Safe and just Earth system boundaries.

The stability and resilience of the Earth system and human well-being are inseparably linked1-3, yet their interdependencies are generally under-recognized; consequently, they are often treated independently4,5. Here, we use modelling and literature assessment to quantify safe and just Earth system boundaries (ESBs) for climate, the biosphere, water and nutrient cycles, and aerosols at global and subglobal scales. We propose ESBs for maintaining the resilience and stability of the Earth system (safe ESBs) and minimizing exposure to significant harm to humans from Earth system change (a necessary but not sufficient condition for justice)4. The stricter of the safe or just boundaries sets the integrated safe and just ESB. Our findings show that justice considerations constrain the integrated ESBs more than safety considerations for climate and atmospheric aerosol loading. Seven of eight globally quantified safe and just ESBs and at least two regional safe and just ESBs in over half of global land area are already exceeded. We propose that our assessment provides a quantitative foundation for safeguarding the global commons for all people now and into the future.

Gastrointestinal manifestations of COVID-19 in a Colombian population. A cross-sectional study

Introduction: gastrointestinal involvement in COVID-19 occurs in approximately 20% of patients and may include nausea, vomiting, abdominal pain, diarrhea or abnormal liver function tests. In our country, the characteristics of gastrointestinal involvement in COVID-19 patients have not been studied. Objectives: to determine the prevalence of gastrointestinal and liver involvement in patients with COVID-19 treated at two hospitals in Bogotá, Colombia. To determine the association between COVID-19 gastrointestinal involvement and length of hospital stay, severity and mortality. Design and methodology: a cross-sectional study carried out at two hospitals in a hospital subnetwork in Bogotá, Colombia from February 2020 to March 2021. Results: a total of 1,176 patients with a positive reverse transcription polymerase chain reaction (RT-PCR) were included. Gastrointestinal manifestations occurred in 50% (95%CI 47-52%), with the most frequent being diarrhea in 18.4%, odynophagia in 17.6%, anorexia in 14.7% and abdominal pain in 8.8%. An association was found between diarrhea during hospitalization and prolonged hospitalization (OR 1.93 95%CI 1.19-3.13), and between gastrointestinal bleeding on admission and death (OR 3.13, 95%CI 1.1-9.1), among others. Abnormal liver function tests occurred in 46% (95%CI 43-49%) and were more frequent in patients with severe disease and those who died. Conclusions: the prevalence of gastrointestinal manifestations in patients with COVID-19 was 50%. Diarrhea was associated with a longer hospital stay, and gastrointestinal bleeding was associated with respiratory failure and death. Forty-six percent of patients had abnormal liver function tests, with elevated transaminases being the most frequent. Elevated aspartate transaminase (AST) on admission was associated with greater mortality. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2729).

Tracheoesophageal fistulas in coronavirus disease 2019 pandemic: A case report.

BACKGROUND: Tracheoesophageal fistulas (TEFs) can be described as a pathological communication between the trachea and the esophagus. According to their origin, they may be classified as benign or malignant. Benign TEFs occur mostly as a consequence of prolonged mechanical ventilation, particularly among patients exposed to endotracheal cuff overinflation. During the severe acute respiratory syndrome coronavirus 2 virus pandemic, the amount of patients requiring prolonged ventilation rose, which in turn increased the incidence of TEFs. CASE SUMMARY: We report the cases of 14 patients with different comorbidities such as being overweight, or having been diagnosed with diabetes mellitus or systemic hypertension. The most common symptoms on arrival were dyspnea and cough. In all cases, the diagnosis of TEFs was made through upper endoscopy. Depending on the location and size of each fistula, either endoscopic or surgical treatment was provided. Eight patients were treated endoscopically. Successful closure of the defect was achieved through over the scope clips in two patients, while three of them required endoscopic metal stenting. A hemoclip was used to successfully treat one patient, and it was used temporarily for another patient pended surgery. Surgical treatment was performed in patients with failed endoscopic management, leading to successful defect correction. Two patients died before receiving corrective treatment and four died later on in their clinical course due to infectious complications. CONCLUSION: The incidence of TEFs increased during the coronavirus disease 2019 pandemic (from 0.5% to 1.5%). We believe that endoscopic treatment should be considered as an option for this group of patients, since evidence reported in the literature is still a growing area. Therefore, we propose an algorithm to lead intervention in patients presenting with TEFs due to prolonged intubation.

