Ultrasound-guided proximal paravertebral anaesthesia in cattle

OBJECTIVE To develop and evaluate a method for ultrasound-guidance in performing the proximal paravertebral block for flank anaesthesia in cattle through a cadaveric study, followed by clinical application. STUDY DESIGN prospective experimental cadaveric study and clinical series. ANIMALS Previously frozen lumbar sections of cows without known spinal abnormalities were used. The clinical case group comprised of ten animals for which a right flank laparotomy was indicated. METHODS Twenty cow cadavers were used to perform ultrasound-guided bilateral injections of 1.0 mL dye (1.0 mL 1% Toluidine Blue in 1% Borax) at the intervertebral foramen at the level of T13, L1 and L2 spinal nerves. Distance and depth of injection, staining of the dorsal and ventral nerve branches, and deviation from the target were evaluated. The investigator's confidence as to visualisation and expected success at staining the nerve was assessed. Ten clinical cases received the ultrasound-guided proximal paravertebral anaesthesia. Analgesic success was evaluated using a 4-grade scoring system at 10 minutes after the injection and during surgery, respectively. Categorical variables were described using frequencies and proportions. RESULTS Both dorsal and ventral branches of the spinal nerves T13, L1 or L2 were at least partially stained in 41% of injections, while in 77% of injections one of the branches was stained. Five out of ten clinical cases had a satisfactory anaesthesia. There was no significant association between confidence at injection and either staining or analgesic success. CONCLUSION Results from the cadaveric and clinical study suggest no significant improvement using ultrasound guidance to perform proximal paravertebral block in cows compared to our previous clinical experience and to references in the literature using the blind method. CLINICAL RELEVANCE Further research should be conducted to improve the ultrasound-guided technique described in this study.

Dynamics of critical incidents with potentially violent outcomes involving ultra fans: an explorative study

This study examines incidents involving a tense atmosphere combined with higher risk of football fan violence. A systematic description of such critical incidents (CIs) identifying their risk factors and warning signs is yet lacking. This study looks beyond fans’ violent acts per se and focuses on CIs involving ultra fans with a potentially – but not necessarily – violent outcome. A preliminary study involving a focus group was conducted followed by a main study including eight case studies. The focus group comprised five professionals working with football fans who discussed CIs’ observable characteristics. Risk factors and warning signs were coded using content analysis, such as, ‘arrest of a fan’. In the main study, people involved in actual CIs were interviewed to explore these phenomena in more depth. An integrated model of CIs’ dynamics, risk factors and warning signs was compiled using data gathered in both studies.

Evaluation of the city of Houston HIV/STD prevention program in Houston Independent School District (HISD) high schools

This cross-sectional study was undertaken to evaluate the impact in terms of HIV/STD knowledge and sexual behavior that the City of Houston HIV/STD prevention program in HISD high schools has had on students who have participated in it by comparing them with their peers who have not, based on self reports. The study further evaluated the program cost-effectiveness for averting future HIV infections by computing Cost-Utility Ratios based on reported sexual behavior. ^ Mixed results were obtained, indicating a statistically significant difference in knowledge with the intervention group having scored higher (p-value 0.001) but not for any of the behaviors assessed. The knowledge score outcome's overall p-value after adjusting for each stratifying variable (age, grade, gender and ethnicity) was statistically significant. The Odds Ratio of intervention group participants aged 15 years or more scoring 70% or higher was 1.86 times; that of intervention group female participants was 2.29 times; and that of intervention group Black/African American participants was 2.47 times relative to their comparison group counterparts. The knowledge score results remained statistically significant in the logistic regression model, which controlled for age, grade level, gender and ethnicity. The Odds Ratio in this case was 1.74. ^ Three scenarios based on the difference in the risk of HIV infection between the intervention and comparison group were used for computation of Cost-Utility Ratios: Base, worst and best-case scenario. The best-case scenario yielded cost-effective results for male participants and cost-saving results for female participants when using ethnicity-adjusted HIV prevalence. The scenario remained cost-effective for female participants when using the unadjusted HIV prevalence. ^ The challenge to the program is to devise approaches that can enhance benefits for male participants. If it is a threshold problem implying that male participants require more intensive programs for behavioral change, then programs should first be piloted among boys before being implemented across the board. If it is a reflection of gender differences, then we might have to go back to the drawing board and engage boys in focus group discussions that will help formulate more effective programs. Gender-blind approaches currently in vogue do not seem to be working. ^

