Impacto de la pandemia COVID-19 en la salud física y mental de pacientes con enfermedades crónicas

Objetivos El objetivo de esta tesis doctoral es analizar la prevalencia y los niveles actuales de ansiedad, angustia, estrés y depresión así como los factores relacionados en pacientes con afecciones crónicas durante la pandemia COVID-19. Asimismo, se pretenden analizar los parámetros clínicos de seguimiento habitual de dichos pacientes en centros sanitarios de Atención Primaria del Servicio Andaluz de Salud. Metodología Los dos primeros estudios sobre niveles y prevalencia de ansiedad, angustia, estrés y depresión se basan en dos revisiones sistemáticas y meta-análisis. Para el tercer estudio se realizó un estudio longitudinal prospectivo en centros de atención primaria del Servicio Andaluz de Salud. Los datos se registraron antes de la pandemia (T1), durante la declaración del estado de emergencia (T2) y en la fase de transición (T3). Resultados En el estudio realizado en pacientes diabéticos, la prevalencia de ansiedad fue del 23% (IC 95% = 19–28) para pacientes con DM1 y del 20% (IC 95% = 6–40) en pacientes con DM2. Para la angustia fue del 41 % (95% IC = 24–60) en DM1 y para los pacientes con DM2 del 36% (95% IC = 2–84). Para el estrés, la prevalencia fue del 79% (IC 95% = 49–98) en pacientes con DM1. El segundo estudio analizó la depresión encontrando una prevalencia para pacientes diabéticos del 17% (95% CI = 7–31) al 33% (95% CI = 16–51), en pacientes con obesidad del 48% (95% CI = 26–71) y en pacientes con hipertensión del 18% (95% CI = 13–24). Los factores relacionados con la depresión fueron sexo femenino, estar soltero, parámetros clínicos de diabetes alterados, cambios en los comportamientos de autocuidado, reducción de la actividad física y tiempo de sueño, así como miedo al contagio. El tercer artículo tras analizar variables clínicas de seguimiento habitual informa que durante la declaración del estado de emergencia así como en las sucesivas olas de contagio hubo mejoras significativas en IMC, niveles totales de colesterol y HDL durante el inicio de la pandemia. El índice de Barthel, Pfeiffer, la presión arterial, triglicéridos y LDL empeoraron en T2 y los efectos negativos se mantuvieron en T3. En comparación con los valores prepandémicos, los niveles de HbA1c mejoraron en T3 pero los niveles de HDL empeoraron. Conclusiones Las revisiones sistemáticas y meta-análisis que se han llevado a cabo en esta tesis doctoral muestran que los pacientes con enfermedades crónicas han visto mermada su salud mental, ya que en pacientes diabéticos se observa un aumento significativo de los niveles de ansiedad, angustia y estrés. Por otro lado, se observa que la prevalencia de depresión en pacientes diabéticos, obesos e hipertensos aumentó. Los estudios revisados muestran como factores asociados a un mayor nivel de depresión, el sexo femenino, estar soltero, parámetros clínicos de diabetes alterados, cambios en los comportamientos de autocuidado, reducción de la actividad física y tiempo de sueño, así como miedo al contagio. Por otro lado, en base a los resultados obtenidos en el trabajo empírico a nivel de atención primaria en pacientes crónicos se encuentra una mayor dificultad para la realización de las actividades de la vida diaria así como un empeoramiento en su evaluación cognitiva. Además, a corto plazo durante el confinamiento y las diferentes olas solo se evidencian reduciones en IMC, niveles totales de colesterol y HDL, por lo que los cambios fueron positivos. Sin embargo, la presión arterial, triglicéridos y LDL empeoraron, manteniendo los efectos negativos durante la fase de