Impacto de la elevación de la cabecera de la cama en los síntomas de pacientes con enfermedad por reflujo gastroesofágico: estudio aleatorizado simple-ciego (IBELGA) / Impact of head of bed elevation in symptoms of patients with gastroesophageal reflux disease: a randomized single-blind study (IBELGA)

INTRODUCCIÓN: El impacto clínico de la elevación de la cabecera de la cama en pacientes con enfermedad por reflujo gastroesofágico es incierto, por inconsistencia y limitaciones metodológicas en estudios previos. PACIENTES Y MÉTODOS: Ensayo clínico controlado aleatorizado unicéntrico simple-ciego cruzado 2x2, en 39 pacientes con enfermedad por reflujo gastroesofágico tratados farmacológicamente. La intervención fue elevar la cabecera de la cama a 20 cm de altura durante 6 semanas y luego a dormir sin inclinación otras 6 semanas, con un lavado de 2 semanas entre períodos. El desenlace primario fue el cambio ≥ 10% de la puntuación RDQ y los desenlaces secundarios fueron el cambio ≥ 10% de la puntuación SF-36, preferencia del paciente y frecuencia de eventos adversos. RESULTADOS: 27 (69,2%) pacientes que utilizaron la intervención cumplieron el desenlace primario, vs. 13 (33,3%) pacientes en el grupo control (RR: 2,08; IC95%: 1,19 - 3,61). No se encontró efecto en la puntuación SF-36 (RR: 1,11; IC95%: 0,47 - 2,60). La preferencia por la intervención fue del 77,1% y la proporción de eventos adversos fue del 54,0%. CONCLUSIÓN: La elevación de la cabecera de la cama redujo los síntomas de reflujo, pero no tuvo efecto en la calidad de vida. Por un balance riesgo-beneficio no óptimo, se requieren estudios adicionales antes de recomendar esta intervención (IBELGA, identificador ClinicalTrials.gov NCT02706938)

BACKGROUND: The clinical impact of head-of-bed elevation in patients with gastro-oesophageal reflux disease is unclear, because of inconsistency and methodological limitations of previous studies. PATIENTS AND METHODS: A randomised single-blind single-centre controlled clinical trial with a 2x2 cross-over design, in 39 pharmacologically treated patients with gastro-oesophageal reflux disease. Active intervention was to use a head-of-bed-elevation of 20cm for 6 weeks and then to sleep without inclination for 6 additional weeks, with a wash-out of 2 weeks between periods. The primary outcome was a change ≥ 10% in RDQ score and secondary outcomes were a change ≥ 10% in SF-36 score, patient preference and frequency of adverse events. RESULTS: 27 (69.2%) patients who used the intervention reached the primary outcome vs 13 (33.3%) patients in the control group (RR: 2.08; 95 CI%: 1.19 - 3.61). No effect was found in SF-36 score (RR: 1.11; 95% CI: 0.47 - 2.60). Preference favouring the intervention was 77.1% and adverse event proportion was 54.0%. CONCLUSION: Head-of-bed elevation improved reflux symptoms but there was no effect on quality of life. The finding of a non-optimal risk-benefit ratio warrants additional studies before this intervention can be recommended (IBELGA, ClinicalTrials.gov identifier NCT02706938)

Impact of head of bed elevation in symptoms of patients with gastroesophageal reflux disease: a randomized single-blind study (IBELGA). / Impacto de la elevación de la cabecera de la cama en los síntomas de pacientes con enfermedad por reflujo gastroesofágico: estudio aleatorizado simple-ciego (IBELGA).

