Resumen La sífilis es una enfermedad prevenible mediante barreras de protección sexual, y curable por un sen cillo tratamiento. A pesar de esto, entre 2010 y 2019, su incidencia casi se triplicó en Argentina, alcanzando 56.1/100 000. Los más afectados son los jóvenes (15-24 años), con mayor porcentaje de mujeres, especialmente entre las embarazadas, en que aumentó de 2.3% a 5.8%, con un pico de 7.7% entre 15 y 24 años. Los casos de sífilis secundaria o terciaria, detectados por pruebas de control, están en aumento. El aumento de sífilis va unido al HIV. Por ello las prue bas rápidas de detección deben hacerse conjuntamente en el primer nivel de atención, lo que facilita el acceso al diagnóstico y al tratamiento de los casos positivos, con la orientación y control correspondientes. El tratamiento con penicilina, para la que no se ha hallado resistencia, es el componente clave del control. También se usa doxicilina (no en embarazadas), o cef triaxona. Está aumentando la resistencia del Treponema pallidum a la azitromicina, por lo que debe evitarse su empleo. En 2022 se notificaron 696 casos de sífilis congénita. La tasa de nacional es 1.3 por 1000 nacidos vivos. La mayoría de los casos notificados provienen del sector público. La sífilis materna es, en áreas de bajos recursos, la causa más común de nacidos muertos. La aplicación estricta de las normas existentes, el fortalecimiento del sistema de atención primaria, y la prevención durante el embarazo, pueden contribuir a controlar y eliminar el problema de la sífilis en Argen tina.

Abstract Syphilis is a disease preventable through sexual pro tection barriers, and curable with a simple treatment. Despite this, between 2010 and 2019, its incidence al most tripled in Argentina, reaching 56.1/100 000. The most affected are young people (15-24 years old), with a higher percentage of women, especially among pregnant women, in whom it increased from 2.3% to 5.8%, with a peak of 7.7% between 15 and 24 years old. Cases of secondary or tertiary syphilis, detected by control tests, are on the rise. The increase in syphilis is linked to HIV. For this reason, rapid detection tests must be carried out jointly at the first level of care, which facilitates access to the diagnosis and treatment of positive cases, with the cor responding guidance and control. Treatment with penicillin, for which no resistance has been found, is the key component of control. Doxycillin is also used (not in pregnant women), or ceftriaxone. The resistance of Treponema pallidum to azithromycin is increasing, so its use should be avoided. In 2022, 696 cases of congenital syphilis were re ported. The national rate is 1.3 per 1000 live births. The majority of reported cases come from the public sector. Maternal syphilis is, in low-income areas, the most com mon cause of stillbirths. Strict application of existing regulations, strength ening the primary care system, and prevention during pregnancy can contribute to controlling and eliminating the syphilis problem in Argentina.

Abstract Background Psoriasis is a skin disease that affects 1.3% of Brazilians. The use of teledermatology (TD) in the public health sector has democratized access to dermatological care. Objective To analyze TD exams with suspected and/or diagnosed psoriasis performed between 2016‒2020 in the state of Santa Catarina (SC). Methods Analytical cross-sectional observational study that used secondary data collected from the records of TD exams from the Telemedicine and Telehealth System (TTS) of SC. The associations were evaluated by the chi-square test and Student'st test. The significance level was set at 5% (p < 0.05). Results During the period, 6,146 TD exams were related to psoriasis, 58% due to the diagnosis provided by the reporting dermatologist and 42% exclusively due to the suspected disease on the request of the examination. The male sex predominated among the diagnoses of dermatosis (51%; p < 0.001). Regarding risk classification, psoriasis diagnoses were predominantly yellow (58.7%; p < 0.001) or blue (39.7%; p < 0.001) risk, respectively indicating moderate to severe psoriasis (referral to tertiary care) and mild psoriasis (treatment in the primary health care [PHC] level). True positive tests, suspected by PHC and diagnosed with psoriasis through TD, were 34.1% (p < 0.001). Study limitations The TD service is available only for the public health network and analysis for a limited period (five years). Conclusions Psoriasis diagnoses performed by TD, when compared to other dermatoses, tend to receive treatment at the primary (p < 0.001) or tertiary (p < 0.001) health care level, reducing the number of referrals to the secondary care level. 13 1 3 1.3 Brazilians (TD andor 20162020 2016 2020 2016‒202 SC . (SC) crosssectional cross sectional TTS (TTS chisquare chi square Studentst Student st 5 0.05. 005 0.05 0 05 0.05) 6146 6 146 6,14 58 42 examination 51% 51 (51% 0.001. 0001 0.001 001 classification 58.7% 587 7 (58.7% 39.7% 397 39 (39.7% referral [PHC level) tests 341 34 34.1 five years. years years) dermatoses 1. 2016202 201 202 2016‒20 (SC 00 0.0 614 14 6,1 4 (51 000 0.00 58.7 (58.7 39.7 (39.7 34. 201620 20 2016‒2 0. 61 6, (5 58. (58. 39. (39. 20162 2 2016‒ ( (58 (39 (3