Issues related to HIV stigma: An embedded case study of PLHAS and community in Nepal

Little is known about HIV stigma in Nepal. Findings from other parts of the world suggest that HIV related stigma acts as a limiting factor for People Living with HIV & AIDS (PLHAs) from accessing needed health care and the subsequent psychological outcomes make PLHAs and their immediate family members more vulnerable. The purpose of this study is to understand and describe Nepalese PLHA's and community peoples' experiences regarding sources, types, causes and mechanism of HIV-associated stigma. This study aimed to best utilize the existing data. Study participants were recruited through local Community Based Organizations working in the field of HIV. The data, collected in the form of focus group discussions in workshop settings, were coded and analyzed. Study has revealed key issues related to HIV stigma in Nepal: hierarchy of stigma, denial and rejection, death as a form of punishment and Mumbaiya disease. A conceptual model was developed to explain the HIV stigma in Nepal. Our hope is that this finding, stigma being a contextual variable, will be helpful in triggering a novel public health discourse in the field of HIV stigma in Nepal, which will eventually be helpful for developing policies and interventions to eliminate HIV-associated stigma.^

Defining barriers in caring for seriously-ill children in a resource-limited setting: An observational study of 2 children's hospitals in Haiti

Background. According to the WHO 2007 country report, Haiti lags behind the Millennium Development Goal of reducing child mortality and maintains the highest under-5 mortality rate in the Western hemisphere. 3 Overall, few studies exist that seek to better grasp barriers in caring for a seriously ill child in a resource-limited setting and only a handful propose sustainable, effective interventions. ^ Objectives. The objectives of this study are to describe the prevalence of serious illnesses among children hospitalized at 2 children's hospitals in Port au Prince, to determine the barriers faced when caring for seriously ill children, and to report hospital outcomes of children admitted with serious illnesses. ^ Methods. Data were gathered from 2 major children's hospitals in Port au Prince, Haiti (Grace Children's Hospital [GCH] and Hopital d l'Universite d'Etat d'Haiti [HUEH]) using a triangulated approach of focus group discussions, physician questionnaires, and retrospective chart review. 23 pediatric physicians participated in focus group discussions and completed a self-administered questionnaire evaluating healthcare provider knowledge, self-efficacy, and perceived barriers relating to the care of seriously ill children in a resource-limited setting. A sample of 240 patient charts meeting eligibility criteria was abstracted for pertinent elements including sociodemographics, documentation, treatment strategies, and outcomes. Factors associated with mortality were analyzed using χ2 test and Fisher exact test [Minitab v.15]. ^ Results. The most common primary diagnoses at admission were gastroenteritis with moderate dehydration (35.5%), severe malnutrition (25.8%), and pneumonia (19.3%) for GCH, and severe malnutrition (32.6%), sepsis (24.7%), and severe respiratory distress (18%) for HUEH. Overall, 12.9% and 27% of seriously ill patients presented with shock to GCH and HUEH, respectively. ^ Shortage of necessary materials and equipment represented the most commonly reported limitation (18/23 respondents). According to chart data, 9.4% of children presenting with shock did not receive a fluid bolus, and only 8% of patients presenting with altered mental status or seizures received a glucose check. 65% of patients with meningitis did not receive a lumbar puncture due to lack of materials. ^ Hospital mortality rates did not differ by gender or by institution. Children who died were more likely to have a history of prematurity (OR 4.97 [95% CI 1.32-18.80]), an incomplete vaccination record (OR 4.05 [95% CI 1.68-9.74]), or a weight for age ≤3rd percentile (OR 6.1 [95% CI 2.49-14.93]. Case-fatality rates were significantly higher among those who presented with signs of shock compared with those who did not (23.1% vs. 10.7%, RR=2.16, p=0.03). Caregivers did not achieve shock reversal in 21% of patients and did not document shock reversal in 50% of patients. ^ Conclusions. Many challenges face those who seek to optimize care for seriously ill children in resource-limited settings. Specifically, in Haiti, qualitative and quantitative data suggest major issues with lack of supplies, pre-hospital factors, including malnutrition as a comorbidity, and early recognition and management of shock. A tailored intervention designed to address these issues is needed in order to prospectively evaluate improvements in child mortality in a high-risk population.^