BACKGROUND: The clinical impact of head-of-bed elevation in patients with gastro-oesophageal reflux disease is unclear, because of inconsistency and methodological limitations of previous studies. PATIENTS AND METHODS: A randomised single-blind single-centre controlled clinical trial with a 2x2 cross-over design, in 39 pharmacologically treated patients with gastro-oesophageal reflux disease. Active intervention was to use a head-of-bed-elevation of 20cm for 6 weeks and then to sleep without inclination for 6 additional weeks, with a wash-out of 2 weeks between periods. The primary outcome was a change ≥10% in RDQ score and secondary outcomes were a change ≥10% in SF-36 score, patient preference and frequency of adverse events. RESULTS: 27 (69.2%) patients who used the intervention reached the primary outcome vs 13 (33.3%) patients in the control group (RR: 2.08; 95 CI%: 1.19 - 3.61). No effect was found in SF-36 score (RR: 1.11; 95% CI: 0.47 - 2.60). Preference favouring the intervention was 77.1% and adverse event proportion was 54.0%. CONCLUSION: Head-of-bed elevation improved reflux symptoms but there was no effect on quality of life. The finding of a non-optimal risk-benefit ratio warrants additional studies before this intervention can be recommended (IBELGA, ClinicalTrials.gov identifier NCT02706938).

Evaluación de la función sexual en mujeres con cáncer de mama, en el Quindío / Evaluation of sexual function in women with breast cancer in Quindío

Objetivo. Evaluar las alteraciones de la función sexual en las mujeres del Quindío que padecen cáncer de mama. Materiales y Métodos. Estudio de tipo observacional, descriptivo y transversal; incluyó una muestra de 48 mujeres con diagnóstico de cáncer de mama; evaluadas mediante el instrumento Índice de Función Sexual Femenina (IFSF), entre junio de 2016 a junio de 2017. Resultados. El promedio de edad fue de 46.8±7.5 años. Alrededor de una tercera parte de las mujeres (29.16%) tenían entre 55 y 64 años. El promedio del puntaje total del IFSF, en la población afectada, fue de 18,09±4,14 puntos (rango 6.81±30.57), estableciendo una prevalencia de trastornos sexuales del 54.16%. El deseo sobresale como la principal alteración (54.16%) y el orgasmo (45.83%). El 58.33% presentó, en simultánea, dos o más trastornos asociados. Conclusiones. Un significativo porcentaje de mujeres con cáncer de mama presentan algún grado de afectación de su función sexual, siendo el deseo y el orgasmo, los más afectados. La alteración de la función sexual es más frecuente en la población de más de 55 años, en las que recibieron quimioterapia y radioterapia, así como en las que se les hizo mastectomía radical.

Objective. To evaluate the alterations of sexual function in Quindío women suffering from breast cancer. Material and Methods. Observational, descriptive and cross-sectional study; It included a sample of 48 women diagnosed with breast cancer; evaluated using the Female Sexual Function Index (IFSF) instrument, between June 2016 and June 2017. Results. The average age was 46.8 ± 7.5 years. About a third of the women (29.16%) were between 55 and 64 years old. The average total IFSF score in the affected population was 18.09 ± 4.14 points (range 6.81 ± 30.57), establishing a prevalence of sexual disorders of 54.16%. Desire stands out as the main alteration (54.16%) and orgasm (45.83%). 58.33% presented, simultaneously, two or more associated disorders. Conclusions. A significant percentage of women with breast cancer have some degree of affectation of their sexual function (62.5 %%), with desire and orgasm being the most affected. The alteration of sexual function is more frequent in the population over 55 years of age, in those who received chemotherapy and radiotherapy, as well as in those who underwent radical mastectomy.

Evaluación de la función sexual en mujeres con cáncer de mama, en el Quindío / Evaluation of sexual function in women with breast cancer in Quindío

Objetivo. Evaluar las alteraciones de la función sexual en las mujeres del Quindío que padecen cáncer de mama. Materiales y Métodos. Estudio de tipo observacional, descriptivo y transversal; incluyó una muestra de 48 mujeres con diagnóstico de cáncer de mama; evaluadas mediante el instrumento Índice de Función Sexual Femenina (IFSF), entre junio de 2016 a junio de 2017. Resultados. El promedio de edad fue de 46.8±7.5 años. Alrededor de una tercera parte de las mujeres (29.16%) tenían entre 55 y 64 años. El promedio del puntaje total del IFSF, en la población afectada, fue de 18,09±4,14 puntos (rango 6.81±30.57), estableciendo una prevalencia de trastornos sexuales del 54.16%. El deseo sobresale como la principal alteración (54.16%) y el orgasmo (45.83%). El 58.33% presentó, en simultánea, dos o más trastornos asociados. Conclusiones. Un significativo porcentaje de mujeres con cáncer de mama presentan algún grado de afectación de su función sexual, siendo el deseo y el orgasmo, los más afectados. La alteración de la función sexual es más frecuente en la población de más de 55 años, en las que recibieron quimioterapia y radioterapia, así como en las que se les hizo mastectomía radical.

Objective. To evaluate the alterations of sexual function in Quindío women suffering from breast cancer. Material and Methods. Observational, descriptive and cross-sectional study; It included a sample of 48 women diagnosed with breast cancer; evaluated using the Female Sexual Function Index (IFSF) instrument, between June 2016 and June 2017. Results. The average age was 46.8 ± 7.5 years. About a third of the women (29.16%) were between 55 and 64 years old. The average total IFSF score in the affected population was 18.09 ± 4.14 points (range 6.81 ± 30.57), establishing a prevalence of sexual disorders of 54.16%. Desire stands out as the main alteration (54.16%) and orgasm (45.83%). 58.33% presented, simultaneously, two or more associated disorders. Conclusions. A significant percentage of women with breast cancer have some degree of affectation of their sexual function (62.5 %%), with desire and orgasm being the most affected. The alteration of sexual function is more frequent in the population over 55 years of age, in those who received chemotherapy and radiotherapy, as well as in those who underwent radical mastectomy.

The undisciplinary journey: early-career perspectives in sustainability science.

The establishment of interdisciplinary Master's and PhD programs in sustainability science is opening up an exciting arena filled with opportunities for early-career scholars to address pressing sustainability challenges. However, embarking upon an interdisciplinary endeavor as an early-career scholar poses a unique set of challenges: to develop an individual scientific identity and a strong and specific methodological skill-set, while at the same time gaining the ability to understand and communicate between different epistemologies. Here, we explore the challenges and opportunities that emerge from a new kind of interdisciplinary journey, which we describe as 'undisciplinary.' Undisciplinary describes (1) the space or condition of early-career researchers with early interdisciplinary backgrounds, (2) the process of the journey, and (3) the orientation which aids scholars to address the complex nature of today's sustainability challenges. The undisciplinary journey is an iterative and reflexive process of balancing methodological groundedness and epistemological agility to engage in rigorous sustainability science. The paper draws upon insights from a collective journey of broad discussion, reflection, and learning, including a survey on educational backgrounds of different generations of sustainability scholars, participatory forum theater, and a panel discussion at the Resilience 2014 conference (Montpellier, France). Based on the results from this diversity of methods, we suggest that there is now a new and distinct generation of sustainability scholars that start their careers with interdisciplinary training, as opposed to only engaging in interdisciplinary research once strong disciplinary foundations have been built. We further identify methodological groundedness and epistemological agility as guiding competencies to become capable sustainability scientists and discuss the implications of an undisciplinary journey in the current institutional context of universities and research centers. In this paper, we propose a simple framework to help early-career sustainability scholars and well-established scientists successfully navigate what can sometimes be an uncomfortable space in education and research, with the ultimate aim of producing and engaging in rigorous and impactful sustainability science.

