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Introducción: La modelación de los flujos de pacientes se considera una herramienta clave para el análisis y mejora de las trayectorias intrahospitalarias. Objetivo: Desarrollar y validar, en un servicio de cirugía general, un modelo matemático para la gestión de flujos de pacientes en servicios hospitalarios. Métodos: Se desarrolló una investigación de tipo cuantitativa descriptiva. Se analizaron diferentes modelos de gestión y se identificaron brechas a solventar. Para su concepción se diseñó un procedimiento metodológico que tiene en cuenta la agrupación de pacientes en categorías diagnósticas mayores, en función de características clínicas homogéneas y similar consumo de recursos. Resultados: Se identificó como problema principal la insuficiente gestión de los flujos de pacientes. Se construyó un modelo matemático de simulación discreta que se validó mediante la comparación de datos reales del servicio y las opiniones subjetivas de especialistas. Se identificó que los recursos limitantes del sistema son las enfermeras y las camas con porcentajes de utilización de 93,377 % y 89,265 % respectivamente. Conclusiones: Se desarrolla un modelo para la gestión de los flujos de pacientes en el servicio de cirugía general y se demuestra su influencia en el análisis, el proceso de toma de decisiones y la mejora de la gestión.

Introduction: Patient flow modeling is considered a key tool for the analysis and improvement of in-hospital trajectories. Objective: To develop and validate a mathematical model for the patient flows management in hospital in a General Surgery service. Methods: A descriptive quantitative research was developed. Different management models were analyzed and gaps to be solved were identified. For its conception, a methodological procedure was designed that takes into account the grouping of patients in Major Diagnostic Categories according to homogeneous clinical characteristics and similar resource consumption. Results: Insufficient patient flow management was identified as the main problem. A mathematical model of discrete simulation was built and validated by comparing real data from the service and the subjective opinions of specialists. It was identified that the limiting resources of the system are nurses and beds with utilization percentages of 93.377% and 89.265% respectively. Conclusions: A model for the patient flows management in the General Surgery service is developed and its influence on the analysis, decision-making process and management improvement is demonstrated.

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RESUMEN El mercado campesino de Coopmercasan inició su funcionamiento en 2011 brindando productos agrícolas frescos e inocuos al municipio de Florencia, departamento del Caquetá. En ocho años de operación, han tenido aciertos y desaciertos, también han recibido el apoyo de diferentes instituciones, sin embargo, a la fecha se desconoce sus realidades actuales y los retos y desafíos que han venido cambiando a lo largo del tiempo. Por lo anterior, esta investigación buscó construir las dinámicas de esta experiencia a través de la autorreflexión, la información base para la toma de decisiones y la orientación de sus acciones de mejora. El trabajo se realizó en el municipio de Florencia, las herramientas para el levantamiento de la información empleadas fueron encuestas, entrevistas y observación participante. Dentro de los principales hallazgos se tiene que, si bien el mercado ha logrado posicionarse con una base interesante de clientes, su oferta no está cumpliendo las expectativas respecto de los volúmenes y la diversidad de demandada de los clientes, y aunque la gran mayoría de los apoyos entregados por las instituciones han sido dirigidos a procesos de fortalecimiento organizativos, sigue siendo el aspecto más débil.

ABSTRACT The COOPMERCASAN peasant market began its operation in 2011, providing fresh and safe agricultural products to the population of Florence. In these eight years of operation, they have had successes and failures, they have also received the support of different institutions, however, to date, their current realities are unknown, as well as the challenges, which have been changing over time. It is because of the above that this research sought to build the dynamics of this experience through self-reflection, base information for decision-making, and the orientation of their improvement actions. The work was carried out in the municipality of Florence, the tools for gathering the information were surveys, interviews, and participant observation. Among the main findings, it was discovered that, although the market has managed to position itself with an interesting customer base, its offer is not meeting expectations in terms of the volumes and diversity demanded by customers and that, although the vast majority of the support provided by the institutions has been directed towards organizational strengthening processes, it continues to be the weakest aspect.