Barriers to adolescent and young men's access of reproductive health care

Purpose. The purpose of this study was to identify the health needs and barriers that young men face in accessing health care and family planning services and to identify what health centers can do to attract young men to the clinic. A focus group format was used to elicit ideas from participants. ^ Methods. Forty-eight young men participated in nine focus groups. The young men were asked about the health issues they have, the barriers they face in accessing reproductive health care, and what clinics can do to attract young men to the clinic. Thematic analysis principles were used to identify the main themes that emerged in the focus groups. ^ Results. Sexually transmitted infections (STIs), mental health problems, and drug use were the major health issues that were mentioned in the majority of the focus groups. The main barriers discussed in the focus groups were attitudinal factors such as young men thinking it is unmanly to seek help, emotional factors such as young men not seeking help because of their ego or pride, and institutional factors such as the location of the clinic. The main suggestions for improvements in the health clinic included decreasing waiting times, emphasizing the fact that the clinics are free for males, having more female nurses, and encouraging clinic staff to treat the young men with respect. Young men suggested advertising and promoting the clinic in schools, in the community, and through the media. Focus group participants also provided their input about the design and format of the clinic flyer. ^ Conclusions. Many studies focus on the reproductive health care needs of adolescent and young females. This study has helped to show that young men also have health care needs and face barriers to accessing reproductive health care services.^

Pediatric obesity: Managed care collaborating with providers to improve diagnosis and treatment

Child overweight and obesity reaches across ethnic, cultural, socioeconomic and regional barriers. It must be assessed, diagnosed and treated to help families make sustainable behavior changes. Treatment recommendations have been made to address pediatric overweight and obesity. They include screening for risk factors, monitoring BMI trends and educating patients and families to make small sustainable changes. Health insurance companies can play a meaningful role in supporting and facilitating provider education and behavior change to diagnose, treat and prevent pediatric overweight and obesity.^ The aims of this thesis were: (1) Describe a disease management program that uses evidence-based practices to create provider behavior change related to pediatric obesity screening, diagnosis and treatment. (2) Identify ways to improve the implementation of the program based on the perceptions of participating clinicians.^ A literature review was completed to evaluate current recommendations for screening and treating pediatric obesity using the Ovid data base. The evidenced-based recommendations were compared against the practices of the Healthy Lifestyles Program (HeLP). The literature confirmed that HeLP is following evidence-based recommendations for assessment, diagnosis and treatment of pediatric obesity.^ A Children’s Mercy Family Health Partners focus group was convened to create a provider survey. The goals of the survey were to assess providers’ perception of the Healthy Lifestyles Program (HeLP). The survey was sent out through email using Survey Monkey. All survey responses were anonymous. The survey was sent to a total of 80 providers who had completed HeLP. Twenty-five percent responded. The survey results were evaluated to make recommendations for HeLP.^ Results of the survey included motivating factors for participation in HeLP. Concern about the increasing prevalence of pediatric obesity was a frequent motivator for participation. Provider barriers to obesity diagnosis were evaluated. Lack of time during clinic visits a frequent barrier to obesity diagnosis. ^ In conclusion several recommendations for the HeLP were made based on survey results. It is recommended that the program evaluate methods and tools for facilitating effective weight management follow up visits. Promotional materials should highlight the increasing prevalence of pediatric obesity when advertising HeLP. These recommendations will be used to refine the current Healthy Lifestyles Program.^

Program for increasing resident's physical activity at the women's home

Obesity and overweight has reached epidemic proportions in the United States, and the prevalence of overweight and obesity among residents of The Women's Home residents is high. This culminating experience is the result of my practicum at The Women's Home located in Houston, TX. The Women's Home is a rehabilitation center for victims of sexual assault, drug abuse, family violence, or a combination. A needs assessment including focus groups and a literature review was conducted to design a a physical activity intervention for the residents. Results from focus group data showed the resident's average BMI was 32, which is termed clinically obese by American standards. The focus groups determined a strong interest (92%) in engaging in more physical activity to combat their weight problem. As well, they expressed interest in using pedometers as a mechanism to increase physical activity. This planned program, “Every Step Counts”, uses reactivity to pedometers in conjunction with goal setting and increased awareness to increasing steps each day. “Every Step Counts” was developed with support and input from stakeholders, with theoretical constructs and previous evidence based studies. Included in this report are recommendations for implementation, program materials, scope and sequence of program activities, and methods for periodic evaluation.^