RESUMO Objetivo. Descrever os efeitos adversos da pandemia de COVID-19 nos serviços de saúde mental do Chile. Métodos. Este estudo é parte de uma pesquisa em andamento em vários países, denominada Mental Health Care - Adverse Sequelae of COVID-19 (Atenção à saúde mental: sequelas adversas da COVID-19, também conhecido como estudo MASC), que inclui sete países. O Chile é o único país da América Latina incluído. O estudo utilizou um delineamento convergente de métodos mistos. O componente quantitativo analisou dados da atenção pública à saúde mental coletados entre janeiro de 2019 e dezembro de 2021 do banco de dados de acesso livre do Ministério da Saúde. O componente qualitativo analisou dados coletados de grupos focais de especialistas que incluíam profissionais responsáveis por serviços de saúde mental, formuladores de políticas, usuários de serviços e cuidadores. Por último, os dados foram sintetizados por triangulação dos dois componentes. Resultados. Até abril de 2020, havia ocorrido uma redução de 88% na prestação de serviços de saúde mental na atenção primária; além disso, os níveis secundários e terciários também haviam reduzido suas atividades de saúde mental em 66,3% e 71,3% dos níveis pré-COVID, respectivamente. Sequelas negativas foram descritas no nível dos sistemas de saúde, e a recuperação total não havia sido alcançada até o final de 2021. A pandemia afetou as características essenciais dos serviços de saúde mental de base comunitária, com impactos adversos na continuidade e na qualidade do atendimento, redução do apoio psicossocial e comunitário e efeitos negativos na saúde mental dos profissionais de saúde. Soluções digitais foram amplamente implementadas para permitir o atendimento remoto, mas os desafios incluíam a disponibilidade de equipamentos, sua qualidade e a exclusão digital. Conclusões. A pandemia de COVID-19 tem tido efeitos adversos significativos e duradouros na atenção à saúde mental. As lições aprendidas podem contribuir para recomendações de boas práticas em pandemias e crises de saúde atuais e futuras. Além disso, destacam a importância de priorizar o fortalecimento dos serviços de saúde mental em resposta a emergências.

RESUMEN Objetivo. Este estudio pretende describir los efectos adversos de la pandemia de COVID-19 en los servicios de salud mental en Chile. Métodos. El estudio forma parte de una investigación multinacional en curso denominada estudio Mental Health Care – Adverse Sequelae of COVID-19 (atención de salud mental: secuelas adversas de la COVID-19), o estudio MASC, en el que participan siete países. Chile es el único de América Latina. En este estudio se utilizó un diseño de métodos mixtos convergentes. En el componente cuantitativo se analizaron los datos de atención en salud mental del sector público obtenidos entre enero del 2019 y diciembre del 2021, provenientes de la base de datos de acceso libre del Ministerio de Salud. En el componente cualitativo se analizaron los datos obtenidos a partir de grupos focales de expertos entre los que había profesionales a cargo de servicios de salud mental, responsables de la formulación de políticas, personas usuarias de los servicios y personas prestadoras de cuidados. Por último, la síntesis de los datos se realizó mediante la triangulación de ambos componentes. Resultados. En abril del 2020, la prestación de servicios de salud mental en atención primaria había disminuido en un 88%; además, los niveles secundario y terciario también habían reducido sus intervenciones en salud mental en un 66,3% y un 71,3%, respectivamente, respecto a los niveles previos a la COVID-19. Se describieron secuelas negativas a nivel de los sistemas de salud, que a fines del 2021 aún no habían logrado su plena recuperación. La pandemia afectó las características esenciales de los servicios de salud mental prestados en la comunidad, con consecuencias adversas en la continuidad y la calidad de la atención, una reducción del apoyo psicosocial y comunitario, y efectos negativos en la salud mental del personal de salud. Se generalizó la adopción de soluciones digitales para posibilitar la atención a distancia, pero algunos de los principales problemas fueron la disponibilidad de equipos, su calidad y la brecha digital. Conclusiones. La pandemia de COVID-19 ha tenido efectos adversos importantes y duraderos en la atención de salud mental. Las enseñanzas extraídas pueden servir de base para formular recomendaciones de buenas prácticas para las pandemias y crisis sanitarias presentes y futuras, a la vez que resaltan la importancia de dar prioridad al fortalecimiento de los servicios de salud mental en las situaciones de respuesta a emergencias.

