"Laboratorio para la promoción humana": una aproximación para la atención y orientación social a adolescentes en condición de vulnerabilidad social de la ciudad de Cartagena de Indias

Se presenta el diseño de un programa de atención y orientación social a población beneficiaria del Club Deportivo y Comunitario KALAMARY denominado "Laboratorio de Promoción Social", que pretende ser desarrollado Adolescentes y sus padres de familia y/o adultos responsables en condiciones de vulnerabilidad social residentes en la Localidad de la Ciudad de Cartagena de Indias. Se propone el uso de la Pedagogía Social como ciencia que guiará el desarrollo de las acciones en aras de aportar al reconocimiento e identificación de las condiciones actuales y reales de la población beneficiaria, la priorización de las áreas de actuación para el desarrollo de procesos de intervención que, en última instancia, es el objetivo marco que guiará el proceso operacional del proyecto. Desde lo metodológico, se pretende abordar la unidad de análisis desde un enfoque Mixto o multivariado con uso de técnicas de recolección de información como el cuestionario y los grupos de discusión. Al finalizar el proyecto, se pretende dejar un diseño integral que permita encausar todas las acciones desarrolladas desde el Club Deportivo y Comunitario KALAMARY para la atención oportuna de los Adolescentes que acuden al desarrollo de las actividades programadas en la misma.Facultad de Humanidades y Ciencias de la Educació

Effectiveness of a cognitive behavioral intervention in patients with medically unexplained symptoms: cluster randomized trial

BACKGROUND: Medically unexplained symptoms are an important mental health problem in primary care and generate a high cost in health services.Cognitive behavioral therapy and psychodynamic therapy have proven effective in these patients. However, there are few studies on the effectiveness of psychosocial interventions by primary health care. The project aims to determine whether a cognitive-behavioral group intervention in patients with medically unexplained symptoms, is more effective than routine clinical practice to improve the quality of life measured by the SF-12 questionary at 12 month. METHODS/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Madrid (Spain). The number of patients required is 242 (121 in each arm), all between 18 and 65 of age with medically unexplained symptoms that had seeked medical attention in primary care at least 10 times during the previous year. The main outcome variable is the quality of life measured by the SF-12 questionnaire on Mental Healthcare. Secondary outcome variables include number of consultations, number of drug (prescriptions) and number of days of sick leave together with other prognosis and descriptive variables. Main effectiveness will be analyzed by comparing the percentage of patients that improve at least 4 points on the SF-12 questionnaire between intervention and control groups at 12 months. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: This study aims to provide more insight to address medically unexplained symptoms, highly prevalent in primary care, from a quantitative methodology. It involves intervention group conducted by previously trained nursing staff to diminish the progression to the chronicity of the symptoms, improve quality of life, and reduce frequency of medical consultations. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01484223 [http://ClinicalTrials.gov].S

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Iberoamerican Reviews

Reseñas iberoamericanasIberoamerican Review

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Evaluación histórica del concepto región y su aplicación en la descentralización administrativa

Tesis (Trabajador(a) Social) -- Universidad de Cartagena. Facultad de Ciencias Sociales y Educación. Programa de Trabajo Social, 1988Investigaciones en el campo de la intervención del trabajador social bajo las perspectivas que le plantea la actual política social

Relación entre el bienestar subjetivo, el bienestar psicológico y el bienestar social en líderes y lideresas víctimas de violencia sociopolítica en el departamento de Sucre

El objetivo del presente estudio fue establecer la relación entre el Bienestar Subjetivo, el Bienestar Psicológico y el Bienestar Social en líderes y lideresas víctimas de violencia sociopolítica en el departamento de Sucre. Se realizó bajo una metodología con paradigma positivista, de enfoque cuantitativo, tipo correlacional, diseño no experimental y de corte transversal, en el cual se aplicaron las escalas de bienestar psicológico, bienestar subjetivo y bienestar social. La muestra estuvo constituida por 50 50 líderes y lideresas víctimas de violencia sociopolítica residentes en Pichilín, Morroa, departamento de Sucre, cuya media de edad fue de 43,56 donde 21 son de sexo masculino y 22 de sexo femenino. El análisis de los datos se realizó inicialmente por medio de los estadísticos descriptivos empleando el programa SPSS, sin embargo, en la segunda fase se realizó un análisis correlacional. En los resultados obtenidos se evidenció que, la variable bienestar subjetivo tuvo una media 13,72, asimismo para bienestar psicológico la dimensión con la media más alta fue auto aceptación con 44,92 y en bienestar social, la escala más elevada fue actualización social con 20,38. Finalmente, se obtuvo como resultado la existencia de correlación positiva significativa entre bienestar psicológico y bienestar social.MaestríaMagister en Desarrollo Socia

"Laboratorio para la promoción humana": una aproximación para la atención y orientación social a adolescentes en condición de vulnerabilidad social de la ciudad de Cartagena de Indias

Se presenta el diseño de un programa de atención y orientación social a población beneficiaria del Club Deportivo y Comunitario KALAMARY denominado "Laboratorio de Promoción Social", que pretende ser desarrollado Adolescentes y sus padres de familia y/o adultos responsables en condiciones de vulnerabilidad social residentes en la Localidad de la Ciudad de Cartagena de Indias. Se propone el uso de la Pedagogía Social como ciencia que guiará el desarrollo de las acciones en aras de aportar al reconocimiento e identificación de las condiciones actuales y reales de la población beneficiaria, la priorización de las áreas de actuación para el desarrollo de procesos de intervención que, en última instancia, es el objetivo marco que guiará el proceso operacional del proyecto. Desde lo metodológico, se pretende abordar la unidad de análisis desde un enfoque Mixto o multivariado con uso de técnicas de recolección de información como el cuestionario y los grupos de discusión. Al finalizar el proyecto, se pretende dejar un diseño integral que permita encausar todas las acciones desarrolladas desde el Club Deportivo y Comunitario KALAMARY para la atención oportuna de los Adolescentes que acuden al desarrollo de las actividades programadas en la misma.Facultad de Humanidades y Ciencias de la Educació