Hábitos de actividad física y costes socioeconómicos de la obesidad y sus patologías asociadas

46 páginas.Tutor de la tesis: Raimundo Prieto Mendoza. Se ha llevado a cabo un estudio cuasiexperimental y transversal habiéndose realizado la medida de las variables entre los meses de marzo y abril de 2007, sobre una población urbana de Andalucía con objeto de analizar el coste socioeconómico que suponen el sobrepeso y la obesidad y sus patologías asociadas en comparación con un grupo de normopeso y entre ellos, a la vez que se compara la realización de actividad física y se comprueban las patologías más frecuentes asociadas a estos grupos. La población a estudio la componen 1367 sujetos que corresponden a las edades comprendidas entre 14 y 64 años de los que se ha extraído un muestra aleatoria de 98 sujetos con semejantes porcentajes por sexo y edad. La media del IMC para mujeres ha sido de 25.1 y para los hombre de 28.2. El perímetro de la cintura ha tenido una media de 100.4 para hombres y de 85.7 para mujeres con una desviación típica semejante. Se observa que el grado de actividad física, tanto en mujeres como en varones es escaso, con un alto porcentaje de actividad ligera. En cuanto al grado de obesidad, destaca el alto porcentaje de sobrepeso en los dos sexos, así como de obesidad en los varones y de normopeso en las mujeres. A mayor grado de obesidad hemos detectado menor grado de realización de actividad física para ambos sexos. A mayor grado de obesidad y menor grado de actividad física, encontramos mayores porcentajes de toma de medicación, de enfermedades y de días de baja laboral, lo que implica mayor uso de recursos sociosanitarios y mayor coste global. En conclusión, el perímetro abdominal a nivel de cintura no se debería de tener en cuenta a la hora de valorar el grado de obesidad en las mujeres y sí el índice cintura-cadera, se deberían de revisar los valores de referencia del IMC para las mujeres, la actividad física realizada en grupos de peso elevado es baja y el sobrepeso y obesidad suponen un aumento de recursos sociosanitarios de forma global

Bioelectrical Phase Angle, Muscle Damage Markers and Inflammatory Response After a Competitive Match in Professional Soccer Players

Abstract Introduction. The purposes of this study were 1) to evaluate changes from baseline levels in bioelectrical phase angle (PhA) and markers of muscle damage and inflammation in professional players 36 h after a soccer match, and 2) to analyze the relationships between PhA and markers of muscle damage and inflammation in order to investigate if PhA might be a useful parameter to monitor recovery. Material and methods. Eighteen male professional soccer players participated in this study. Plasma lactate dehydrogenase (LDH) and creatine kinase (CK) activities, plasma C-reactive protein (CRP) and interleukin-6 (IL-6) concentrations, and PhA were measured before and 36 h after a competitive match. Results. Changes in LDH and CK 36 h after the match were greater than their reference change values (RCV). Changes in CRP and IL-6 were, however, lower than their corresponding RCV. 36 h after the match, significant correlations were observed between PhA and LDH (r = 0.714, p = 0.001), PhA and CK (r = 0.787, p = 0.000), and PhA and CRP (r = 0.554, p = 0.017). Conclusions. Although IL-6 and CRP have been traditionally analyzed together to monitor inflammation after intense exercise, since 36 h after the match they have already returned or started to return to baseline levels, the use of them alone is not a good option to monitor inflammation throughout recovery. PhA might be used as a predictor of muscle damage and inflammation, but further studies covering the whole recovery period are warranted

Commissioning of a synchrotron-based proton beam therapy system for use with a Monte Carlo treatment planning system

