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

Implementación de un asistente basado en inteligencia artificial para ambientes de aprendizaje de niños con discapacidad visual

“El objetivo principal de la presente investigación fue crear una intervención educativa mediada y guiada por una tecnología emergente como es la inteligencia artificial, de tal forma que configurada como un sistema tutor inteligente comandado por voz, permitiera una comunicación directa entre el alumno con discapacidad visual y la computadora utilizando el lenguaje natural, que coadyuvara a construir aprendizajes significativos y con capacidad de promover la equidad e inclusión educativa, digital, social, y asistencia laboral. Está orientado a alumnos de educación básica del Centro de Atención Múltiple que derivado de su condición presentan dificultades para interactuar con la computadora de manera normal, ya que la accesibilidad y usabilidad del dispositivo no está acorde a sus limitaciones físicas, ni cuentan con las herramientas adecuadas para su aprendizaje. El estudio es cuantitativo, con enfoque de investigación-acción, con estudio de caso, descriptivo, se emplearon las técnicas de observación participante y grupos focales; como instrumentos: una guía y diario de observación, la muestra es no probabilística ya que la selección de las unidades de análisis fueron a criterio del investigador como sujetos tipo.

Felicidad y bienestar humano: Miradas desde la reflexión, investigación y la intervención en América Latina.

The book “Happiness and Human well-being: perspectives from reflection, research, and intervention in Latin America” arises as a process of the Latin American Network of Study and Intervention of Happiness and Well-being formed by a group of academics and researchers from Colombia (linked to the Universidad Nacional Abierta y a Distancia, Universidad Mariana, and Universidad Única), Mexico (linked to the Universidad de Puebla), Argentina (Universidad Católica de Argentina and Universidad de Buenos Aires), and Venezuela (Universidad Metropolitana). Among its value purposes, this network aims to “increase the levels of happiness and well-being of Latin American people in their jobs, their families, educational institutions, and society.” This goal is in full harmony with the third goal of solidarity development of the Organisation for Economic Co-operation and Development (OECD), which seeks to ensure a healthy life and promote well-being at all ages, considering it crucial for sustainable development. Therefore, this book presents nine chapters in which the research results are addressed, or the intervention processes are systematized, including various topics related to the clinic, education, and organizations, thus allowing to show approaches to happiness and human well-being in children and university students. Moreover, the book includes works that relate happiness and well-being with health, life project, and insecurity. In addition, it deepens the understandings of happiness and well-being within the framework of approaches made from optimism, logotherapy, and flourishing. In short, the book is considered an important contribution to the understanding of happiness and human well-being as it reviews different conceptual and theoretical positions and their applications, all based on careful and rigorous academic processes with deep social commitmentEste libro surgió desde la Red latinoamericana de estudio e intervención en felicidad y bienestar consolidada a finales del año 2020. El inicio de este feliz equipo de trabajo se dio a partir de las inquietudes de un grupo de investigadores de la Universidad Nacional Abierta y a Distancia, pertenecientes al Grupo Psicología Desarrollo Emocional y Educación que se interesaron en el análisis y estudio de diferentes problemas relacionados con la calidad de vida y el bienestar. De estas inquietudes nació el evento denominado Coloquio Internacional: Felicidad y Bienestar Humano, cuya primera edición se realizó en 2016 y posteriormente se ha realizado bianualmente (2018 y 2020), cumpliendo ya tres versiones, en las cuales participaron diferentes investigadores y conferencistas sobre el tema y los enfoques particulares propuestos para cada edición.O livro “Felicidade e bem-estar humano: perspectivas de reflexão, pesquisa e intervenção na América Latina” surge como um processo da Rede Latino-Americana para o estudo e intervenção da felicidade e bem-estar formada por um grupo de acadêmicos e pesquisadores da Colômbia ligados à Universidade Nacional Aberta e a Distância, Universidade Mariana e Universidade Única, do México à Universidade de Puebla, da Argentina à Universidade Católica da Argentina e Universidade de Buenos Aires, e da Venezuela à Universidade Metropolitana. Um dos objetivos da rede é “aumentar o nível de felicidade e bem-estar dos latino-americanos em seus empregos, famílias, instituições educacionais e sociedade”, um compromisso que está em plena sintonia com o terceiro objetivo de desenvolvimento solidário da Organização para Cooperação e Desenvolvimento Econômico (OCDE), que visa garantir uma vida saudável e promover o bem-estar em todas as idades, considerando-o essencial para o desenvolvimento sustentável. Assim, o livro apresenta nove capítulos nos quais são abordados resultados de pesquisas ou são sistematizados processos de intervenção, incluindo diversos temas ligados à clínica, educação e organizações que nos permitem mostrar abordagens da felicidade e bem-estar humano em crianças, estudantes universitários, bem como obras que nos permitem relacionar felicidade e bem-estar com saúde, projetos de vida, insegurança; também se aprofunda na própria compreensão da felicidade e bem-estar no marco de abordagens feitas a partir do otimismo, da logoterapia, do florescimento ou do florescimento. Em suma, o livro é considerado uma importante contribuição para a compreensão da felicidade e do bem-estar humano, revisando diferentes posições conceituais e teóricas e suas aplicações, tudo baseado em cuidadosos e rigorosos processos acadêmicos com profundo compromisso social

Estudio de la función endotelial mediante tomografía por emisión de positrones en pacientes con hipercolesterolemia

La hipercolesterolemia predispone al desarrollo de disfunción endotelial (DE) y la DE precipita la aterogénesis. La DE ocurre temprano en el curso de la aterogénesis y es considerada un marcador pronóstico para el desarrollo de cardiopatía isquémica. Objetivo: Evaluar la función endotelial (FE) mediante tomografía por emisión de positrones (PET) de pacientes asintomáticos con dislipidemia sin antecedente de cardiopatía isquémica ni tratamiento hipolipemiante previo. Material y métodos: Se estudiaron catorce pacientes asintomáticos con diagnóstico reciente (&lt; 6 meses) de dislipidemia mediante un perfil lipídico, glucosa en sangre y un estudio de 13N-amonio PET en tres fases: reposo, prueba presora con frío (CPT) y estrés farmacológico con adenosina. Se evaluó su FE mediante el cálculo de la reserva de flujo coronario (RFC), índice de vasodilatación endotelio-dependiente (IVED) y porcentaje del incremento del flujo coronario en CPT (% &#916; FC). Resultados: El 79% de los pacientes tuvieron disfunción endotelial (DE), y todos los valores de los pacientes con dislipidemia fueron menores a los parámetros normales previamente publicados: flujo coronario (FC) en reposo (FCR) 0.44 ± 0.12 vs 0.57 ± 0.147 (p = 0.002), FC en CPT 0.57 ± 0.17 vs 0.88 ± 0.26 (p = 0.001), FC en estrés (FCE) 1.24 ± 0.05 vs 1.81 ± 0.35 (p = 0.005), IVED 1.28 ± 0.25 vs 1.53 ± 0.24 (p 0.017), RFC 2.79 ± 0.94 vs 3.15 ± 0.48 (p 0.198) y % &#916; FC 29.08 ± 24.62% vs 53 ± 24.60% (p 0.022). Conclusiones: Los pacientes asintomáticos en etapas tempranas de dislipidemia tienen mayor prevalencia de DE que puede ser identificada mediante 13N-amonio PET