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OBJECTIVE: The purposes of this study were three-fold: (i) to describe handgrip strength in older individuals aged ≥60 years in Colombia; (ii) to identify sex-specific and age-specific muscle weakness cut-off points in older adults; and (iii) to determine the odds of adverse events for each of the intrinsic capacity domains for individuals with handgrip strength greater than the muscle weakness cut-off points, as compared with their weaker counterparts. METHODS: A cross-sectional study was conducted in Colombia, among 5237 older adults aged ≥60 years old (58.5% women, 70.5 ± 7.8 years), according to 'SABE Survey 2015'. Handgrip strength data were obtained with a Takei dynamometer. Sociodemographic variables, five domains of intrinsic capacity (i.e. locomotion, vitality, cognition, psychological, and sensory), and medical conditions were assessed and analyzed. Adjustments variables were age, ethnicity, socio-economic status, urbanicity, body mass index, smoking status, alcohol intake, drug use, physical activity, and co-morbid chronic diseases. Sex-stratified analyses were conducted with logistic regression models. RESULTS: Handgrip strength was greater among men than among women (26.7 ± 8.5 vs. 16.7 ± 5.7 kg, respectively, P < 0.001) at all ages. Weak handgrip strength cut-off points ranged from 17.4 to 8.6 and from 10.1 to 4.9 in men and women, respectively. Overall, participants with optimal handgrip strength had better intrinsic capacity [in men, odds ratio (OR) = 0.62, 95% confidence interval (CI) 0.53 to 0.71; P < 0.001; and in women, OR = 0.79, 95% CI 0.68 to 0.92; P = 0.002] than their weaker counterparts. Also, men with optimal handgrip strength had a lower risk of hospitalization (OR = 0.47, 95% CI 0.29 to 0.78; P = 0.004) than their weaker counterparts. CONCLUSIONS: This study is the first to describe handgrip strength values and cut-off points for muscle weakness among a nationally representative sample of Colombian older adults by age and sex. After categorizing older adults as weak or not weak based on the handgrip cut-off points, non-weakness was associated with a decreased odds of intrinsic capacity impairments. These cut-off points may be good candidates for clinical assessment of risks to physical and mental health in older Colombian adults.

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Introducción El síndrome metabólico es una condición muy prevalente en nuestra sociedad, y durante las últimas dos décadas la prevalencia ha aumentado significativamente convirtiéndose en un problema con una carga en salud importante. El cáncer de próstata por su parte es la primera causa de cáncer en hombres en el mundo. Numerosos estudios han sugerido una asociación entre la presencia de síndrome metabólico y el diagnóstico de cáncer de próstata. La información acerca de la asociación Del cáncer de próstata y obesidad es controversial. Nuestro objetivo es determinar si existe una relación entre la presencia de obesidad y el diagnóstico de cáncer de próstata en adultos mayores de la ciudad de Bogotá. Objetivos y Métodos Se analizaron los datos del estudio Salud, Bienestar y Envejecimiento (SABE) Bogotá 2012. Se utilizó como variable dependiente el autorreporte de examen de próstata en los 2 últimos años y se evaluó con respecto a variables antropométricas así como factores sociodemográficos por medio de un análisis multivariado. Resultados La prevalencia de cáncer de próstata fue de 3,15%. El 31.9% de los hombres tienen un IMC mayor de 30. Se encontró una asociación significativa entre el IMC y el diagnóstico de cáncer de próstata (p = 0.005), Enfermedad coronaria y cáncer de próstata (p = 0.03) y nivel de escolaridad y diagnóstico de Cáncer de próstata (p = 0.012). Conclusión Nuestro estudio demuestra que existe una asociación significativa entre estas dos entidades en una población bogotana de adultos mayores. Es necesario realizar más estudios que aporten mayor información acerca de esta asociación.

Introduction Metabolic syndrome is a very prevalent condition in our society, and during the last two decades the prevalence has increased remarkably becoming a problem with a significant health burden. Prostate cancer, on the other side, is the leading cause of cancer in men around the world. Several studies have suggested an association between the presence of metabolic syndrome and the diagnosis of prostate cancer. The information about the association of prostate cancer and obesity is controversial. Our objective is to determine if there is a relationship between the presence of obesity and the diagnosis of prostate cancer in older adults in the city of Bogotá. Objective and Methods Data from the Health, Wellbeing and Aging study (SABE) Bogotá 2012 were analyzed. Self-report of prostate exam in the last 2 years was used as a dependent variable and was evaluated with respect to anthropometric variables as well as sociodemographic factors through a multivariate analysis. Results The prevalence of prostate cancer was 3.15%. 31.9% of men have a BMI greater than 30. A significant association was found between BMI and the diagnosis of prostate cancer (p = 0.005), coronary disease and prostate cancer (p = 0.03) and level of education and diagnosis of prostate cancer (p = 0.012). Conclusion Our study shows that there is a significant association between these two entities in a Bogota population of older adults. It is necessary to carry out more studies that provide more information about this association.

