Situación de extraedad, ingreso tardío de los estudiantes as sistemas escolar

Como lo demuestran los resultados de las evaluaciones realizadas por el Ministerio de Educación Nacional-MEN- (2012) en el país, los niños están terminando la primaria sin contar con un dominio adecuado de las competencias básicas. El fracaso escolar se hace evidente en las altas tasas de repetición de los primeros grados, así como la preocupante deserción del sistema, ya sea de manera recurrente o definitiva. De otra parte, y como se argumentó anteriormente, en muchas regiones, especialmente en zonas rurales, el ingreso tardío al sistema escolar aún, es una situación bastante común, pese a los esfuerzos realizados en los últimos años para lograr que todos los niños y niñas accedan oportunamente a la escuela. El MEN ha establecido claros estándares que deben ser apropiados como verdaderos indicadores de medición a la gestión de los actores involucrados en el proceso Enseñanza–Aprendizaje, independientemente que se trate de un modelo pedagógico para la educación regular o para los llamados Métodos Flexibles, caso el programa de Aceleración de Aprendizaje. En este sentido, la definición de estándares en educación tiene varios propósitos. En primera instancia, se trata de orientar los contenidos de la enseñanza y establecer cuáles son esos mínimos conocimientos y destrezas que cada niño debe aprender en su respectivo grado. Por otra parte, los estándares buscan equidad. Es decir, asegurar que todos los niños tengan las mismas oportunidades educativas, independiente de su estrato económico o lugar de residencia. Si no hay estándares, los niños pobres o de minorías no tienen igual acceso a cursos desafiantes; y ante la ausencia de evaluaciones (basadas en dichos estándares) no se puede conocer si la brecha entre la calidad de la educación que están recibiendo los estudiantes está aumentando o disminuyendo. A modo de conclusiones parciales encontradas por los investigadores, como se podrá apreciar al final del trabajo, si bien el municipio de Bello ha incorporado el Programa Extraedad al articularlo como Plan Educativo a su Plan de Desarrollo Municipal, dicho programa refleja grandes deficiencias en materia presupuestal, dificultades persistentes para afrontar la problemática de incursión laboral de adolescentes, falta de interés de algunos cuidadores en el proceso Enseñanza-Aprendizaje mancomunadamente con las instituciones escolares, incipientes ayudas tecnológicas TIC como recursos didácticos que fueron prometidos en la canasta Ingreso tardío de Jóvenes al sistema educativo: problemática social. 18 educativa y, padecimiento desnutricional de infantes y adolescentes que origina ausentismo y deserción

Situación de extraedad, ingreso tardío de los estudiantes as sistemas escolar

Como lo demuestran los resultados de las evaluaciones realizadas por el Ministerio de Educación Nacional-MEN- (2012) en el país, los niños están terminando la primaria sin contar con un dominio adecuado de las competencias básicas. El fracaso escolar se hace evidente en las altas tasas de repetición de los primeros grados, así como la preocupante deserción del sistema, ya sea de manera recurrente o definitiva. De otra parte, y como se argumentó anteriormente, en muchas regiones, especialmente en zonas rurales, el ingreso tardío al sistema escolar aún, es una situación bastante común, pese a los esfuerzos realizados en los últimos años para lograr que todos los niños y niñas accedan oportunamente a la escuela. El MEN ha establecido claros estándares que deben ser apropiados como verdaderos indicadores de medición a la gestión de los actores involucrados en el proceso Enseñanza–Aprendizaje, independientemente que se trate de un modelo pedagógico para la educación regular o para los llamados Métodos Flexibles, caso el programa de Aceleración de Aprendizaje. En este sentido, la definición de estándares en educación tiene varios propósitos. En primera instancia, se trata de orientar los contenidos de la enseñanza y establecer cuáles son esos mínimos conocimientos y destrezas que cada niño debe aprender en su respectivo grado. Por otra parte, los estándares buscan equidad. Es decir, asegurar que todos los niños tengan las mismas oportunidades educativas, independiente de su estrato económico o lugar de residencia. Si no hay estándares, los niños pobres o de minorías no tienen igual acceso a cursos desafiantes; y ante la ausencia de evaluaciones (basadas en dichos estándares) no se puede conocer si la brecha entre la calidad de la educación que están recibiendo los estudiantes está aumentando o disminuyendo. A modo de conclusiones parciales encontradas por los investigadores, como se podrá apreciar al final del trabajo, si bien el municipio de Bello ha incorporado el Programa Extraedad al articularlo como Plan Educativo a su Plan de Desarrollo Municipal, dicho programa refleja grandes deficiencias en materia presupuestal, dificultades persistentes para afrontar la problemática de incursión laboral de adolescentes, falta de interés de algunos cuidadores en el proceso Enseñanza-Aprendizaje mancomunadamente con las instituciones escolares, incipientes ayudas tecnológicas TIC como recursos didácticos que fueron prometidos en la canasta Ingreso tardío de Jóvenes al sistema educativo: problemática social. 18 educativa y, padecimiento desnutricional de infantes y adolescentes que origina ausentismo y deserción

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries