Resumen El turismo es un sector económico fuerte en la economía mundial que genera beneficios económicos importantes para los países. Este artículo es resultado de la investigación desarrollada por el grupo CERES. El objetivo de la investigación se centró en la revisión de diferentes modelos de competitividad turística para implementarlos en la Provincia de Sugamuxi, centro de la investigación. Para llegar al cumplimiento de los objetivos, se planteó una metodología cualitativa con un método de análisis documental para destacar los estudios y modelos de competitividad más relevantes para la implementación; lo que generó la aplicación del modelo de Crouch y Ritchie (1999); se identificaron los factores más impactantes para la región. Dentro de los resultados se muestran las fortalezas como el tipo de turismo natural que se genera y dentro de las debilidades la falta de asociación por parte de los actores que intervienen en el sector turístico, encontrando como grandes retos la infraestructura, la información, organización y lazos del mercado, estas debilidades se tienen que mejorar puesto que el sector turístico se está proyectando como clase mundial. JEL: D4; L1; L25; L14; M1

Abstract Tourism is a strong economic sector in the world economy that generates significant economic benefits for countries. This article is the result of research carried out by ``Group CERES``. The objective of the research focused on reviewing different models of tourist competitiveness and implementing them in the Province of Sugamuxi, the focus of the research. To reach the objectives, a qualitative methodology was proposed with a method of documentary analysis to highlight the most relevant studies and competitiveness models for implementation; what generated the application of the Crouch and Ritchie (1999) model; the most impactful factors for the region were identified. The results show the strengths such as the type of natural tourism that is generated and within the weaknesses the lack of association on the part of the actors involved in the tourism sector, finding infrastructure, information, organization and market ties, these weaknesses have to be improved as the tourism sector is projecting itself as world class. JEL: D4; L1; L25; L14; M1

Resumo O turismo é um setor econômico forte na economia mundial que gera benefícios econômicos significativos para os países. Este artigo é resultado de uma pesquisa realizada pelo grupo CERES. O objetivo da pesquisa centrou-se em rever diferentes modelos de competitividad de turística e implementá-los na Província de Sugamuxi, foco da pesquisa. Para atingir o cumprimento dos objetivos, foi proposta uma metodologia qualitativa com um método de análise documental para evidenciar os estudos e modelos de competitividade mais relevantes para implementação; o que gerou a aplicação do modelo de Crouch e Ritchie (1999); os fatores mais impactantes para a região foram identificados. Os resultados mostram os pontos fortes como o tipo de turismo natural que é gerado e dentro dos pontos fracos a falta de associação por parte dos atores envolvidos no setor do turismo, encontrando infraestruturas, informação, organização e laços de mercado, essas fragilidades precisam ser melhoradas, pois o setor de turismo se projeta como de classe mundial. JEL: D4; L1; L25; L14; M1

ABSTRACT Objective: To evaluate the association between HbA1c levels measured in the third trimester and the risk for large for gestational age (LGA) in neonates of mothers affected by gestational diabetes mellitus (GDM). Secondarily, we aimed to identify an ideal cut-off for increased risk of LGA amongst pregnant women with GDM. Materials and methods: Observational retrospective review of singleton pregnant women with GDM evaluated in a diabetes and pregnancy clinic of a tertiary and academic hospital. From January/2011 to December/2017, 1,085 pregnant women underwent evaluation due to GDM, of which 665 had an HbA1c test in the third trimester. A logistic regression model was performed to evaluate predictors of LGA. A receiver-operating-characteristic (ROC) curve was used to evaluate the predictive ability of third trimester HbA1c for LGA identification. Results: A total of 1,085 singleton pregnant women were evaluated during the study period, with a mean age of 32.9 ± 5.3 years. In the multivariate analysis, OGTT at 0 minutes (OR: 1.040; CI 95% 1.006-1.076, p = 0.022) and third trimester HbA1c (OR: 4.680; CI 95% 1.210-18.107, p = 0.025) were associated with LGA newborns. Using a ROC curve to evaluate the predictive ability of third trimester HbA1c for LGA identification, the optimal HbA1c cut-off point was 5.4% where the sensitivity was 77.4% and the specificity was 71.7% (AUC 0.782; p < 0.001). Conclusions: Few studies in the Mediterranean population have evaluated the role of HbA1c in predicting neonatal complications in women with GDM. A third trimester HbA1c > 5.4% was found to have good sensitivity and specificity for identifying the risk of LGA.

Abstract The prevalence of malnutrition in patients with Chronic Kidney Disease is high, increasing in patients with SARS-CoV-2 infection. The relationship between inflammation and nutrition in kidney disease is known, so the previous presence of malnutrition conditions worsens the prognosis of infection. The objective of this article is the creation of specific dietary recommendations for patients with chronic kidney disease and infection or post-infection by the SARS-CoV-2 virus, adapted to the stage of the disease and the stage of the infection process. The nutritional approach begins with the assessment of nutritional status, recommending minimizing physical contact through the use of the Global Leadership Initiative on Malnutrition (GLIM) criteria and the rapid sarcopenia questionnaire (SARC-F). The dietary recommendations should consider the stage of chronic kidney disease, the stage of infection by SARS-CoV-2 and the complications arising that compromise oral intake, among the most common are: anorexia, ageusia, dysphagia and diarrhea. In this document, tables of daily intakes have been prepared adapted to different situations. In those patients who do not meet the nutritional requirements, it is recommended to start with an early nutritional supplementation, considering the consequences of the infection described. Due to the high risk of malnutrition in patients with chronic kidney disease and SARS-CoV-2 infection, it is recommended to adapt the assessment of nutritional status and treatment, as well as to carry out monitoring after the active infection phase.

Resumen La prevalencia de malnutrición en paciente con Enfermedad Renal Crónica es elevada, aumentando en pacientes con infección por SARS-CoV-2. La relación existente entre inflamación y nutrición es conocida en la enfermedad renal, por lo que la presencia previa de cuadros de malnutrición empeora el pronóstico de la infección. El objetivo del presente artículo es la creación de recomendaciones dietéticas específicas para pacientes con enfermedad renal crónica e infección o post- infección por SARS-CoV-2, adaptadas al estadio de enfermedad y a la etapa del proceso de infección. El abordaje nutricional comienza por la valoración del estado nutricional, para lo que se recomiendan minimizar el contacto físico mediante la utilización de los criterios Global Leadership Initiative on Malnutrition (GLIM), y el cuestionario rápido de sarcopenia (SARC-F). Las recomendaciones dietéticas deben considerar el estadio de enfermedad renal crónica, la etapa de infección por SARS-CoV-2 y las complicaciones surgidas que comprometan la ingesta oral, entre las más comunes se encuentran: anorexia, ageusia, disfagia y diarrea. En el presente documento se han elaborado tablas de raciones de ingestas diarias adaptadas a las diferentes situaciones. En aquellos pacientes que no cubran los requerimientos nutricionales se recomienda comenzar con la suplementación nutricional de manera precoz, considerando las consecuencias de la infección descrita. Debido al elevado riesgo de malnutrición en pacientes con enfermedad renal cónica e infección por SARS-CoV-2, se recomienda la adaptación de la valoración del estado nutricional y su tratamiento, así como realizar una monitorización tras la fase de infección activa.