Development of a standard sign-out procedure for clinicians in a pediatric intensive care unit

Background: Poor communication among health care providers is cited as the most common cause of sentinel events involving patients. Sign-out of patient data at the change of clinician shifts is a component of communication that is especially vulnerable to errors. Sign-outs are particularly extensive and complex in intensive care units (ICUs). There is a paucity of validated tools to assess ICU sign-outs. ^ Objective: To design a valid and reliable survey tool to assess the perceptions of Pediatric ICU (PICU) clinicians about sign-out. ^ Design: Cross-sectional, web-based survey ^ Setting: Academic hospital, 31-bed PICU ^ Subjects: Attending faculty, fellows, nurse practitioners and physician assistants. ^ Interventions: A survey was designed with input from a focus group and administered to PICU clinicians. Test-retest reliability, internal consistency and validity of the survey tool were assessed. ^ Measurements and Main Results: Forty-eight PICU clinicians agreed to participate. We had 42(88%) and 40(83%) responses in the test and retest phases. The mean scores for the ten survey items ranged from 2.79 to 3.67 on a five point Likert scale with no significant test-retest difference and a Pearson correlation between pre and post answers of 0.65. The survey item scores showed internal consistency with a Cronbach's Alpha of 0.85. Exploratory factor analysis revealed three constructs: efficacy of sign-out process, recipient satisfaction and content applicability. Seventy eight % clinicians affirmed the need for improvement of the sign-out process and 83% confirmed the need for face- to-face verbal sign-out. A system-based sign-out format was favored by fellows and advanced level practitioners while attendings preferred a problem-based format (p=0.003). ^ Conclusions: We developed a valid and reliable survey to assess clinician perceptions about the ICU sign-out process. These results can be used to design a verbal template to improve and standardize the sign-out process.^

Redes personales digitales y contexto escolar : estudio de un grupo de adolescentes de Mendoza (Argentina)

Este artículo se centra en el análisis de redes personales digitales de un grupo de adolescentes del último año de una escuela secundaria de gestión privada en Mendoza, Argentina. Se escogió Facebook porque es la red más difundida entre ellos. El objetivo de este estudio fue analizar las redes de Facebook de adolescentes de una escuela con una fuerte implementación de las TIC y comprender las percepciones que tienen sobre sus vinculaciones digitales. La recolección de los datos fueron tres momentos (administración de TouchGraph sobre Facebook, entrevista individual y Focus Group). El análisis de los datos fue cuantitativo, de análisis de grafos y cualitativo. Con respecto a los resultados se observaron que los varones tuvieron redes con mayor dispersión en cuanto al número de miembros y las mujeres mayor homogeneidad (menor número de subgrupos). En los grafos se observó que la familia tuvo una baja importancia (está aislada, es pequeña y con baja relación o no está). El análisis cualitativo, reveló un acercamiento crítico a Facebook y que la protección de la privacidad obstaculiza la relación a través de esta red con la escuela y los padres. Finalmente las redes personales digitales brindan apoyo afectivo, informacional, tangible y axiológico.

Por uma Governança Democrática : Triangulo Mineiro - Brasil - Uberlândia

The City Educator Program is articulated with PROEX-Pro - Deanship Culture and Student Affairs through the Directorate of Extension, along with the Institute of Geography, Faculty of Architecture, Urban Planning and Design Institute and the City Futura Pro. Program is conducted since 2008 by the Federal University of Uberlândia and Motion City Futura. The outreach program aims to promote democratic governance and smart planning municipal and regional level, enabling public and social (government technicians, law enforcement officers, and civil society leaders) seeking implementation of legal instruments, urban and tributaries in the counties of Araguari and Uberlândia, established in the City Statute and Master Plans, and the Fiscal Responsibility, Social Rights established by the Constitution, and all the instruments of social control in the municipalities involved. The methodology includes content developed through dynamic, research participant, group work and exposure dialogue. The results were relevant to holding the Course on Urban Management and Sustainable Democratic, Uberlândia A Forum for Sustainable Leadership Training Course Ethical and Sustainable, Community Workshops Seminars in Neighborhoods assessment; Map Workshop Speaker, Research Participants, Seminars and Interactive Campaigns Mobilization office in the territory. Were produced articles, reports and reflections that are public in book form. At the end of the implementation of program activities, the municipal governments, entities and non-governmental organizations as well as citizens who, directly or indirectly, involved with the program, attended the final seminar where, besides the presentation of results, was made, collectively, evaluation and assessment of all activities