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Edentulism is related to a number of conditions in older adults, impacting their overall health status and thus their quality of life and relationship with the environment. At the same time, self-rated health has been shown to be an accurate marker of overall health status. However there is little information on how edentulism relates to self-rated health in older adults of Hispanic origin. The aim of this study was to evaluate the impact of edentulism on self-rated health in older adults. We analyzed data from SABE Ecuador 2009, a cross-sectional study that included a probabilistic representative sample of 5, 235 community-dwelling older adults aged 60 years or older. The dependent variable was self-rated health and the independent variable was edentulism, with age, sex and comorbidities as confounding variables. In order to test the independent association of edentulism with self-rated health, a logistic regression model was fitted. Out of the whole sample, 77. 13% of older adults reported having fair/poor self-rated health. We found an independent association between edentulism and self-rated health with incremental risk according to number of missingteeth, ranging from OR 1. 35 (CI 95% 0. 75 - 2. 43) p 0. 32 for less than 4 missing teeth to OR 1. 88(1. 06 - 3. 32) p 0. 029for more than half of teeth missing. Even though oral health has long been considered separately from the rest of the body and mind, it is clear from our results that oral health is a very important component of global health status in the elderly.

El edentulismo se ha asociado con una gran variedad de condiciones en los adultos mayores afectando el estado general de su salud. Por lo tanto, afecta la calidad de vida de la persona y su relación con el medio ambiente. Por otro lado, la autoevaluación de la salud ha demostrado ser un marcador preciso del estado general de la salud. Sin embargo, hay escasa información sobre cómo estas dos condiciones se relacionan entre sí en adultos mayores de origen hispano. El objetivo de este estudio fue evaluar el impacto del edentulismo en la autoevaluación de la salud en adultos mayores. Se analizaron los datos de SABE Ecuador 2009, un estudio transversal que incluyó una muestra probabilística y representativa de 5. 235 personas de 60 anos de edad o más. La variable dependiente fue la salud autoevaluada y edentulismo fue la variable independiente, teniendo edad, sexo y comorbilidades como variables de confusión. Con el fin de probar la asociación independiente de edentulismo con la auto-evaluación de la salud un modelo de regresión logística se ajustó. De la muestra entera, un 77, 13% de los adultos mayores reportaron tener salud auto-evaluada regular / pobre. Se encontró una asociación independiente entre edentulismo y salud autoevaluada con un riesgo incremental dependiendo del número de dientes ausentes de OR 1, 35 (IC 95% 0, 75 - 2, 43) p 0, 32, en adultos mayores con menos de 4 dientes ausentes hasta OR 1, 88 (1, 06 - 3, 32) p 0, 029, con más de la mitad de dientes ausentes. La salud oral se ha considerado de forma independiente del resto del cuerpo y la mente, es claro por nuestros resultados que la salud oral es un componente muy importante del estado de salud global en las personas mayores.