This work tackles the commissioning and validation of a novel combination of a synchrotron-based proton beam therapy system (Hitachi, Ltd.) for use with a Monte Carlo treatment planning system (TPS). Four crucial aspects in this configuration have been investigated: (1) Monte Carlo-based correction performed by the TPS to the measured integrated depth-dose curves (IDD), (2) circular spot modelling with a single Gaussian function to characterize the synchrotron physical spot, which is elliptical, (3) the modelling of the range shifter that enables using only one set of measurements in open beams, and (4) the Monte Carlo dose calculation model in small fields. Integrated depth-dose curves were measured with a PTW Bragg peak chamber and corrected, with a Monte Carlo model, to account for energy absorbed outside the detector. The elliptical spot was measured by IBA Lynx scintillator, EBT3 films and PTW microDiamond. The accuracy of the TPS (RayStation, RaySearch Laboratories) at spot modelling with a circular Gaussian function was assessed. The beam model was validated using spread-out Bragg peak (SOBP) fields. We took single-point doses at several depths through the central axis using a PTW Farmer chamber, for fields between 2 × 2cm and 30 × 30cm. We checked the range-shifter modelling from open-beam data. We tested clinical cases with film and an ioni- zation chamber array (IBA Matrix). Sigma differences for spots fitted using 2D images and 1D profiles to elliptical and circular Gaussian models were below 0.22 mm. Differences between SOBP measurements at single points and TPS calculations for all fields between 5 × 5 and 30 × 30cm were below 2.3%. Smaller fields had larger differences: up to 3.8% in the 2 × 2cm field. Mean differences at several depths along the central axis were generally below 1%. Differences in range- shifter doses were below 2.4%. Gamma test (3%, 3 mm) results for clinical cases were generally above 95% for Matrix and film. Approaches for modelling synchrotron proton beams have been validated. Dose values for open and range- shifter fields demonstrate accurate Monte Carlo correction for IDDs. Elliptical spots can be successfully modelled using a circular Gaussian, which is accurate for patient calculations and can be used for small fields. A double-Gaussian spot can improve small-field calculations. The range-shifter modelling approach, which reduces clinical commissioning time, is adequat

Composição corporal de pacientes acamados por fraturas do quadril

As fraturas do quadril são a maior causa de hospitalização da terceira idade, e constituem um considerável encargo econômico e social. A taxa de mortalidade atual após um ano de fratura é acima de 33%, e o risco de morte é maior do quarto ao sexto mês após a fratura. O objetivo deste estudo foi de avaliar alterações na composição corporal de pacientes idosos, durante sua hospitalização por fraturas fêmur proximal, através de métodos antropométricos e análise dos valores fisiológicos de gasto energético. Foi realizado um estudo prospectivo utilizando-se 45 pacientes consecutivos com diagnóstico de fratura do quadril. Em todos os casos, foram obtidas medidas diretas e avaliações antropométricas indiretas baseadas em estimativas, nas primeiras 24 horas e repetidas após uma semana de admissão hospitalar. Após uma semana de internação houve diminuição da média do perímetro do braço (0,73 cm, p=0.0052) e da espessura da prega tricipital (1.41 mm, p=0.0181), sem haver modificação das outras variáveis estudadas. A avaliação antropométrica como um meio de se fazer um mapa da composição corporal, em conjunto com as estimativas indiretas sugeridas neste estudo, podem ajudar a determinar o estado nutricional e necessidades calóricas de pacientes idosos

Quantification of dosimetric uncertainties in lung stereotactic body radiation therapy

Lung stereotactic body radiation therapy (SBRT) is associated with sources of geometric uncertainties, such as respiratory motion, daily anatomical variations (anatomical baseline shifts between daily and planned position) and the simultaneous movement between the tumor and the multileaf collimator (the so-called interplay effect) during treatment delivery. In this work, several methodologies have been implemented based on deformable image registration to quantify the dosimetric impact of those geometric uncertainties in lung SBRT. These methodologies revealed two main conclusions: First, daily anatomical deviations in patient anatomy generally had a larger dosimetric impact than respiratory motion. Second, the impact of interplay effect could be a concern for highly irregular patient breathing patterns or for long breathing periods, and whether small field size were used for dose conformation purposes. Furthermore, these methodologies developed would be very helpful for clinicians involved in treatment planning and delivery to evaluate treatment robustness against the geometric uncertainties studied in this work.La radioterapia corporal estereotáctica (SBRT, por sus siglas en inglés) para cáncer de pulmón está asociada a fuentes de incertidumbres geométricas, como pueden ser: el movimiento del tumor por la respiración del paciente, variaciones anatómicas diarias con respecto a la anatomía planificada y el movimiento simultáneo del tumor y del campo de radiación (conocido como ”efecto interplay”) en la administración de la dosis. En el presente trabajo, se han implementado una serie metodologías basadas en registro deformable de imágenes para cuantificar el impacto dosimétrico de dichas incertidumbres. Dichas metodologías revelaron dos conclusiones fundamentales: La primera, que el impacto dosimétrico de las variaciones anatómicas diarias con respecto a la anatomía de planificación, tuvieron un mayor impacto en los tratamientos que el movimiento del tumor por la respiración del paciente. La segunda, que el ”efecto interplay” podría suponer un problema si el paciente tiene un patrón respiratorio muy irregular o de períodos largos, y si se han utilizado campos de radiaciones muy pequeños para conseguir una mayor conformación en la dosis entregada al tumor. Además, las metodologías desarrolladas podrían ser muy útiles en el día a día clínico para evaluar la robustez de los tratamientos frente a las incertidumbres estudiadas en el presente trabajo