Experiencias en la formación de médicos familiares en la modalidad a distancia y virtual: una posibilidad para el sistema de salud colombiano / Experiencies in training family physicians through both virtual and distance-learning modes: a possibility for Colombia ́s health system / Experiências na formação de médicos familiares à distância e virtual: uma possibilidade para o sistema de saúde colombiano

Introducción. Mediante la Resolución 429 de 2016, Colombia adoptó el modelo de Atención Primaria en Salud como una política de atención integral en salud. Los médicos familiares son un elemento fundamental para su desarrollo. Para 2014, se estimó que en Colombia había poco más de 1,2 médicos familiares por 100.000 habitantes y solo siete programas de formación de posgrado presencial en todo el país, concentrados en las ciudades más desarrolladas. Por este motivo, el Ministerio de Educación y el Ministerio de Salud y Protección Social buscan incrementar la formación de especialistas en Medicina Familiar. Brasil, India, México, Paraguay y Sudan, entre otros países, exploraron la educación virtual y a distancia como una opción de formación médica para esta especialidad. Por lo anterior, los investigadores se preguntaron si las características que permitieron el desarrollo de estas experiencias en otros países podrían servir para orientar la creación de un programa similar en Colombia. Objetivo. Hacer una descripción detallada de las características que permitieron el desarrollo de experiencias de formación a distancia y virtual para médicos familiares en el mundo y, a partir de su análisis, encontrar bases que puedan servir para el desarrollo de un programa similar en Colombia. Metodología. Se trata de un estudio cualitativo, hermenéutico, basado en la recopilación y el análisis documentales. La búsqueda se hizo en Pub-med, ProQuest, Embase, Lilacs, Bireme, Springer Link, PlosOne y World Library of Science, utilizando los términos "distance learning", "family practice", "e-learning", "education B-learning", "ICT learning", "computer-assisted instruction", "educación a distancia", "educación virtual", y "medicina familiar y comunitaria". Resultados. Se seleccionaron 71 artículos de 23 países. Se señalaron las características comunes en los programas de educación virtual y a distancia, mediante una matriz de fortalezas, oportunidades, debilidades y amenazas, y se reseñaron los rasgos políticos, económicos, sociales, y tecnológicos del contexto colombiano que pudieren favorecer o no el desarrollo de un programa similar. Conclusiones. La educación de posgrado a distancia para médicos familiares ha sido posible en diferentes países. En Colombia, deben desarrollarse ajustes políticos, económicos, tecnológicos y legales para que un programa de estas características tenga un impacto significativo en el desarrollo de la especialidad.

Overview: Through Resolution 429 promulgated in 2016, Colombia adopts Primary Care model as comprehensive health service policy and family physicians have been essential for such model adoption. According to different sources, in 2014 there was an estimated 1.2 family physicians per 100.000 in-habitants and only 7 Family Medicine postgraduate programs throughout the country. Consequently, Colombia ́s National Health Ministry sought to increase training of Family Physicians. Countries such as Brazil, India, México, Paraguay y Sudan looked into virtual and distance- learning strategies as options for family physicians training. This led researchers to inquire whether such education options could allow the implementation of similar experiences in ColombiaObjective: Conducting a thorough description of features involved in the development of distance-learning and virtual education strategies for family physician training worldwide. Such description aimed as a means to develop a similar program in Colombia. Methodology: Qualitative-hermeneutic study based on data collection and analysis. Search was conducted through the following web search engines: PubMed, ProQuest, Embase, Lilacs, Bireme, Springer Link, Plos One and World library Of Science. Search terms included: "distance learning", "family practice", "e-learning", "education B-learning", "ICT learning", "computer-assisted instruction", " distance-learning education", "on -line education" and "family and community medicine." Results: 71 articles from 23 countries around the world were selected. Commonalities amongst on line education and distance-learning programs were drawn through the use of SWOT analysis that included social, political, economic and technological contextual features that may favor or hinder the development of a similar program in Colombian Conclusions: Graduate distance learning for Family Physicians has been successful in various countries. Colombia ought to implement political, economic, technological and legal adjustments to allow for the development of such an educational program and its significant impact for this medical specialty.