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Objetivos: Revisar la normatividad de residuos peligrosos en Colombia, su aplicabilidad y reglamentación, en un departamento pequeño que tiene una reducida generación, con el fin de identificar los vacíos existentes y la aplicabilidad de la política ambiental nacional, así como un análisis DOFA en la aplicabilidad de la normatividad de residuos peligrosos en el departamento del Quindío, comprobando la gestión integral y sus implicaciones. Metodología: La revisión incluyó la revisión de la comprensión de la normatividad, así como la bibliografía usada en la formulación de la política, los casos exitosos en otros países y la realización de encuestas en el trabajo de campo a los generadores de residuos, con lo cual se obtuvo la información necesaria para evaluar la aplicación de la Política Nacional en el departamento del Quindío. Resultados: Se visibilizaron las realidades de los generadores de residuos peligrosos en los cinco municipios del Quindío frente a la normativa ambiental y la Política Nacional, se encontró que la normativa nacional excluye a este sector, toda vez que hace exigencias que son difíciles de cumplir, por tanto no se aplica la norma. Discusión: Actualmente, no se promueve a nivel regional y nacional, la gestión de residuos peligrosos ni las opciones que faciliten el cumplimiento de las normas específicas, sin poner en riesgo la sustentabilidad ambiental, la sostenibilidad económica y social de los generadores de residuos peligrosos en los cinco municipios del Quindío. Conclusiones: Como producto de la investigación, se propone un modelo de gestión de residuos peligrosos, con dos variables dependiendo del volumen y características de los residuos generados, que incluye el ajuste normativo, la asociatividad de los generadores, una modificación del marco tarifario (con base en la regulación de los parámetros críticos de recolección y transporte), y el acompañamiento de los sectores comprometidos con la sostenibilidad ambiental, principalmente con la capacitación, formación ambiental y fortalecimiento técnico referido al manejo de los residuos o desechos peligrosos (líquidos, gaseosos, sólidos), orgánicos (que pueden tener procesos de compostaje) e inorgánicos (que pueden ser utilizados como reciclado o reutilizados como logística reversa o inversa) y los inservibles. Existe un gran desafío para un país, en especial cuando éste se enmarca en compromisos de convenios internacionales, al no tener en cuenta la heterogeneidad de las regiones, en cuanto a las capacidades de gestión y eliminación adecuada de residuos.

Objectives: To review the regulations for hazardous waste in Colombia, its applicability and regulation, in a small Department that has a reduced generation in order to identify gaps, and the applicability of the national environmental policy, as well as a DAFO analysis in the applicability of the regulations of hazardous waste in the department of Quindío, checking integrated management and its implications. Methodology: The revision included a review of the understanding of the regulations, as well as the literature used in the formulation of the policy, the successful cases in other countries and surveys to waste generators in the field work, with the purpose of obtaining the information needed to evaluate the implementation of the National Policy in the Department of Quindío. Results: The realities of hazardous waste generators became visible in the five municipalities of Quindío against the environmental regulations and the National Policy. It was found that the national legislation excludes this sector since it makes demands that are difficult to fulfill, therefore the rule is not applied. Discussion: Currently, management of hazardous waste or options to facilitate the achievement of specific standards without compromising environmental, economic and social sustainability of the generators of hazardous waste in the five municipalities of Quindío is not promoted at the regional and national level. Conclusions: As a result of the research, a model of hazardous waste management is proposed with two variables depending on the volume and characteristics of waste generated including regulatory setting, the association of the generators, a modification of the rate structure (based on the regulation of critical collection and transport parameters), and the accompaniment of the sectors committed to environmental sustainability, mainly through training, environmental education and technical strengthening relative to the handling of residues or hazardous waste (liquid, gaseous, solids), organic (which may have composting processes) and inorganic (which can be used as recycled or reused as reverse or inverse logistics) and unusable. There is a great challenge for a country, especially when it is part of commitments to international conventions, when it does not take into account the heterogeneity of the regions in terms of management skills and proper waste disposal.

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Edentulism is related to a number of conditions in older adults, impacting their overall health status and thus their quality of life and relationship with the environment. At the same time, selfrated health has been shown to be an accurate marker of overall health status. However there is little information on how edentulism relates to selfrated health in older adults of Hispanic origin. The aim of this study was to evaluate the impact of edentulism on selfrated health in older adults. We analyzed data from SABE Ecuador 2009, a crosssectional study that included a probabilistic representative sample of 5,235 communitydwelling older adults aged 60 years or older. The dependent variable was selfrated health and the independent variable was edentulism, with age, sex and comorbidities as confounding variables.In order to test the independent association of edentulism with selfrated health, a logistic regression model was fitted. Out of the whole sample,77.13% of older adults reported having fair/poor selfrated health. We found an independent association between edentulism and selfrated health with incremental risk according to number of missingteeth,ranging from OR 1.35 (CI 95% 0.75 2.43) p 0.32 for less than 4 missing teeth to OR 1.88(1.06 3.32) p 0.029 for more than half of teeth missing. Even though oral health has long been considered separately from the rest of the body and mind, it is clear from our results that oral health is a very important component of global health status in the elderly (AU)

