La aproximación multimétodo en evaluación de necesidades

La evaluación de necesidades es una modalidad de investigación social aplicada, de carácter evaluativo, que consiste en identificar y priorizar los problemas existentes en un contexto determinado, como base para la planificación de intervenciones que incidan sobre las principales carencias detectadas. A pesar de la amplia variedad de métodos de investigación disponibles para el desarrollo de este tipo de estudios, la práctica de la evaluación de necesidades suele caracterizarse por cierta pobreza metodológica, con un claro predominio de la encuesta como principal o único método de recogida de información. En el presente trabajo, tras realizar una breve revisión de las aproximaciones metodológicas alternativas que es posible adoptar en el ámbito general de la investigación social y la evaluación de programas, se propone un modelo multimétodo de evaluación de necesidades que plantea el uso combinado de técnicas de investigación tanto cuantitativas como cualitativas.Needs assessment is a type of applied social evaluative research, focused on the identification and prioritization of problems in a specific context, as a base for intervention planning oriented to solve the main identified needs. In spite of the huge availability of research methods for the development of this kind of studies, needs assessment practice is too often charaterized by certain methodological poverty, with a clear dominance of the survey as the main or only research method. In the present paper, after a brief revision of the methodological approaches that may be adopted in the general field of social research and programme evaluation, a multimethod needs assessment model is proposed, suggesting the combined use of both qualitative and quantitative research techniques

LA IDENTIDAD DE LA FAMILIA. RETOS DEL CAMBIO EDUCATIVO EN LOS MOMENTOS ACTUALES: LA IDENTIDAD DE LA FAMILIA. RETOS DEL CAMBIO EDUCATIVO EN LOS MOMENTOS ACTUALES

Economic, socio-political changes and the challenges of development in the scientific-technical field in an increasingly globalized world impose on education the challenge of the integral formation of new generations whenever they have to be prepared to face the accelerated pace of the scientific revolution - predominant technique. Communication responds to the research project Management competencies in education, which takes place at the University of Las Tunas. Working the family identity from the initial training of the professional of Pedagogy-Psychology, is an imperative need in these times of so many changes and transformations that are happening today's Cuban society, where the family is not alien to them if we take into account that these professionals they will be in charge of guiding and advising the formative work that takes place in the school and in other educational institutions. In the research an analysis of the definition of identity is carried out and the main challenges, challenges and perspectives on which this professional must be prepared for his actions in pre-professional practice are shown. We used research methods of theoretical and empirical level that allowed us to corroborate the need to study this problem, based on the problems that the family presents in the fulfillment of its basic functions, despite the diversity and types with which today it has Cuban society.Los cambios económicos, sociopolíticos y los desafíos del desarrollo en el campo científico-técnico en un mundo cada vez más globalizado imponen a la educación el reto de la formación integral de las nuevas generaciones toda vez que tienen que estar preparados para enfrentar el ritmo acelerado de la revolución científico – técnica predominante. La comunicación responde al proyecto de investigación Competencias de dirección en educación, que se desarrolla en la Universidad de Las Tunas. Trabajar la identidad familiar desde la formación inicial del profesional de Pedagogía-Psicología, constituye una necesidad imperiosa en estos tiempos de tantos cambios y transformaciones que están ocurriendo la sociedad cubana actual, donde la familia no está ajena a ellos si tenemos en cuenta que estos profesionales serán los encargados de orientar y asesorar la labor formativaque se desarrolla en la escuela y en otras instituciones educativas. En la investigación se realiza un análisis de la definición de identidad y se muestran los principales retos, desafíos y perspectivas sobre los cuales debe estar preparado este profesional para su accionar en la práctica pre profesional. Fueron utilizados métodos de investigación de nivel teórico y empírico que permitieron corroborar la necesidad del estudio de esta problemática, a partir de los problemas que presenta la familia en el cumplimiento de sus funciones básicas, a pesar de la diversidad y tipos con los que hoy cuenta la sociedad cubana