Quantification of dosimetric uncertainties in lung stereotactic body radiation therapy

Lung stereotactic body radiation therapy (SBRT) is associated with sources of geometric uncertainties, such as respiratory motion, daily anatomical variations (anatomical baseline shifts between daily and planned position) and the simultaneous movement between the tumor and the multileaf collimator (the so-called interplay effect) during treatment delivery. In this work, several methodologies have been implemented based on deformable image registration to quantify the dosimetric impact of those geometric uncertainties in lung SBRT. These methodologies revealed two main conclusions: First, daily anatomical deviations in patient anatomy generally had a larger dosimetric impact than respiratory motion. Second, the impact of interplay effect could be a concern for highly irregular patient breathing patterns or for long breathing periods, and whether small field size were used for dose conformation purposes. Furthermore, these methodologies developed would be very helpful for clinicians involved in treatment planning and delivery to evaluate treatment robustness against the geometric uncertainties studied in this work.La radioterapia corporal estereotáctica (SBRT, por sus siglas en inglés) para cáncer de pulmón está asociada a fuentes de incertidumbres geométricas, como pueden ser: el movimiento del tumor por la respiración del paciente, variaciones anatómicas diarias con respecto a la anatomía planificada y el movimiento simultáneo del tumor y del campo de radiación (conocido como ”efecto interplay”) en la administración de la dosis. En el presente trabajo, se han implementado una serie metodologías basadas en registro deformable de imágenes para cuantificar el impacto dosimétrico de dichas incertidumbres. Dichas metodologías revelaron dos conclusiones fundamentales: La primera, que el impacto dosimétrico de las variaciones anatómicas diarias con respecto a la anatomía de planificación, tuvieron un mayor impacto en los tratamientos que el movimiento del tumor por la respiración del paciente. La segunda, que el ”efecto interplay” podría suponer un problema si el paciente tiene un patrón respiratorio muy irregular o de períodos largos, y si se han utilizado campos de radiaciones muy pequeños para conseguir una mayor conformación en la dosis entregada al tumor. Además, las metodologías desarrolladas podrían ser muy útiles en el día a día clínico para evaluar la robustez de los tratamientos frente a las incertidumbres estudiadas en el presente trabajo

A method using 4D dose accumulation to quantify the interplay effect in lung stereotactic body radiation therapy

The purpose of this study was to devise and evaluate a method to quantify the dosimetric uncertainty produced by the interplay between the movement of multileaf collimator and respiratory motion in lung stereotactic body radiation therapy. The method calculates the dose distribution for all control points from a dynamic treatment in all respiratory phases. The methodology includes some characteristics of a patient's irregular breathing patterns. It selects, for each control point, the phases with maximum and minimum mean dose over the tumor and their corresponding adjacent phases, whenever necessary. According to this selection, the dose matrices from each control point are summed up to obtain two dose distributions in each phase, which are accumulated in the reference phase subsequently by deformable image registration (DIR). D 95 and [Formula: see text] were calculated over those accumulated dose distributions for Gross Tumor Volume (GTV), Planning Target Volume-based on Internal Target Volume approach-and Evaluation Target Volume (ETV), a novel concept that applies to 4D dose accumulation. With the ETV, DIR and interplay uncertainties are separated. The methodology also evaluated how variations in the breathing rate and field size affects the mean dose received by the GTV. The method was applied retrospectively in five patients treated with intensity modulated radiotherapy-minimum area defined by the leaves configuration at any control point was at least 4 cm2. Uncertainties in tumor coverage were small (in most patients, changes on D 95 and [Formula: see text] were below 2% for GTV and ETV) but significant over- and under-dosages near ETV, which can be accentuated by highly irregular breathing. Uncertainties in mean dose for GTV tended to decrease exponentially with increasing field size and were reduced by an increase of breathing rate. The implementation of this method would be helpful to assess treatment quality in patients with irregular breathing. Furthermore, it could be used to study interplay uncertainties when small field sizes are used

Conceptualización del aprendizaje en red, uso problemático de internet y actividades digitales