Introdução. Em 2016 mediante a Resolução 429, a Colômbia adotou o modelo de Atenção primária em Saúde (APS) como uma política de atenção integral em saúde (PAIS), os médicos familiares são um elemento fundamental para seu desenvolvimento. Para 2014 foi estimado no país mais do que 1,2 médicos familiares por cada 100.000 habitantes e somente 7 programas de formação de Pós-Graduação presencial no país todo, concentrados nas principais cidades. Os Ministérios de Educação e de Saúde e proteção Social procuram incrementar a formação de especialistas em Medicina Familiar. Brasil, India, México, Paraguay e Sudán, são entre outros países, exploraram a educação virtual e a distância como uma opção de formação médica para esta especialidade. Pelo anterior, os pesquisadores questionam sobre se as características que permitiram o desenvolvimento dessa experiência nesses países, servem para orientar a criação de um programa semelhante na Colômbia. Objetivo. Descrever detalhadamente as características que permitiram o desenvolvimento de experiências de formação à distância e virtual para médicos familiares no mundo, para buscar alternativas de desenvolvimento de um programa semelhante na Colômbia.Metodologia. estudo qualitativo, hermético, baseado na colheita e análise documental. A busca bibliográfica foi realizada nas bases de dados especializadas (Pubmed, ProQuest, Embase, Lilacs, Bireme, Springer Link, Plos One y World library Of Science) usando os térmos "distance learning", "family practi-ce", "e-learning", "education B-learning", "ICT learning", "computer-assisted instruction", "educación a distancia", "educación virtual" e "medicina familiar y comunitaria". Resultados. Foram selecionados 71 artigos de 23 países para identificar características comuns dos programas de educação virtual e a distância, com fortalezas, oportunidades, fraquezas e ameaças, sendo também resenhados os atributos políticos, econômicos, sociais e tecnológicos do contexto colombiano. Conclusões. A educação de Pós-graduação a distância para médicos familiares tem sido possível em vários países. Na Colômbia podem ser desenvolvidos ajustes para gerar as condições que favoreçam a realização de um programa como esse com alto impacto significativo.

Operationalising a social-ecological system perspective on the Arctic Ocean.

We propose a framework to support management that builds on a social-ecological system perspective on the Arctic Ocean. We illustrate the framework's application for two policy-relevant scenarios of climate-driven change, picturing a shift in zooplankton composition and alternatively a crab invasion. We analyse archetypical system dynamics between the socio-economic, the natural, and the governance systems in these scenarios. Our holistic approach can help managers identify looming problems arising from complex system interactions and prioritise among problems and solutions, even when available data are limited.

Estrés, estrategias de afrontamiento, estilos de aprendizaje, y comunicación asertiva, en una muestra de estudiantes del Programa de Medicina de la Universidad de Manizales, y diseño de un proceso de mejora: 2012 / Stress, coping strategies, learning styles, and assertive communication, in a sample of students of the Medicine Program at the University of Manizales, and design of an improve-ment process: 2012

Objetivo: El propósito de esta investigación fue identificar las causas de estrés académicos en los estudiantes de primero y segundo Semestre del Programa de Medicina de la Universidad de Manizales, además identificar las estrategias de afrontamiento del mismo; el componente de investigación aplicada consistió en fomentar el uso de estrategias de afrontamiento asertivo del estrés en esta población, mediante la implementación de un programa tendiente a controlar los niveles de frustración. Materiales y métodos: Estudio cuasi-experimental, participaron 47 estudiantes de primer y segundo semestre del programa de medicina de la Universidad de Manizales. Se diseñó un proceso de 7 sesiones, en el cual se evaluaron los niveles de estrés, estrategias de afronatmiento, métodos de estudio, a través de cuestionarios diagnósticos, además se intervino con talleres sobre técnicas de estudio, técnicas de relajación, comunicación asertiva y proyecto de vida. Resultados: La búsqueda de apoyo social como estrategia de afrontamiento del estrés se encontró en un 29,8% de los estudiantes participantes, en un 46,8%; se identificó un riesgo de somatizar el estrés, predomina el estilo de aprendizaje teórico 31,9%, el 42,6% prefiere el método visual como canal de aprendizaje. Los participantes dieron al proceso una calificación promedio de 4,03 sobre la base de su utilidad inmediata en su vida académica. Conclusiones: El estudio permitió confirmar la necesidad de establecer y mantener un adecuado equipo de apoyo interdisciplinario dirigido a ofrecer apoyo y orientación a los estudiantes en sus primeros semestres de vida universitaria.