Definition of a FPGA-based SoC architecture for PRBS transmission in optical spectroscopy

Optical spectroscopy is a well-known tool typically employed for characterizing the properties of materials by analyzing their iteration with light. One of the most spread techniques is the dual comb spectroscopy, since it accomplishes ultra-high resolution, and high sensitivity measurements with a relatively simple platform including a single, relatively narrowband photodetector. The employed optical dual comb can be implemented through electro-optical (EO) modulation driven by pseudo-ransom binary sequences (PRBS) at high data rates, commonly in the range of tens of Gbps. For that purpose, the runtime generation and transmission of adaptive PRBS is still an open challenge, often involving expensive and not flexible high-speed digital systems, with a few commercially available solutions that sometimes do not match the application requirements efficiently. In this context, this work describes the definition and implementation of a System-on-Chip (SoC) architecture, based on a FPGA device, capable of generating and transmitting two PRBS for a dual comb, at a data rate up to 5 Gbps. The architecture can be configured and its operation modified in run time, thanks to the general-purpose processor involved, in charge of managing an Ethernet link to receive new PRBS to be transmitted or set up certain parameters. The proposed design has been validated experimentally on a dual comb spectroscopy measurement, where the absorption of a hydrogen cyanide (HCN) gas cell has been successfully characterized.Agencia Estatal de InvestigaciónMinisterio de Ciencia e Innovació

Comparative efficacy of exercise, diet and/or pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity: a systematic review and network meta-analysis

Supplementary data are available at Human Reproduction Update online: https://academic.oup.com/humupd/article-lookup/doi/10.1093/humupd/dmae008#supplementary-dataBACKGROUND The increasing prevalence of obesity worldwide poses a significant threat to reproductive function owing, in part, to hormonal disturbances caused by negative feedback between excess adiposity and the hypothalamic–pituitary–ovarian axis. Consequently, finding the most appropriate strategies to lose weight and improve ovulation in women with overweight or obesity is a clinically relevant matter that needs to be investigated. A comprehensive comparison of the independent and combined efficacy of lifestyle and/or pharmacological interventions on BMI, ovulation, and hormonal profile in women with overweight or obesity at risk of anovulatory infertility would facilitate improving fertility strategies in this population. OBJECTIVE AND RATIONALE This study aimed to evaluate the comparative efficacy of exercise, diet, and pharmacological interventions on BMI, ovulation, and hormonal profile in reproductive-aged women with overweight or obesity. SEARCH METHODS A systematic review was performed by searching PubMed, Scopus, Web of Science, PsycINFO, and Cochrane Library up to 14 December 2023, for randomized controlled trials assessing the effects of exercise, diet and/or pharmacological interventions (i.e. weight-lowering drugs or ovulation inducers) on BMI, ovulation, and/or hormonal profile in reproductive-aged women with overweight or obesity. We performed frequentist random-effect network meta-analyses and rated the certainty of the evidence. The primary outcomes were BMI and ovulation rate, and the secondary outcomes were serum reproductive hormone levels (gonadotrophins, androgens, or oestrogens). We performed sensitivity analyses, including the studies that only involved women with PCOS. OUTCOMES Among 1190 records screened, 148 full texts were assessed for eligibility resulting in 95 trials (9910 women), of which 53% presented a high or unclear risk of bias. The network meta-analyses revealed that, compared to control: diet combined with weight-lowering drugs (mean difference (MD) −2.61 kg/m2; 95% CI −3.04 to −2.19; τ2 = 0.22) and adding exercise (MD −2.35 kg/m2; 95% CI −2.81 to −1.89; τ2 = 0.22) led to the greatest decrease in BMI; exercise combined with diet and ovulation inducers (risk ratio (RR) 7.15; 95% CI 1.94–26.40; τ2 = 0.07) and exercise combined with diet and weight-lowering drugs (RR 4.80; 95% CI 1.67–13.84; τ2 = 0.07) produced the highest increase in ovulation rate; and exercise combined with diet and weight-lowering drugs was the most effective strategy in reducing testosterone levels (standardized mean difference (SMD) −2.91; 95% CI −4.07 to −1.74; τ2 = 2.25), the third most effective strategy in increasing sex hormone-binding globulin levels (SMD 2.37; 95% CI 0.99–3.76; τ2 = 2.48), and it was coupled with being ranked first in terms of free androgen index reduction (SMD −1.59; 95% CI −3.18 to 0.01; τ2 = 1.91). The surface under the cumulative ranking curve scores suggested that: diet combined with weight-lowering drugs is the strategy most likely (94%) to produce the highest BMI reduction; and exercise combined with diet and ovulation inducers is the strategy most likely (89%) to produce the highest ovulation rate improvement. The sensitivity analyses, which exclusively included studies involving women diagnosed with PCOS, were consistent with the results presented above. WIDER IMPLICATIONS Overall, the findings of this network meta-analysis indicate that the combination of exercise, diet, and pharmacological interventions is effective for weight loss, improving ovulation, and normalizing the androgen levels of women with overweight or obesity. Although higher quality studies are needed, these results support that the optimal treatment strategy for women with overweight or obesity wishing to conceive must consider exercise, diet, and pharmacological interventions during the shared decision-making process.Ministerio de Economía y Competitividad (MINECO), Plan Nacional de IþDþi call RETOS 2018 (grant number RTI2018-093302-A-I00).Ministry of Science, Innovation and Universities of the government of Spain Grant number FPU20/05746 Grant number FPU21/04573Plan Propio de Investigación, ‘Gerty Cori program’, from University of Almería, SpainProjects Endo-Map PID2021- 12728OB-100 and ROSY CNS2022-135999 funded by MICIU/AEI/ 10.13039/501100011033 and by FEDER, EUFunding for open access charge: Universidad de Almería (Spain)/CBU