transición. En comparación con los valores prepandémicos, los niveles de HbA1c mejoraron a largo plazo durante la etapa de transición, pero los niveles de HDL empeoraron.Objective The objective of this doctoral thesis is to analyse the prevalence and current levels of anxiety, distress, stress and depression as well as related factors in patients with chronic conditions during the COVID-19 pandemic. Also, this thesis aims to analyse the clinical parameters of the usual follow-up of these patients in Primary Care health Centres of the Andalusian Health Service. Methodology The first two studies about the levels and prevalence of anxiety, distress, stress and depression were based on two systematic reviews and meta-analyses. For the third study, a prospective longitudinal study was carried out in primary care centres of the Andalusian Health Service. The data was recorded before the pandemic (T1), during the declaration of the state of emergency (T2) and in the transition phase (T3). Results In the study carried out in diabetic patients, the prevalence of anxiety was 23% (95% CI = 19–28) for patients with DM1 and 20% (95% CI = 6–40) in patients with DM2. For distress it was 41% (95% CI = 24–60) in DM1 and for patients with DM2 it was 36% (95% CI = 2–84). For stress, the prevalence was 79% (95% CI = 49–98) in patients with DM1. The second study analysed depression, finding a prevalence for diabetic patients of 17% (95% CI = 7–31) to 33% (95% CI = 16–51), in patients with obesity of 48% (95% CI = 26). –71), and in patients with hypertension of 18% (95% CI = 13–24). The factors related to depression were female sex, being single, altered clinical parameters of diabetes, changes in self-care behaviours, reduction in physical activity and sleep time, as well as fear of contagion. The third article, after analysing routine follow-up clinical variables, reported that during the declaration of the state of emergency as well as in the successive waves of contagion, there were significant improvements in BMI, total cholesterol and HDL levels during the beginning of the pandemic. The Barthel and Pfeiffer index, blood pressure, triglycerides and LDL worsened in T2 and the negative effects were maintained in T3. Compared to pre-pandemic values, HbA1c levels improved in T3 but HDL levels worsened. Conclusions The systematic reviews and meta-analyses done in this doctoral thesis showed that patients with chronic diseases have seen their mental health diminished, since a significant increase in levels of anxiety, distress and stress was observed in diabetic patients. On the other hand, it was observed that the prevalence of depression in diabetic, obese and hypertensive patients increased. The studies reviewed showed that factors associated with a higher level of depression include female sex, being single, altered clinical parameters of diabetes, changes in self-care behaviours, reduction in physical activity and sleep time, as well as fear of contagion. On the other hand, based on the results obtained in the empirical study at the primary care level in chronic patients, greater difficulty was found in carrying out activities of daily living as well as a worsening in their cognitive evaluation. Furthermore, in the short term during confinement and the different waves, only reductions in BMI, total cholesterol and HDL levels were evident, so the changes were positive. However, blood pressure, triglycerides and LDL worsened, maintaining the negative effects during the transition phase. Compared to pre-pandemic values, HbA1c levels improved in the long term during the transition phase, but HDL levels worsened