ABSTRACT Objective. This study seeks to describe the adverse effects of the COVID-19 pandemic on mental health services in Chile. Methods. This study is part of ongoing multicountry research known as the Mental Health Care – Adverse Sequelae of COVID-19 study (or the MASC study) that includes seven countries. Chile is the only one in Latin America. This study used a convergent mixed methods design. The quantitative component analyzed data about public mental health care collected between January 2019 and December 2021 from the open-access database at the Ministry of Health. The qualitative component analyzed data collected from focus groups of experts that included professionals in charge of mental health services, policy-makers, service users and caregivers. Finally, the data synthesis was performed by triangulation of both components. Results. By April 2020, mental health service provision had been reduced by 88% in primary care; moreover, secondary and tertiary levels had also reduced their mental health activities by, respectively, 66.3% and 71.3% of pre-COVID levels. Negative sequelae were described at the health systems level, and full recovery had not been achieved by the end of 2021. The pandemic affected the essential characteristics of community-based mental health services, with adverse impacts on the continuity and quality of care, reduced psychosocial and community support, and negative effects on health workers’ mental health. Digital solutions were widely implemented to enable remote care, but challenges included the availability of equipment, its quality and the digital divide. Conclusions. The COVID-19 pandemic has had significant and enduring adverse effects on mental health care. Lessons learned can inform recommendations for good practices for the ongoing and future pandemics and health crises, and highlight the importance of prioritizing the strengthening of mental health services in response to emergencies.

Resumen El objetivo de esta investigación es realizar un diagnóstico de la Economía Popular y Solidaria (EPS) de Ecuador que sirva para plantear un marco referencial de una Economía Social y Comunitaria. Se aplica una metodología de investigación bibliográfica con fuentes secundarias y terciarias, y una revisión de literatura de conceptos y definiciones de economía, en especial aquellos diferentes al pensamiento económico tradicional. En conclusión, se encuentra evidencia de un desarrollo importante de la asociatividad en el Ecuador, como parte medular de la EPS, principalmente en el sector agrícola, en donde se registró un crecimiento de 83% entre 2012 y 2018, y 10% entre 2019 y 2021 a pesar de la crisis provocada por la pandemia mundial.

Abstract The aim of this research is to make a diagnosis of the Popular and Solidarity Economy (EPS) of Ecuador that serves to propose a referential framework of a Community Economy. A bibliographic research methodology is applied with secondary and tertiary sources, and a literature review of concepts and definitions of economics, especially those different from traditional economic thought. We have found important and relevant evidence of progress in associativity that is a medullary part of EPS, mainly in the agricultural area. Agricultural EPS grew 83% between 2012 and 2018, and 3.8% between 2019 and 2021 despite the crisis caused by the global pandemic.

BACKGROUND: This study aimed to determine the prevalence of pathological neck of femur (NOF) fractures at a tertiary referral hospital through histological examination of specimens in all NOF fracture patients undergoing hip arthroplasty. A secondary aim was to determine whether the current practice of sending all femoral heads for histological evaluation, to avoid missing unsuspected malignancies, is financially warranted. METHODS: A retrospective folder review of patients who underwent arthroplasty for NOF fractures was conducted. Patients with suspected pathological fractures were managed by the divisional Bone Tumour Unit while fragility traumatic fractures were managed by the Arthroplasty Unit. All femoral heads were sent for histological analysis regardless of suspicion of pathological fracture. Quotes from the public and private sector were sought to determine cost implications of sending femoral head specimens for histology. RESULTS: A total of 311 patients were included. Of these, 11 patients (4%) had suspected pathological fractures, with fragility/traumatic fractures being diagnosed in the remaining 300 patients (97%). Histology results were available for 195 patients (63%), including all the patients with suspected pathological fractures. No unexpected malignant histological results were observed, while nine of the suspected pathological fracture group had pathological fractures, confirmed with histology. CONCLUSION: Pathological lesions were identified in 3% of patients undergoing arthroplasty for NOF fractures in our population, which is higher than other reports in the literature. Routine histological screening of femoral heads to exclude pathological fracture might not be necessary and cost effective, as pathological lesions can accurately be identified by clinical and radiographic evaluation. Level of evidence: Level 4