Implementación de las nuevas tecnologías digitales en la biblioteca del Policlínico Docente ¨Noelio Capote¨

Introducción: Las nuevas tecnologías de la información son herramientas tecnológicas de la información y la comunicación que permiten cambios en la manera en que los individuos se comunican e interactúan en el ámbito de la medicina.Objetivo:Caracterizar el uso de las nuevas tecnologías digitales en la biblioteca del Policlínico Docente ¨Noelio Capote¨, municipio Jaruco.Métodos: Se realizó un estudio descriptivo desde septiembre 2018 a julio 2019. El universo fueron los 596 usuarios que acudieron a la biblioteca en el periodo antes mencionado, tomando una muestra aleatoria de 184 usuarios. Se estudiaron las variables: edad, sexo, categoría, especialidad, secciones utilizadas y tiempo de uso. La información se obtuvo del modelo estadístico de la biblioteca, la cual se plasmó en una planilla creada al efecto. La misma se procesó utilizando el software estadístico para Windows, SPSS-15.0.Resultados: Predominaron los usuarios con edades entre 25 a 34 años, sexo femenino y profesionales médicos, siendo el recurso más utilizado las bases de datos.Conclusiones: En la biblioteca se implementan las nuevas tecnologías de la información, aunque se debe perfeccionar su utilización por parte de los usuarios

Incidence of cardiovascular events and associated risk factors in kidney transplant patients: a competing risks survival analysis

