En el marco de un creciente interés de la sociología del medioambiente y la energía por estudiar los procesos de transición hacia sistemas energéticos proambientales, este artículo presenta los principales hallazgos empíricos de un estudio de caso que aborda cualitativamente una política de recambio de estufas en la ciudad de Temuco, Chile. El artículo utiliza dos enfoques teóricos complementarios, la Multilevel Perspective (MLP) y la teoría de las prácticas sociales (TPS) para describir la existencia de mecanismos de bloqueo a los procesos de transición sostenible, tanto a nivel institucional como a nivel de las prácticas asociadas al uso de las estufas. El artículo se basa en 23 entrevistas semiestructuradas a actores clave del proceso de recambio y 23 ejercicios de observación participante orientados a describir las prácticas de calefacción de los hogares de Temuco. En base a esta evidencia, el artículo plantea la necesidad de abordar las transiciones energéticas proambientales articulando enfoques teóricos que permitan dar cuenta de las distintas escalas y actores que constituyen este tipo de procesos. Este enfoque puede facilitar una mayor sensibilidad a las distintas dificultades inherentes a los procesos de transición energética.
Papers 2015, 100/4 http://dx.doi.org/10.5565/rev/papers.2169 577-606Redes sociales, capital social y acción colectiva en dos territorios campesinos de la región de La Araucanía, en Chile, para enfrentar problemas asociados al acceso al agua* ResumenEl artículo presenta un análisis de las redes sociales y el capital social como condiciones necesarias para el surgimiento de la acción colectiva, específicamente, en comunidades campesinas de la región de La Araucanía, para enfrentar problemas de acceso al agua. Chile, a diferencia de la mayoría de los países de América Latina, posee un sistema de asignación, distribución y gestión hídricas basado en principios de mercado, es decir, el agua deja de ser un bien común y se transforma en un bien privado desvinculado de la propiedad de la tierra, con lo cual se despoja a los campesinos e indígenas de las aguas que tradicionalmente han utilizado. El aumento de los conflictos por el agua en Chile no se debe exclusivamente a problemas asociados a la escasez, sino a las particularidades del modelo de gestión institucionalizado y a la restricción para generar acción colectiva local que permita la gestión sustentable del recurso. Metodológicamente, se aplicaron encuestas y se realizaron análisis de redes sociales. Los principales resultados muestran que las redes sociales tienen propiedades estructurales que no favorecerían la formación del capital social necesario para * Este artículo es parte de los resultados del proyecto FONDECYT Regular 2014, N°1141249, financiado por la Comisión Nacional de Ciencia y Tecnología de Chile.578 Papers 2015, 100/4Francisca Fontseca: René Montalba; Mauricio García la acción colectiva. No obstante, al analizar las propiedades relacionales de las redes, se observa que los escasos vínculos existentes son lazos fuertes, a partir de los cuales se podría realizar gestión de redes, con el propósito de establecer articulaciones sinergéticas orientadas a transformar la estructura de las redes, haciéndolas más cohesivas, y, de este modo, crear condiciones para la formación de acción colectiva en las áreas de estudio. Palabras clave: campesino; cooperación social; organizaciones; acceso al agua; gestión del agua; información; reciprocidad; normas sociales; estructura de red; gobernanza. Abstract. Social networks, social capital, and collective action in two rural areas of La Araucania region, Southern Chile, to address problems related to the access to waterThe article presents an analysis of social networks and social capital as necessary conditions for the emergence of collective action, specifically in rural communities in La Araucanía Region to address problems related to the access to water. Chile, unlike most Latin American countries, has a water distribution and management system based on market principles, in which water is no longer a common good but a private one disconnected from land property, thus depriving small farmers and indigenous peoples from access to the water they have traditionally used. Increasing water conflicts in Chile are not...
Background and Aims End stage kidney disease (ESKD) treatment choice may be very difficult mainly for elderly patients. Dialysis can be burdensome for the frail patients, offering more aggressive procedures and less quality of life. Conservative Care (CC) may shorten life in a fit patient. This study aimed to describe our elderly patients' choices when it comes to CKD treatment options and reflect about them. Method We designed a single center retrospective observational, cross-sectional study regarding patients (pts) over 80 years old (yo) who attend the appointment of ESKD treatment modalities between July 2015 and and December 2021, since a Conservative Care Program is available in our hospital. Results During these 6,5 years, 113 pts over 80 yo were attended. Mean age was 85 yo (range 80–103). 66% were male and mean charlson comorbidity index (CMI) was 7 (sd ± 1,2). Mean seric creatinine was 3,69 mg/dl (sd 0,99; range 1,8-7,0). Mean estimated glomerular filtration rate was 17,41 (sd ±4,12) and 14,64 (sd ± 7,6) ml/min per 1.73 m2 when calculated with BIS1 and CKD-EPI equation, respectively. Two patients were already on a regular program of dialysis. Regarding CKD etiology, 31,9% was from multifactorial origin, 27,4% was from undetermined origin, 10,6% was hypertensive, 8% was diabetic, 6,2% was from chronic pyelonephritis and 9,7% was in the context of cardiorenal syndrome. Regarding treatment options, 54% chose hemodialysis, 38,9% chose conservative care (CC), 2,7% chose peritoneal dialysis and 2,7% refused any treatment. We also observed a significant increase in the CC during these 6.5 years of study. Of those who chose hemodialysis, 22,95% (n = 14) died before starting on a regular program of dialysis, 62,3% (n = 38) actually started on a regular program and 14,75% (n = 9) still maintain follow-up in nephrology appointment. Regarding those who died before starting on dialysis treatment, the mean time between choosing dialysis and death was 1,36 years (range 115 days to 5,46 years, median 1,36 years), and between starting on a regular program and death was 1,38 year (range 11 days to 4,9 years). The main cause of death was unknown (66%) (by lack of data), followed by infectious cause (26,6%). Considering those who chose CC, 31,8% (n = 14) died before starting the regular follow up, 54,5% (n = 24) are on a regular program of follow up, and 4,5% (n = 2) lately decided for dialysis. Regarding those who died before CC, the mean time between choosing it and death was approximately 1 year (range 29 days to 3,4 years), and between starting on a regular follow up and death was 0,68 years (range 14 days to 1,7 years). We didn’t find any statistical significance between CMI and the ESRD modality chosen (p = 0.709) or the occurrence of death (p = 0,496). Conclusion Even considering the poor prognosis and the high mortality rate, the majority of patients over 80 years old still chose dialysis over conservative kidney treatment. In our cohort, there was no survival benefit from those who choose dialysis instead of CC. CC should be offered as an alternative treatment to all the patients who may not benefit from dialysis. It is important to find tools who help us to guide patients in the best suitable choice in regard to ESKD treatments.
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