Boikaraelo ba maano a tikoloho mabapi le kholo ea botsitso ba tikoloho bo ananeloa hohle, empa boinahano holima tsusumetso ea maano ena, haholo-holo, tikolohong e meeling ea naha, e ea fokola. E le ho arabela hona, sengoloa sena se hlahloba mekhoa e meraro ea mantlha, eleng sebopeho sa lekala la moruo, boqapi le marang-rang a tsebo, hammoho le litsi tsa mmuso e le lisebelisoa tsa maano bakeng sa ho eketsa botsitso ba tikoloho meeling ea naha ea Afrika Boroa. Karolo e 'ngoe le e' ngoe ea mekhoa ena e lekantsoe le ho lekanyetsoa ka lits'oants'o tse boletsoeng joalo ka GVA, Tress Index le ICT Access Index, le lits'oants'o tsa mmuso tse kang liphetho tsa tlhahlobo ea libuka le tlhaiso-leseling ea phano ea litsebeletso libakeng tse hlano tsa meralo ea profinse ea Kapa Leboea. Sengoliloeng sena se totobatsa hore ho matlafatsa boemo ba botsitso ba tikoloho ho ka khonahala ka ho sebelisa maano a tsepamisitseng maikutlo mekhoeng ena e meraro, hammoho le tlhaiso-leseling ea moruo oa tikoloho. Se boetse se totobatsa hore sebaka se ruileng tsebo ha sea itsetleha nts'etsopeleng ea lekala le le leng la moruo, empa se ikitlaetsa nts'etsopeleng ea moruo ka makala a 'maloa, mekhahlelong e fapaneng, ele ho fokotsa litsisinyeho le litsitiso tse tsoang kantle. Ho ts'ehetsa sena, khato e nkiloeng ka kopanelo ke mmuso mmoho le mafapha a mang ele ho hatiselletsa boikarabello le ts'ebetso ea puso ea libaka le lebatooa, o tla matlafatsa le ho holisa nts'etsopele tikolohong e mathokong a naha.

The role of regional policy mechanisms towards increased regional resilience is widely recognised, but limited consideration is given to the impact of these mechanisms in, specifically, the peripheral region. In reaction hereto, this article explores the role of three key mechanisms, i.e. economic sectoral composition, innovation and knowledge networks, as well as government institutions as policy tools towards increased regional resilience in a peripheral region in South Africa. The role of each of these mechanisms is quantified and measured by specified indices such as the GVA, the Tress Index and the ICT Access Index, and government indicators such as audit outcomes and service delivery data in five planning regions of the Northern Cape province. This article highlights that a state of dynamic stability and resilience is more feasible through policy intervention focused on these three mechanisms, coupled with detailed regional socio-economic analysis. It also emphasises that a knowledge-rich region will be less dependent on single sector development, pushing itself into a new development stage of secondary and tertiary sector focus through economic diversification, lessening its vulnerability to external shocks and disturbances, and impeding regional lock-in. In support hereto, collective institutional action by a responsive and accountable local and regional government, operating beyond their functional limits, will reinforce and amplify development in the peripheral region.

Die rol van streeksbeleidsmeganismes vir verhoogde streeksveerkragtigheid word wyd erken, maar beperkte oorweging word gewy aan die impak van hierdie mega-nismes in spesifiek die periferiese streek. In reaksie hierop ondersoek hierdie artikel die rol van drie sleutelmeganismes, naamlik ekonomiese sektorale samestelling, innovasie- en kennisnetwerke, sowel as regeringsinstellings as beleidsinstrumente vir verhoogde streeksweerstand in 'n periferiese streek in Suid-Afrika. Die rol van elk van hierdie meganismes word gekwantifiseer en gemeet teen gespesifiseerde indekse soos die GVA, die Tress-indeks en die ICT-toegangsindeks, en regeringsaanwysers soos oudituitkomste en diensleweringsdata in vyf beplan-ningsstreke van die Noord-Kaap provinsie. Hierdie artikel beklemtoon dat 'n toestand van dinamiese stabiliteit en veerkragtigheid meer haalbaar is deur beleidsinmenging gefokus op hierdie drie meganismes, tesame met gedetaill eerde streeksanalise. Die artikel beklemtoon ook dat 'n kennisryke streek minder afhanklik sal wees van 'n enkele sektor deur 'n fokus op ekonomiese diversifikasie. Hierdeur kan 'n streek in 'n nuwe ontwikkelingsfase van sekondêre en tersiêre sektorfokus inbeweeg. Die kwesbaarheid van die streek vir eksterne skokke en versteurings sal verminder en streekuitsluiting word voorkom. Ter ondersteuning hiertoe, sal institu-sionele kollektiewe optrede deur 'n reaktiewe en verantwoordbare plaaslike en streeksregering wat buite hul funk-sionele perke werk, die ontwikkeling van die periferiese streek versterk en kwesbaarheid vir eksterne skokke verminder.

