focused on women victims in the development plans of the Alto Patía

A pesar de la firma del Acuerdo Final para la Terminación del Conflicto y la Construcción de una Paz Estable y Duradera, en la subregión del Alto Patía persiste una alta ocurrencia de hechos victimizantes que afectan de manera desproporcionada a las mujeres víctimas de la subregión. Este impacto desproporcionado hacia las mujeres se manifiesta en las numerosas facetas de género en escenarios de conflicto armado como: la agudización de los patrones estructurales de violencia y discriminación de género ya presentes en la sociedad colombiana; las afectaciones a los proyectos de vida producto de los hechos victimizantes, y los problemas y necesidades específicos de las mujeres víctimas que difieren de las mujeres no desplazadas y de los hombres desplazados. Por ello se requiere, que las entidades territoriales del Alto Patía, como primeros respondientes de la política de víctimas, apropien acciones en sus planes de desarrollo para atender a estas particularidades y con ello, propender por la paz territorial. No obstante, lo que se evidencia, es que, estos no se han manifestado en los planes de desarrollo por la ausencia de capacidades para su implementación. En consecuencia, este documento propone lineamientos para la incorporación de acciones diferenciadas para la atención de las mujeres víctimas en los planes de desarrollo territorial de las entidades del Alto Patía, mediante la incorporación de metas y estrategias, que finalmente conlleven a la paz territorial. Estos lineamientos se basan en esquemas de coordinación nación-territorio, y proponen una perspectiva de gestión de redes y gobernanza colaborativa en la que las mujeres víctimas se convierten en el principal factor transformador de los territorios.Despite the signing of the Final Agreement to End the Conflict, in the Alto Patía subregion there continues to be a high occurrence of victimizing acts that disproportionately affect the female victims who live in this region. This impact on them is manifested in the numerous gender facets to which they are subjected in scenarios of armed conflict, such as the structural patterns of violence and gender discrimination that are present in Colombian society and that are exacerbated in the conflict, the effects on life projects derived from the consequences of the victimizing acts and the specific problems and needs of the women victims as such, which are not experienced by non-displaced women or displaced men. For this reason, it is required that the territorial entities of Alto Patía, as first responders of the public policy of victims, take appropriate actions in their development plans to attend to these particularities and with this, promote territorial peace. Despite this, what is evident is that these commitments have not been manifested in a differentiated way in the local development plans, due to the lack of capacities for their implementation. Therefore, this document seeks to establish guidelines that facilitate this incorporation into local development plans, through interaction schemes based on the principles of Nation-Territory coordination, from the perspective of network management and collaborative governance, in the which women victims become the main processors of their territories.Magíster en Gobierno del Territorio y Gestión PúblicaMaestrí

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