Resumen basado en el de la publicaciónSe realiza una búsqueda de literatura científica para conceptualizar el aprendizaje en red y lo que conlleva que un estudiante utilice los dispositivos tecnológicos sin la capacidad de gestionar el tiempo y el modo de usarlo. Se destacan las características de las redes de aprendizaje: intercambio de conocimiento y experiencias, proyectos colaborativos, grupos de trabajo, autoevaluaciones, recibir y dar apoyo a los miembros de la red, entre otras. Se aclara que una red de aprendizaje debe tener un objetivo que ha de ser evaluado y adaptado constantemente, además de centrarse en la conexión entre usuarios, dar apoyo a los docentes y crear herramientas que favorezcan la interacción. Se analiza el “uso problemático de Internet”, que alude al malestar en el comportamiento producido por el empleo abusivo hacia internet; y se propone realizar un diagnóstico exhaustivo en aquellos estudiantes que presenten conductas negativas para combatir este problema. Se destacan recursos y modelos de enseñanza que integran recursos tecnológicos emergentes como son: la realidad virtual y aumentada, la robótica y la gamificación. Se concluye que en educación superior es necesario fomentar las redes de aprendizaje y el uso de las TIC para facilitar al alumnado, al profesorado y a la propia institución educativa, capacidad de maniobra para innovar y enriquecer el aprendizaje. Además de promover buenas prácticas que sirvan de referentes al resto de docentes sobre cómo promover una inclusión eficiente de los recursos tecnológicos en las diferentes enseñanzas así como una mejora en variables personales y académicas del estudiantado, tales como la motivación hacia el proceso de aprendizaje, autorregulación, rendimiento académico o autonomía del aprendizaje.ES

A method using 4D dose accumulation to quantify the interplay effect in lung stereotactic body radiation therapy

The purpose of this study was to devise and evaluate a method to quantify the dosimetric uncertainty produced by the interplay between the movement of multileaf collimator and respiratory motion in lung stereotactic body radiation therapy. The method calculates the dose distribution for all control points from a dynamic treatment in all respiratory phases. The methodology includes some characteristics of a patient's irregular breathing patterns. It selects, for each control point, the phases with maximum and minimum mean dose over the tumor and their corresponding adjacent phases, whenever necessary. According to this selection, the dose matrices from each control point are summed up to obtain two dose distributions in each phase, which are accumulated in the reference phase subsequently by deformable image registration (DIR). D 95 and [Formula: see text] were calculated over those accumulated dose distributions for Gross Tumor Volume (GTV), Planning Target Volume-based on Internal Target Volume approach-and Evaluation Target Volume (ETV), a novel concept that applies to 4D dose accumulation. With the ETV, DIR and interplay uncertainties are separated. The methodology also evaluated how variations in the breathing rate and field size affects the mean dose received by the GTV. The method was applied retrospectively in five patients treated with intensity modulated radiotherapy-minimum area defined by the leaves configuration at any control point was at least 4 cm2. Uncertainties in tumor coverage were small (in most patients, changes on D 95 and [Formula: see text] were below 2% for GTV and ETV) but significant over- and under-dosages near ETV, which can be accentuated by highly irregular breathing. Uncertainties in mean dose for GTV tended to decrease exponentially with increasing field size and were reduced by an increase of breathing rate. The implementation of this method would be helpful to assess treatment quality in patients with irregular breathing. Furthermore, it could be used to study interplay uncertainties when small field sizes are used

A method using 4D dose accumulation to quantify the interplay effect in lung stereotactic body radiation therapy

The purpose of this study was to devise and evaluate a method to quantify the dosimetric uncertainty produced by the interplay between the movement of multileaf collimator and respiratory motion in lung stereotactic body radiation therapy. The method calculates the dose distribution for all control points from a dynamic treatment in all respiratory phases. The methodology includes some characteristics of a patient's irregular breathing patterns. It selects, for each control point, the phases with maximum and minimum mean dose over the tumor and their corresponding adjacent phases, whenever necessary. According to this selection, the dose matrices from each control point are summed up to obtain two dose distributions in each phase, which are accumulated in the reference phase subsequently by deformable image registration (DIR). D 95 and [Formula: see text] were calculated over those accumulated dose distributions for Gross Tumor Volume (GTV), Planning Target Volume-based on Internal Target Volume approach-and Evaluation Target Volume (ETV), a novel concept that applies to 4D dose accumulation. With the ETV, DIR and interplay uncertainties are separated. The methodology also evaluated how variations in the breathing rate and field size affects the mean dose received by the GTV. The method was applied retrospectively in five patients treated with intensity modulated radiotherapy-minimum area defined by the leaves configuration at any control point was at least 4 cm2. Uncertainties in tumor coverage were small (in most patients, changes on D 95 and [Formula: see text] were below 2% for GTV and ETV) but significant over- and under-dosages near ETV, which can be accentuated by highly irregular breathing. Uncertainties in mean dose for GTV tended to decrease exponentially with increasing field size and were reduced by an increase of breathing rate. The implementation of this method would be helpful to assess treatment quality in patients with irregular breathing. Furthermore, it could be used to study interplay uncertainties when small field sizes are used