ABSTRACT This study analyzes the behavior of the stock returns of a sample of firms in the Chilean stock market, classified by industrial sector, which made announcements of mergers and acquisitions (M&A) between 2010 and 2014. The sample consists of 30 firms that made 61 announcements for M&A: 13 announcements corresponded to the secondary sector and 48 to the tertiary sector. The results indicated that tertiary sector showed a positive and statistically significant average abnormal return on the day prior to the announcement of M&A, which revealed a possible leak of private information before the announcement, and could be the result of the insider trading.

RESUMEN En el estudio se analizó el comportamiento de los retornos accionarios de 30 firmas del mercado bursátil de Chile, clasificadas por sector industrial, que realizaron 61 anuncios de fusiones y adquisiciones (F&A) entre los años 2010 y 2014, de los cuales 13 correspondieron al sector secundario y 48 al terciario. Los resultados indicaron que el sector terciario evidenció un retorno anormal promedio positivo y estadísticamente significativo el día previo al anuncio de F&A, que reveló una posible filtración de información privada y pudo ser la causa de la actividad realizada por insiders en el mercado bursátil y del uso de información privilegiada.

Abstract The contribution of the study is the identification of the economic structure of the state of Hidalgo, Mexico. For this, the analysis of factors and main components is used and seven groups are located. In the first two, economic activities of the tertiary sector prevail; in the remaining five, the secondary ones predominate; those of the primary sector are scarce and appear modestly in the three groupings. The foregoing has a historical background and is consistent with the current production and employment of the entity. The results of this work contribute to the state of the art of the regional economy of Mexico´s entities.

Resumen El aporte del estudio es la identificación de la estructura económica del estado de Hidalgo, México, mediante el esclarecimiento de sus agrupamientos industriales. Para ello, se utiliza el análisis de factores y componentes principales y se ubican siete agrupamientos. En los dos primeros prevalecen las actividades económicas del sector terciario, en los cinco restantes predominan las del secundario; las del sector primario son escasas y aparecen de forma modesta en tres agrupamientos. Lo anterior tiene un antecedente histórico y es coherente con la producción y el empleo actuales de la entidad. El documento contribuye al estado del arte de la economía regional de las entidades de México.

Abstract Public and private investment have behaved as complementary or substitutes in economies. The objective of this research is to analyze the effect of public investment on private investment in Mexico’s production. A cost function translog was used to derive a system of five demands of disaggregated factors (public investment, private investment, work in the primary sector, work in the secondary sector and work in the tertiary sector), in the 1994-2015 period. Public investment resulted complementary with private investment and with work in the primary sector, contributing to economic growth.

Resumen La inversión pública y la privada se han comportado como complementarias o sustitutas en las economías. El objetivo de esta investigación fue analizar el efecto de la inversión pública sobre la inversión privada en la producción de México. Se usó una función de costo translog para derivar un sistema de cinco demandas de factores desagregados (inversión pública, inversión privada, trabajo en el sector primario, trabajo en el sector secundario y trabajo en el sector terciario), en el periodo 1994-2015. La inversión pública resultó complementaria con la inversión privada y con el trabajo en el sector primario contribuyendo al crecimiento económico.

Resumo: A presente pesquisa teve por objetivo caracterizar, a partir de indicadores econômicos, os municípios de Mato Grosso do Sul (MS) com influência direta e indireta na criação do Corredor Bioceânico, que ligará o Brasil ao Oceano Pacífico. Para a presente análise, foram avaliados todos os municípios, em dois traçados distintos, entre a capital de Mato Grosso do Sul, Campo Grande e Porto Murtinho, cidade sul-mato-grossense que faz fronteira com Paraguai. Os indicadores econômicos utilizados foram: PIB; PIB per capita; população; arrecadação de impostos; valor adicionado bruto setorial; e atividade econômica principal, secundária e terciária. Os resultados trazem evidências não só de desenvolvimento econômico entre 2010 e 2015, como também de diferenças na variação do crescimento de acordo com a atividade produtiva de cada município avaliado. A análise de cluster apresentou municípios com similitudes, e, neste contexto, Campo Grande diverge dos demais municípios, enquanto Maracaju e Sidrolândia formam um cluster único de grande impacto econômico no Estado. Do ponto de vista econômico, Porto Murtinho - apesar do crescimento do setor de turismo no município - é a cidade mais vulnerável, apresentando baixa dinâmica produtiva, com uma economia baseada na pecuária e, ainda, fortemente dependente de recursos da administração pública.