Testimonios de un Pasado Imperfecto : Vida Cotidiana de Mujeres bajo Dictadura en Valparaíso y Viña del Mar, Chile 1980-1987

Este proyecto de investigación se caracteriza como estudio histórico-etnográfica basado en estudios de casos de la vida cotidiana de nueve mujeres en Valparaíso y Viña del Mar durante la dictadura chilena, analizando el testimonio de los efectos del régimen autoritario en la vida cotidiana de estas mujeres chilenas entre 1980 y 1987. La metodología se radica firmemente en el método etnográfico con entrevistas semi-abiertas y el análisis del discurso de los relatos. En la metáfora de la arpillera (un tapiz anónimo cosido en lona ensamblado a partir de piezas de tela que muestra escenas de la vida cotidiana o protesta la dictadura de Pinochet), trozos y pedazos de experiencia se juntan en el encima de la lona de la historia para dar forma al testimonio de vida la vida cotidiana. Este proyecto se centra en tres aspectos diferentes de la relación entre el Estado autoritario y la vida cotidiana: las técnicas de gobernabilidad (macro), narraciones de silencio y miedo (micro) y trayectorias narrados (espacial), el último inspirado por el ensayo Halbwachs en caminar por la ciudad. Para cerrar, la relevancia del estudio se destaca por el intento de comprender el efecto de un estado autoritario en el sujeto femenino y las respuestas y adaptaciones que las mujeres chilenas adoptaron en la vida privada y pública mediada por la violencia y el miedo bajo dictadura. La dialéctica del acontecimiento y la rutina de la vida cotidiana bajo la dictadura se unen en las memorias narradas, mediada por el presente vivido, lo cual permite una reflexión sobre la cuestión de la alteridad en la sociedad chilena.Este proyecto de investigación se caracteriza como estudio histórico-etnográfica basado en estudios de casos de la vida cotidiana de nueve mujeres en Valparaíso y Viña del Mar durante la dictadura chilena, analizando el testimonio de los efectos del régimen autoritario en la vida cotidiana de estas mujeres chilenas entre 1980 y 1987. La metodología se radica firmemente en el método etnográfico con entrevistas semi-abiertas y el análisis del discurso de los relatos. En la metáfora de la arpillera (un tapiz anónimo cosido en lona ensamblado a partir de piezas de tela que muestra escenas de la vida cotidiana o protesta la dictadura de Pinochet), trozos y pedazos de experiencia se juntan en el encima de la lona de la historia para dar forma al testimonio de vida la vida cotidiana. Este proyecto se centra en tres aspectos diferentes de la relación entre el Estado autoritario y la vida cotidiana: las técnicas de gobernabilidad (macro), narraciones de silencio y miedo (micro) y trayectorias narrados (espacial), el último inspirado por el ensayo Halbwachs en caminar por la ciudad. Para cerrar, la relevancia del estudio se destaca por el intento de comprender el efecto de un estado autoritario en el sujeto femenino y las respuestas y adaptaciones que las mujeres chilenas adoptaron en la vida privada y pública mediada por la violencia y el miedo bajo dictadura. La dialéctica del acontecimiento y la rutina de la vida cotidiana bajo la dictadura se unen en las memorias narradas, mediada por el presente vivido, lo cual permite una reflexión sobre la cuestión de la alteridad en la sociedad chilena.

Trabajar en la niñez : ¿Marcas o cicatrices?

En esta presentación se aborda la cuestión del Trabajo Infantil en dos comunidades vulnerables de la ciudad de La Plata. Las reflexiones y cuestionamientos que se formulan son el resultado de un Proyecto de Investigación, aún en curso. El objetivo principal es indagar las producciones subjetivas que el trabajo de niños y niñas inscribe en ellos y en adultos del barrio. A este fin, se empleó metodología cualitativa; y se utilizaron como técnicas, entrevistas semiestructuradas, focus group con niños, asociación libre de palabras. Entre las conclusiones a las que hemos arribado hasta aquí, señalamos la necesidad de abordar esta cuestión desde las condiciones que habilitan el trabajo infantil como estrategia de supervivencia. También, hemos observado el registro de estos niños y niñas acerca del futuro como una prolongación del presente, sin posibilidad de transformación.