Prevalence of Depression and Related Factors among Patients with Chronic Disease during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

The management of chronic diseases in the midst of the COVID-19 pandemic is especially challenging, and reducing potential psychological harm is essential. This review aims to determine the prevalence of depression during the COVID-19 pandemic in patients with chronic disease, and to characterize the impacts of related factors. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The meta-analysis was performed using StatsDirect software. The review identified 33 articles with a total of 50,905 patients with chronic diseases. Four meta-analyses were performed to estimate the prevalence of depression. In diabetic patients, the prevalence ranged from 17% (95% CI = 7–31) (PHQ-9) to 33% (95% CI = 16–51) (PHQ-8); in obese patients, the prevalence was 48% (95% CI = 26–71); and in hypertensive patients, the prevalence was 18% (95% CI = 13–24). The factors significantly associated with depression were female sex, being single, deterioration in the clinical parameters of diabetes, a decrease in self-care behavior, reduced physical activity and sleep time and fear of contagion. The COVID-19 pandemic has significantly increased levels of depression among persons with chronic disease. Pandemics and other emergency events have a major impact on mental health, so early psychological interventions and health management policies are needed to reinforce chronic patients’ physical and mental health

Leisure time shared as a family_ a socio-educational interpretation of the galician situation.

[ES] La sociedad apresurada en la que nos encontramos inmersos incrementa las dificultades de las familias con hijos para organizar sus tiempos cotidianos. Las ocupaciones relativas al ámbito laboral y familiar están ligadas a la falta de tiempo en las rutinas diarias, resultando más complejo atender a otras facetas vitales para el bienestar y desarrollo humano como es el ocio. Esta falta de tiempo condiciona los ritmos cotidianos de los más pequeños que, habitualmente, ven limitadas sus posibilidades de compartir experiencias lúdicas con sus progenitores, situando al tiempo de ocio familiar en un segundo plano. Ante esta realidad, el presente artículo tiene como objetivos: a) conocer cómo configuran las familias gallegas con hijos escolarizados en Educación Primaria sus tiempos de ocio vinculados al ámbito artístico-cultural y físico-deportivo; y b) estudiar cómo influye el nivel de estudios e ingresos de los progenitores en la configuración de dichos tiempos. La metodología de investigación es cuantitativa, empleando para la recogida de información un cuestionario elaborado ad hoc, obteniendo un total de 2037 válidos. Los resultados evidencian que las familias gallegas tienden a la corresponsabilidad al compartir experiencias de ocio con sus hijos, pero cuando se estudia el protagonismo de la madre y del padre en solitario se observan diferencias notables en sus papeles, especialmente en función de la tipología de actividad de ocio. Como conclusiones podemos afirmar que, en general, las familias prefieren compartir conjuntamente con sus hijos las actividades de ocio estudiadas, pero cuando se analiza el papel de los progenitores en solitario se detectan desigualdades en cuanto al género, siendo mayor el protagonismo de las madres. También se comprueba que existen desigualdades en cuanto al nivel económico y de estudios de las familias. Es necesario desarrollar políticas socioeducativas para la promoción de un ocio compartido con independencia del género y de factores socioeconómicos. [EN] The fast-paced world in which we live today makes it increasingly difficult for parents to organise the day-to-day lives of their children. Work and family-related commitments dominate daily routines and make it increasingly difficult to find time for other aspects that are essential for our well-being and development, such as leisure. This lack of time determines the rhythms of the daily lives of children who routinely find it difficult to share recreational experiences with their parents, as family leisure time is often relegated to second place. In view of this situation, this article has the following aims: a) to find out how Galician families with children in primary school organise their leisure time in terms of artistic/cultural and physical/ sporting activities; and b) to examine how parents’ educational level and income influence this leisure time. We used a quantitative research methodology consisting of an ad hoc questionnaire for the collection of data, from which a total of 2,037 valid responses were obtained. The results show that Galician parents tend to share responsibility for leisure experiences with their children, but when examining the role of the mother and father in isolation, there are notable differences in their roles, especially with respect to the type of leisure activity carried out. In terms of conclusions, we can confirm that parents generally prefer to share leisure activities with their children, but when the role of the parents is analysed in isolation, inequalities are detected in terms of gender, with mothers being more actively involved. The study also shows that there are inequalities in terms of the income and educational level of the parents. It is necessary to develop socio-educational policies for the promotion of shared leisure regardless of gender and socio-economic factors

Air–water properties in rectangular free-falling jets

This study analyzes the air–water flow properties in overflow nappe jets. Data were measured in several cross-sections of rectangular free-falling jets downstream of a sharp-crested weir, with a maximum fall distance of 2.0 m. The flow properties were obtained using a conductivity phase-detection probe. Furthermore, a back-flushing Pitot-Prandtl probe was used in order to obtain the velocity profiles. Five specific flows rates were analyzed, from 0.024 to 0.096 m3/s/m. The measurements of the air–water flow allowed us to characterize the increment of the air entrainment during the fall, affecting the flow characteristic distributions, reducing the non-aerated water inner core, and increasing the lateral spread, thereby leading to changes in the jet thickness. The results showed slight differences between the upper and lower nappe trajectories. The experimental data of the jet thickness related to a local void fraction of 50% seemed to be similar to the jet thickness due only to gravitational effects until the break-up length was reached. The amount of energy tended to remain constant until the falling distance was over 15 times greater than the total energy head over the weir crest, a distance at which the entrained air affected the entire cross-section, and the non-aerated core tended to disappear. The new experiments related with air–water properties in free-falling jets allow us to improve the current knowledge of turbulent rectangular jets