Abstract: The objective of this research was to characterize, based on economic indicators, the municipalities of Mato Grosso do Sul (MS) with direct and indirect influence on the creation of the Bioceanic Highroad Crossing, which will connect Brazil to the Pacific Ocean. For the present analysis, all the municipalities were evaluated, in two different routes, between the capital of Mato Grosso do Sul, Campo Grande and Porto Murtinho, south-mato-grossense city that borders Paraguay. The economic indicators used were: GDP; GDP per capita; the population; tax collection; gross sectoral value added; and main, secondary and tertiary economic activity. The results bring evidence not only of economic development between 2010 and 2015, but also of differences in the growth variation according to the productive activity of each municipality evaluated. The cluster analysis presented municipalities with similarities, and in this context, Campo Grande differs from the other municipalities, while Maracaju and Sidrolândia form a unique cluster of great economic impact in the State. From the economic point of view, Porto Murtinho - despite the growth of the tourism sector in the municipality - is the most vulnerable city, presenting low productive dynamics, with an economy based on livestock and, still, strongly dependent on administration resources public.

Resumen: La presente investigación tuvo por objetivo caracterizar, a partir de indicadores económicos, los municipios de Mato Grosso do Sul (MS) con influencia directa e indirecta en la creación de la Ruta Bioceánica, que conectará el Brasil al Océano Pacífico. Para el presente análisis, se evaluaron todos los municipios, en dos trazados distintos, entre la capital de Mato Grosso do Sul, Campo Grande y Porto Murtinho, ciudad sur-mato-grossense que limita con Paraguay. Los indicadores económicos utilizados fueron: PIB; PIB per cápita; la población; recaudación de impuestos; valor agregado bruto sectorial; y la actividad económica principal, secundaria y terciaria. Los resultados traen evidencias no sólo de desarrollo económico entre 2010 y 2015, sino también de diferencias en la variación del crecimiento de acuerdo con la actividad productiva de cada municipio evaluado. El análisis de cluster presentó municipios con similitudes, y en este contexto, Campo Grande difiere de los demás municipios, mientras que Maracaju y Sidrolândia forman un cluster único de gran impacto económico en el Estado. Desde el punto de vista económico, Porto Murtinho - a pesar del crecimiento del sector turístico en el municipio - es la ciudad más vulnerable, presentando baja dinámica productiva, con una economía basada en la ganadería y, aún, fuertemente dependiente de recursos de la administración pública.

Resumen El texto evalúa la pertinencia de entender las características de la reforma educativa en Chile, en continuidad con la idea de un cambio de paradigma de la política pública en educación. En este sentido, el artículo puntualiza la importancia de las movilizaciones estudiantiles de 2006 y 2011, encabezadas por estudiantes del nivel secundario y terciario, respectivamente, como instancias sociales críticas a la base de la generación de tal cambio. La noción de “paradigma”, acuñada por Kuhn, sirve así como concepto heurístico que permite expicar los fenómenos y su impacto. En relación con este objetivo, se analiza la situación de la política educativa chilena, con el propósito de dar cuenta de sus principales ejes de acción. Dichos ejes evidencian un estado de crisis, así como la necesidad de resolverla. No obstante, la eventualidad de alcanzar una solución a las dificultades del sector, colisionan con el punto de partida en virtud del cual se formulan las explicaciones acerca de por qué el sistema educativo chileno presenta estos rasgos. A este hecho es al que se denomina “empate neoliberal” y es el que, en opinión de los autores, exige un cambio de estándares de racionalidad.