El edentulismo se ha asociado con una gran variedad de condiciones en los adultos mayores afectando el estado general de su salud. Por lo tanto, afecta la calidad de vida de la persona y su relación con el medio ambiente. Por otro lado, la autoevaluación de la salud ha demostrado ser un marcador preciso del estado general de la salud. Sin embargo, hay escasa información sobre cómo estas dos condiciones se relacionan entre sí en adultos mayores de origen hispano. El objetivo de este estudio fue evaluar el impacto del edentulismo en la autoevaluación de la salud en adultos mayores. Se analizaron los datos de SABE Ecuador 2009, un estudio transversal que incluyó una muestra probabilística y representativa de 5.235 personas de 60 años de edad o más. La variable dependiente fue la salud autoevaluada y edentulismo fue la variable independiente, teniendo edad, sexo y comorbilidades como variables de confusión. Con el fin de probar la asociación independiente de edentulismo con la autoevaluación de la salud un modelo de regresión logística se ajustó. De la muestra entera, un 77,13% de los adultos mayores reportaron tener salud autoevaluada regular / pobre. Se encontró una asociación independiente entre edentulismo y salud autoevaluada con un riesgo incremental dependiendo del número de dientes ausentes de OR 1,35 (IC 95% 0,75 2,43) p 0,32, en adultos mayores con menos de 4 dientes ausentes hasta OR 1,88 (1,06 3,32) p 0,029, con más de la mitad de dientes ausentes. La salud oral se ha considerado de forma independiente del resto del cuerpo y la mente, es claro por nuestros resultados que la salud oral es un componente muy importante del estado de salud global en las personas mayores (AU)

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OBJECTIVE: To determine the impact of pain on the quality of life in older adults and its association with functionality. MATERIALS AND METHODS: Data was taken from SABE Bogota study. A cross-sectional study was carried out during 2012, interviewing 2,000 individuals of 60 years and older, as a probabilistic cluster and representative sample. The variable 'presence of pain' to was used to identify associations with sociodemographic factors, self-rated health, comorbidities, functional status, cognitive status, and quality of life. The latter was estimated using a visual analogue scale of the EuroQOL tool (EQ-VAS). RESULTS: The majority of older adults were women (63.4%); the mean age was 71.17 years (SD=8.05), with a higher frequency of individuals in the age group between 60 and 69years (48%). When comparing groups with pain vs. no pain, significantly lower scores were found in the group with pain (P<.001) in both the functionality and quality of life EQ-VAS scales. The strongest associations with pain were: joint diseases (OR: 3.08 [2.24-4.23]), severe depression (OR: 2.80 [1.63-4.79]) and functional impairment of the Basic Activities of Daily Living (BADL) (OR: 2.45 [1.31-4.58]). CONCLUSIONS: Pain negatively impacts the functional independence and the perception of the quality of life in older adults, predisposing them to adverse outcomes.

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INTRODUCTION: The aging of the population is a universal epidemiological phenomenon which is not unfamiliar to us and is accompanied by a marked increase of life expectancy. Age-dependent comorbidities, such as hearing disorders, are more prevalent and affect the quality of life in a noticeable manner. OBJECTIVE: To estimate the prevalence of hearing disorders, of the associated factors and their impact on the quality of life of older adults in Bogota. MATERIALS AND METHODS: Data was taken from the Bogotá SABE Study, which included 2,000 individuals aged =60 years in a probabilistic cross-sectional study sampled by clusters (with 81.9% coverage). We used the "hearing disorders" variable relating it to socio-demographic variables, as well as to the use of hearing aids, the self-perceived health, the comorbidities, the functionality, the cognition and the quality of life as measured with the Visual Analog Scale of the EuroQol Group (EQ-VAS). RESULTS: We found a prevalence of hearing disorders in 267 individuals (13.5%), of whom 15% used hearing aids. The frequency was higher in individuals aged =75 years (46.1%), in the low socioeconomic level (20.2%) and among illiterate people (19.3%, p<0.05). Regarding comorbidities, we found a higher prevalence in individuals suffering from depression (20.2%, p<0.001), and high blood pressure (15%, p<0.01). The quality of life was worse in individuals with hearing disorders, as measured with the EuroQol EQ-VAS (60.93 ± 1.38 vs. 71.75 ± 0.45, p< 0.0001), but it improved among those who used hearing aids as compared to those who did not use them (59.59 ± 1.52, p<0.01). CONCLUSIONS: Hearing disorders are relevant in elderly individuals and they affect their perceived quality of life in a noticeable manner. In addition, they are associated with other clinical, functional and cognitive problems. Nevertheless, the intervention with hearing aids reverses that perception.

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