Poor Cognitive Agility Conservation in Obese Aging People

Life expectancy has been boosted in recent decades at expenses of increasing the ageassociated diseases. Dementia, for its incidence, stands out among the pathologies associated with aging. The exacerbated cognitive deterioration disables people from carrying out their daily lives autonomously and this incidence increases exponentially after 65 years of age. The etiology of dementia is a miscellaneous combination of risk factors that restrain the quality of life of our elderly. In this sense, it has been established that some metabolic pathologies such as obesity and diabetes act as a risk factor for dementia development. In contrast, a high educational level, as well as moderate physical activity, have been shown to be protective factors against cognitive impairment and the development of dementia. In the present study, we have evaluated the metabolic composition of a population between 60–90 years old, mentally healthy and with high academic degrees. After assessing agility in mental state, we have established relationships between their cognitive abilities and their body composition. Our data support that excess body fat is associated with poorer maintenance of cognition, while higher percentages of muscle mass are associated with the best results in the cognitive tests.Junta de Andalucia European Commission P20-01061 P18-RT-3324 P20-01293 PECART-0096-2020Ministry of Science and Innovation, Spain (MICINN) Spanish Government PID2019-110960GB-I0

Evaluando la influencia de la calidad de la distancia peatonal en la cobertura de paradas del metro ligero de Granada (España)

Aunque las características del entorno urbano y social tienen una marcada influencia en la distancia peatonal al transporte público, existe una escasa atención a este fenómeno en el contexto de los análisis de accesibilidad. Sin embargo, considerar la calidad de la distancia peatonal en la evaluación de la accesibilidad podría constituir una herramienta útil para conseguir una mayor y mejor integración del transporte público en los entornos urbanos. En este artículo se diseña la herramienta Q-WD: Calidad de la Distancia Peatonal (Quality of Walking Distance) testeándola en el caso de la ciudad de Granada, y en concreto en varios entornos de movilidad vinculados a la línea de metro ligero. Los resultados muestran cómo la cobertura de las paradas se reduce en aquellos casos en los que la calidad peatonal de los entornos de parada es baja, mientras que los entornos de parada con alta calidad peatonal producen una extensión de la cobertura de parada del transporte público. Asimismo, los resultados de la aplicación de la herramienta Q-WD evidencian cómo el recuento total de población servida varía en los entornos peatonales cuando se considera la calidad de la distancia.The characteristics of the urban and social environment may have a strong influence in the walking distance to public transport. Nevertheless, scarce attention has been paid to this fact in the context of accessibility analysis. Even though, taking into account the quality of the walking distance in the evaluation of accessibility could be a useful tool to enhance higher public transport integration into urban environments. In this paper we develop the tool Q-WD: Quality of Walking Distance, which is tested in in the city of Granada, specifically on some mobility environments linked to stops of the light rail system. The results show how the catchment area decreases as the pedestrian environment quality diminishes, whilst in those pedestrian environments of high quality the catchment area expands. Furthermore, the results of applying the Q-WD tool allow to detect a change in the population served count, which is influenced by the distance quality.Junta de Andalucía y los fondos FEDER para el Proyecto de Excelencia P12-RNM-1514: “Instrumentos para la valoración de escenarios urbanos frente al cambio climático. Diseño de un software para la evaluación ambiental (MITIGA)“ (2014–2018