Abstract The text evaluates the relevance of understanding the characteristics of the educational reform in Chile, in continuity with the idea of a paradigm shift in public policy in education. In this sense, the article points out the importance of the student mobilizations of 2006 and 2011, headed by secondary and tertiary level students, respectively, as critical social instances on the basis of the generation of such change. The notion of "paradigm", coined by Kuhn, serves as a heuristic concept that allows to explain the phenomena and their impact. In relation to this objective, the situation is analyzed of the Chilean educational policy in order to account for its main lines of action. These axes show a state of crisis, as well as the need to solve it. However, the eventuality of reaching a solution to the difficulties of the sector collides with the starting point by which explanations are formulated about why the Chilean educational system presents these features. This is what is called a "neoliberal draw" and is what in our opinion, requires a change in standards of rationality.

BACKGROUND. A maternal near-miss is defined as a life-threatening pregnancy-related complication where the woman survives. The World Health Organization (WHO) has produced a tool for identifying near-misses according to criteria that include the occurrence of a severe maternal complication together with organ dysfunction and/or specified critical interventions. Maternal deaths have been audited in the public sector Metro West maternity service in Cape Town, South Africa, for many years, but there has been no monitoring of near-misses. OBJECTIVES. To measure the near-miss ratio (NMR), maternal mortality ratio (MMR) and mortality index (MI), and to investigate the near-miss cases. METHODS. A retrospective observational study conducted during 6 months in 2014 identified and analysed all near-miss cases and maternal deaths in Metro West, using the WHO criteria. RESULTS. From a total of 19 222 live births, 112 near-misses and 13 maternal deaths were identified. The MMR was 67.6 per 100 000 live births and the NMR 5.83 per 1 000 live births. The maternal near-miss/maternal death ratio was 8.6:1 and the MI 10.4%. The major causes of near-miss were hypertension (n=50, 44.6%), haemorrhage (n=38, 33.9%) and puerperal sepsis (n=13, 11.6%). The first two conditions both had very low MIs (1.9% and 0%, respectively), whereas the figure for puerperal sepsis was 18.9%. Less common near-miss causes were medical/surgical conditions (n=7, 6.3%), non-pregnancy-related infections (n=2, 1.8%) and acute collapse (n=2, 1.8%), with higher MIs (33.3%, 66.7% and 33.3%, respectively). Critical interventions included massive blood transfusion (34.8%), ventilation (40.2%) and hysterectomy (30.4%). Considering health system factors, 63 near-misses (56.3%) initially occurred at a primary care facility, and the patients were all referred to the tertiary hospital; 38 (33.9%) occurred at a secondary hospital, and 11 (9.8%) at the tertiary hospital. Analysis of avoidable factors identified lack of antenatal clinic attendance (11.6%), inter-facility transport problems (6.3%) and health provider-related factors (25.9% at the primary level of care, 38.2% at secondary level and 7.1% at tertiary level). CONCLUSIONS. The NMR and MMR for Metro West were lower than in other developing countries, but higher than in high-income countries. The MI was low for direct obstetric conditions (hypertension, haemorrhage and puerperal sepsis), reflecting good quality of care and referral mechanisms for these conditions. The MIs for non-pregnancy-related infections, medical/surgical conditions and acute collapse were higher, suggesting that medical problems need more focused attention.

ABSTRACT Introduction: In primary health care, medical appointments for otorhinolaryngological causes reach up to 40%-50%. Of these cases, many are referred for the evaluation of the tertiary level of health. Aim: Assess the usefulness of an otorhinolaryngology evaluation at the primary health care level to screen the number of referrals to specialist. Explore strategies to replicate the experience. Material and method: Attention by otorhinolaryngologist is considered in two different scenarios, where patients who were waiting for formal care by the secondary level were evaluated. Results: 201 patients were evaluated. 60.9% of the patients were females and 39.1% were males. The median waiting time for referral was 20 months, with an interquartile range of 8 - 29 months. The maximum waiting time for consultation was 6 years (73 months). Of the total number of consultations, 71.7% were discharged with treatment according to the cause, while only the remaining 28.3% of the consultations were considered necessary to maintain consultation at the tertiary level. Conclusion: The results of this evaluation allow us to propose the usefulness of an otorhinolaryngological evaluation in primary health care. This would reduce the flow of referrals and waiting lists to the secondary sector, decongest the system, prioritize the most relevant referrals, create expedited channels of communication between levels of care, contribute to continuous training in both teams and levels.

