Bienes simbólicos: ciudadanía y educación popular

El proyecto del Voluntariado (SPU) y de un programa interinstitucional articulado desde la UNVM, desarrolla en el barrio Las Playas de Villa María (Córdoba), experiencias de participación ciudadana y educación popular a partir de la creación de talleres culturales, educativos y artísticos para niños, en la lógica de la Educación Popular. Las condiciones de posibilidad de este proyecto se actualizan en el nuevo contexto de redefiniciones de la relación Estado-Sociedad a partir de la centralidad que están adquiriendo las políticas públicas. Por ello vimos necesario construir estrategias pedagógicas-políticas que tiendan a fortalecer el acceso a recursos sociales que favorezcan la participación real de los sectores populares en la negociación redistributiva. De esta manera se consolidan acciones que tiendan a transformar las relaciones de opresión social en la infancia, contraponiendo el fortalecimiento de vínculos democráticos. La construcción de la ciudadanía tiene como objeto favorecer el acceso a bienes materiales y simbólicos que amplíen el horizonte de lo posible, y que desnaturalicen los límites en estos niños, habilitando herramientas que permitan posicionarlos políticamente como parte de un Estado y de una territorialidad -material y simbólica- que impacta en su vida cotidiana. Pensar la ciudadanía implica entenderla como un proceso político permanente, dialógico y por ello superador de aquellas nociones totalizadoras de raíz liberal que la interpretan como un concepto estático. Como estudiantes y docentes de la Universidad Nacional de Villa María, recuperamos a la Educación Popular como lógica político pedagógica que propone una relación donde el conocimiento y los saberes –académicos y populares- interactúan en la resolución colectiva de necesidades y articulan demandas que amplíen los umbrales ciudadanos. Creemos que la Extensión Universitaria potencia la apertura a la docencia y a la investigación de las voces de las clases subalternas, pero también permite objetivar los límites que las lógicas de conocimiento han venido produciendo en esa apertura. En este sentido cuando Freire recomienda construir el universo temático que da sentido a las prácticas populares “para conocer, dialogando con ellas, no sólo la objetividad en que se encuentran, sino la conciencia que de esta objetividad estén teniendo, vale decir, los varios niveles de percepción que tengan de sí mismos y del mundo en el que y con el que están”, deberíamos hacer lo mismo con los sentidos que sostienen el universo temático de nuestros espacios académicos, para que el diálogo con el afuera nos interpele como co-reponsables de las transformaciones que supone un proyecto educativo liberador

Femvertising : entre la ola verde y el mercado

Femvertising es el neologismo de habla inglesa con el cual la comunicación publicitaria se refiere a la publicidad feminista. Según la mayor parte de los textos, femvertising unifica los términos feminisim y advertising. En español, mujer o feminismo y publicidad. Es decir, reúne el movimiento social que busca definir, establecer y defender los derechos políticos, económicos, culturales y sociales de las mujeres y terminar con las diferencias y opresión de género con la clase de comunicación que busca influir en las decisiones de compra de la población a través de un determinado lenguaje, imágenes y las construcciones de representación.Fil: Miranday, Agustina. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Buenos Aires, ArgentinaFil: Romano, Lucía Carla. Universidad de Buenos Aires. Facultad de Ciencias Sociales. Buenos Aires, Argentin

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

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