Testimonios de un Pasado Imperfecto : Vida Cotidiana de Mujeres bajo Dictadura en Valparaíso y Viña del Mar, Chile 1980-1987

Este proyecto de investigación se caracteriza como estudio histórico-etnográfica basado en estudios de casos de la vida cotidiana de nueve mujeres en Valparaíso y Viña del Mar durante la dictadura chilena, analizando el testimonio de los efectos del régimen autoritario en la vida cotidiana de estas mujeres chilenas entre 1980 y 1987. La metodología se radica firmemente en el método etnográfico con entrevistas semi-abiertas y el análisis del discurso de los relatos. En la metáfora de la arpillera (un tapiz anónimo cosido en lona ensamblado a partir de piezas de tela que muestra escenas de la vida cotidiana o protesta la dictadura de Pinochet), trozos y pedazos de experiencia se juntan en el encima de la lona de la historia para dar forma al testimonio de vida la vida cotidiana. Este proyecto se centra en tres aspectos diferentes de la relación entre el Estado autoritario y la vida cotidiana: las técnicas de gobernabilidad (macro), narraciones de silencio y miedo (micro) y trayectorias narrados (espacial), el último inspirado por el ensayo Halbwachs en caminar por la ciudad. Para cerrar, la relevancia del estudio se destaca por el intento de comprender el efecto de un estado autoritario en el sujeto femenino y las respuestas y adaptaciones que las mujeres chilenas adoptaron en la vida privada y pública mediada por la violencia y el miedo bajo dictadura. La dialéctica del acontecimiento y la rutina de la vida cotidiana bajo la dictadura se unen en las memorias narradas, mediada por el presente vivido, lo cual permite una reflexión sobre la cuestión de la alteridad en la sociedad chilena.Este proyecto de investigación se caracteriza como estudio histórico-etnográfica basado en estudios de casos de la vida cotidiana de nueve mujeres en Valparaíso y Viña del Mar durante la dictadura chilena, analizando el testimonio de los efectos del régimen autoritario en la vida cotidiana de estas mujeres chilenas entre 1980 y 1987. La metodología se radica firmemente en el método etnográfico con entrevistas semi-abiertas y el análisis del discurso de los relatos. En la metáfora de la arpillera (un tapiz anónimo cosido en lona ensamblado a partir de piezas de tela que muestra escenas de la vida cotidiana o protesta la dictadura de Pinochet), trozos y pedazos de experiencia se juntan en el encima de la lona de la historia para dar forma al testimonio de vida la vida cotidiana. Este proyecto se centra en tres aspectos diferentes de la relación entre el Estado autoritario y la vida cotidiana: las técnicas de gobernabilidad (macro), narraciones de silencio y miedo (micro) y trayectorias narrados (espacial), el último inspirado por el ensayo Halbwachs en caminar por la ciudad. Para cerrar, la relevancia del estudio se destaca por el intento de comprender el efecto de un estado autoritario en el sujeto femenino y las respuestas y adaptaciones que las mujeres chilenas adoptaron en la vida privada y pública mediada por la violencia y el miedo bajo dictadura. La dialéctica del acontecimiento y la rutina de la vida cotidiana bajo la dictadura se unen en las memorias narradas, mediada por el presente vivido, lo cual permite una reflexión sobre la cuestión de la alteridad en la sociedad chilena.

Trabajar en la niñez : ¿Marcas o cicatrices?

En esta presentación se aborda la cuestión del Trabajo Infantil en dos comunidades vulnerables de la ciudad de La Plata. Las reflexiones y cuestionamientos que se formulan son el resultado de un Proyecto de Investigación, aún en curso. El objetivo principal es indagar las producciones subjetivas que el trabajo de niños y niñas inscribe en ellos y en adultos del barrio. A este fin, se empleó metodología cualitativa; y se utilizaron como técnicas, entrevistas semiestructuradas, focus group con niños, asociación libre de palabras. Entre las conclusiones a las que hemos arribado hasta aquí, señalamos la necesidad de abordar esta cuestión desde las condiciones que habilitan el trabajo infantil como estrategia de supervivencia. También, hemos observado el registro de estos niños y niñas acerca del futuro como una prolongación del presente, sin posibilidad de transformación.