RESUMEN Introducción: En Atención Primaria de Salud (APS), las consultas por causas otorrinolaringológicas alcanzan hasta el 40%-50%. De éstos, muchos son enviados para evaluación al nivel secundario de salud. Objetivo: Evaluar la utilidad de una atención de otorrinolaringología en APS para tamizar el número de interconsultas al especialista. Explorar estrategias que permitan replicar la experiencia. Material y método: Se consideran las consultas de otorrinolaringología realizadas en dos escenarios diferentes, donde se evaluaron pacientes que se encontraban a la espera de atención formal por el nivel secundario. Resultados: Se evaluaron 201 pacientes. El 60,9% fueron de sexo femenino y el 39,1% masculino. La mediana de tiempo de espera para la derivación fue de 20 meses, con un rango intercuartil de 8-29 meses. El tiempo máximo de espera de interconsulta fue de 6 años (73 meses). Del total de interconsultas, 71,7% fueron dadas de alta con tratamiento según la causa, mientras que sólo en el restante 28,3% de las interconsultas se consideró necesario mantener la interconsulta al nivel secundario. Conclusión: Los resultados de la presente evaluación permiten plantear la utilidad de una evaluación otorrinolaringológica en APS. Esto permitiría reducir el flujo de derivaciones y listas de espera hacia el sector secundario, descongestionar el sistema, priorizar las derivaciones más pertinentes, crear canales de comunicación expeditos entre los niveles de atención, contribuir a la capacitación continua en ambos equipos y niveles.

ORIENTATION: A university, and equally so a university campus, has the ability to influence the economy through its sectoral links. This raises the question as to what sectors benefit as a result of expenditure made by a university campus that is situated within a small city in South Africa. RESEARCH PURPOSE: This paper identified the university-sector links by applying a bill-of-goods approach to identify which sectors benefit as a result of an operational university campus. MOTIVATION FOR THE STUDY: The findings of this study will be used in refining provincial or local social accounting matrix (SAM) models to improve the measurement of an economic impact assessment for the university campus, especially as SAM models are not readily available on such a micro-level within South Africa. RESEARCH DESIGN, APPROACH AND METHOD: The bill-of-goods is a detailed representation of the purchases of goods and services for the campus. The goods and services are grouped into the corresponding sector according to the Standard Industrial Classification to identify and quantify university-sector linkages. MAIN FINDINGS: The results indicated a significant benefit for tertiary sectors of the economy, which receive approximately 85% of university expenditure. On a sectoral level, there is an increased benefit to the utility, retail and personal services sectors, whereas manufacturing and construction turn out to be less significant. Growth prospects for sectors within the tertiary sectors are higher compared to sectors in the primary and secondary sectors. PRACTICAL AND MANAGERIAL IMPLICATIONS: Understanding this link enables strategic spatial planning on the part of local government and will enable proactive land-use planning, based on the strength and growth prospects of each individual sector that benefits from university expenditure. CONTRIBUTION OR VALUE-ADD: This approach provided exceptional value in identifying the sectors that benefit and provide important trend analyses that will be combined with input-output models to improve the accuracy of measuring university impact assessment on a local level.

En el sector agropecuario de la cuenca media del río Chinchiná, Colombia, en 2012 y 2013 se evaluaron los beneficios socio-ambientales generados por la implementación de estrategias de producción más limpia en el sector agropecuario. La metodología incluyó la recolección de datos de campo desde entrevistas y diálogos semi-estruturados, procesamiento y análisis de datos a partir de la adaptación de matrices y construcción de diagrama de redes, evaluación de los beneficios con determinación de la significancia socio-ambiental a través de la adaptación de la metodología de Leopold con el uso de parámetros de magnitud e importancia. Los resultados mostraron que las estrategias para el estudio de producción más limpia implementadas en las fincas localizadas en la zona permitieron identificar y categorizar estrategias de conservación, reducción o eliminación, siendo posible evaluar los beneficios socio-ambientales correspondientes, a partir de la determinación de los beneficios primarios, secundarios y terciarios relacionados tanto con los beneficios que prestan los ecosistemas como los sociales que se generan.

The purpose of this paper is to assess the socio-environmental benefits generated by the implementation of cleaner production strategies in the agriculture and livestock sectors, in the middle part of the Chinchina river basin, Colombia. The methodology involves recording of field data on the basis of interviews and semi-structured dialogue; processing and analysis of data on the basis of matrix adaptation and network diagramming; and assessment of socio-environmental benefits, with determination of socio-environmental significance, based on adaptation of the Leopold methodology, using the parameters of magnitude and importance. The main results are: i) the cleaner production strategies implemented in the farms located in the study zone were identified and categorized into conservation, reduction or elimination strategies; ii ) the corresponding socio-environmental benefits were evaluated by determining primary, secondary and tertiary benefits related to both the benefits provided by ecosystems and the social benefits generated.