Sensores de fibra óptica y sus aplicaciones en elmedio ambiente

En esta investigación se hace un análisis sobre sensores de fibra óptica y su aplicación en el medio ambiente, teniendo en cuenta la calidad del agua, suelo y aire, áreas con un mayor interés del campo de estudio, debido a que forman parte del entorno en que la vida se desarrolla. Un cuerpo de agua, aire o suelo con altos contenidos de contaminantes son lugares no aptos para la vida y desarrollo de las especies. Cuando se trata de medir uno o varios parámetros físicos del agua o aire, o de de-tectar alguna sustancia y cuantificarla, es necesario utilizar algún tipo de sensor que nos proporcione datos confiables para poder aplicar so-luciones que mitiguen los riesgos que existen. Los tipos de sensores que más se utilizan para estos fines son mecánicos, electroquímicos, así como, para algunos parámetros ya en aplicación, sensores ópticos. En la sociedad en la que vivimos, cada vez se hace más necesario el desarrollo de pequeños dispositivos de análisis que sean de bajo costo, portátiles, fiables, selectivos, de fácil manejo y que requieran de pocos microlitros de muestra para determinar un parámetro concreto

Overcoming non-local effects and Brillouin threshold limitations in Brillouin distributed sensors

We demonstrate, for the first time to our knowledge, a Brillouin optical time domain analysis sensor that is able to operate with a probe power larger than the Brillouin threshold of the deployed sensing fiber and that is free from detrimental non-local effects. The technique is based on a dual-probe-sideband setup in which a frequency modulation of the probes waves along the fiber is introduced. This makes the frequency of maximum interaction between pump and probes to vary along the fiber, thus mitigating the pump pulse depletion and making it possible to use very large probe power, which brings an improved signal-to-noise ratio in detection

Realive (2016): from cellular to human cryopreservation. Myth and reality for teacher training in the area of health sciences

There is a growing thought of delaying the progression of a terminal illness by cryopreservation of the bodies of patients. Faced with the fear of dying from diseases, they are confident that in the future they will be able to be revived and treated with novel therapies that will lead to the cure and elimination of the pathology. Although it seems science fiction, the reality is that it is already being carried out with cellular organisms for the conservation of species and against diseases that alter reproduction. However, when it comes to embryos, the ethical committees do not yet have a defined strategy. For this reason, this work tries to focus on an interrelation between teachers and students for the discussion and reflection of the cryopreservation of patients, showing the latest advances and reports on this aspect.Existe un creciente pensamiento de postergar el avance de una enfermedad terminal mediante la criopreservación de los cuerpos de los pacientes. Ante el miedo a morir de enfermedades se confían que en el futuro podrán ser reanimados y tratados con novedosas terapias que le supondrán la cura y eliminación de la patología. Aunque parezca ciencia ficción la realidad es que ya se está realizando con organismos celulares para la conservación de especies y ante enfermedades que alteran la reproducción. Sin embargo, cuando se trata de embriones los comités éticos no tienen todavía una estrategia definida. Por esa razón, este trabajo intenta enfocar una interrelación entre profesorado y alumnado para la discusión y reflexión de la criopreservación de pacientes, mostrando los últimos avances e informes sobre este aspecto

Overcoming nonlocal effects and Brillouin threshold limitations in Brillouin optical time-domain sensors

We demonstrate, for the first time to our knowledge, a Brillouin optical timedomain analysis (BOTDA) sensor that is able to operate with a probe power larger than the Brillouin threshold of the deployed sensing fiber and that is free from detrimental nonlocal effects. The technique is based on a dual-probe-sideband setup in which an optical frequency modulation of the probe waves along the fiber is introduced. This makes the optical frequency of the Brillouin interactions induced by each probe wave on the pump vary along the fiber so that two broadband Brillouin gain and loss spectra that perfectly compensate are created. As a consequence, the pulse spectral components remain undistorted, avoiding nonlocal effects. Therefore, very large probe power can be injected, which improves the signal-to-noise ratio (SNR) in detection for long-range BOTDA. Moreover, the probe power can even exceed the Brillouin threshold limit due to its frequency modulation, which reduces the effective amplification of spontaneous Brillouin scattering in the fiber. Experiments demonstrate the technique in a 50-km sensing link in which 8 dBm of probe power is injected.This work was supported by the Universidad Pública de Navarra, by the Universidad de Cantabria, and by the Spanish Ministerio de Ciencia e Innovación through project TEC2013-47264-C2 and Feder funds