[Abstract] Background: The high prevalence of cardiovascular risk factors among the renal transplant population accounts for increased mortality. The aim of this study is to determine the incidence of cardiovascular events and factors associated with cardiovascular events in these patients. Methods: An observational ambispective follow-up study of renal transplant recipients (n = 2029) in the health district of A Coruña (Spain) during the period 1981-2011 was completed. Competing risk survival analysis methods were applied to estimate the cumulative incidence of developing cardiovascular events over time and to identify which characteristics were associated with the risk of these events. Post-transplant cardiovascular events are defined as the presence of myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances, peripheral vascular disease and cardiovascular disease and death. The cause of death was identified through the medical history and death certificate using ICD9 (390-459, except: 427.5, 435, 446, 459.0). Results: The mean age of patients at the time of transplantation was 47.0 ± 14.2 years; 62% were male. 16.5% had suffered some cardiovascular disease prior to transplantation and 9.7% had suffered a cardiovascular event. The mean follow-up period for the patients with cardiovascular event was 3.5 ± 4.3 years. Applying competing risk methodology, it was observed that the accumulated incidence of the event was 5.0% one year after transplantation, 8.1% after five years, and 11.9% after ten years. After applying multivariate models, the variables with an independent effect for predicting cardiovascular events are: male sex, age of recipient, previous cardiovascular disorders, pre-transplant smoking and post-transplant diabetes. Conclusions: This study makes it possible to determine in kidney transplant patients, taking into account competitive events, the incidence of post-transplant cardiovascular events and the risk factors of these events. Modifiable risk factors are identified, owing to which, changes in said factors would have a bearing of the incidence of events

A randomized clinical trial to determine the effectiveness of CO-oximetry and anti-smoking brief advice in a cohort of kidney transplant patients who smoke: study protocol for a randomized controlled trial

Randomized controlled trial[Abstract]Background: The cardiovascular risk in renal transplant patients is increased in patients who continue to smoke after transplantation. The aim of the study is to measure the effectiveness of exhaled carbon monoxide (CO) measurement plus brief advisory sessions, in comparison to brief advice, to reduce smoking exposure and smoking behavior in kidney transplant recipients who smoke. The effectiveness will be measured by: (1) abandonment of smoking, (2) increase in motivation to stop smoking, and (3) reduction in the number of cigarettes smoked per day. Design: a randomized, controlled, open clinical trial with blinded evaluation. Scope: A Coruña Hospital (Spain), reference to renal transplantation in the period 2012-2015. Inclusion criteria: renal transplant patients who smoke in the precontemplation, contemplation or preparation stages according to the Prochaska and DiClemente's Stages of Change model, and who give their consent to participate. Exclusion criteria: smokers attempting to stop smoking, patients with terminal illness or mental disability that prevents them from participating. Randomization: patients will be randomized to the control group (brief advisory session) or the intervention group (brief advisory session plus measuring exhaled CO). The sample target size is n = 112, with 56 patients in each group. Allowing for up to 10 % loss to follow-up, this would provide 80 % power to detect a 13 % difference in attempting to give up smoking outcomes at a two-tailed significance level of 5 %. Measurements: sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking habit, drug use, level of dependence (the Fagerström test), stage of change (Prochaska and DiClemente's Stages of Change model), and motivation to giving up smoking (the Richmond test). Response: the effectiveness will be evaluated every 3, 6, 9 and 12 months as: pattern of tobacco use (self-reported tobacco use), smoking cessation rates, carbon monoxide (CO) levels in exhaled air measured by CO-oximetry, urinary cotinine tests, nicotine dependence (Fagerström test), motivational stages of change (Prochaska and DiClemente's stages) and motivation to stop smoking (the Richmond test). Analysis: descriptive statistics and linear/logistic multiple regression models will be performed. Clinical relevance will be measured as relative risk reduction, absolute risk reduction and the number needed to treat. Ethics: informed consent of the patients and Ethical Review Board was obtained (code 2011/061). Discussion: Tobacco is a modifiable risk factor that increase the risk of morbidity and mortality in kidney transplant recipients. If effectiveness of CO-oximetry is confirmed to reduce tobacco exposure, we would have an intervention that is easy to use, low cost and with great implications about cardiovascular risk prevention in these patients.Instituto de Salud Carlos III; PI11/0135

Incidence of cardiovascular events after kidney transplantation and cardiovascular risk scores: study protocol

[Abstract] Background: Cardiovascular disease (CVD) is the major cause of death after renal transplantation. Not only conventional CVD risk factors, but also transplant-specific risk factors can influence the development of CVD in kidney transplant recipients. The main objective of this study will be to determine the incidence of post-transplant CVD after renal transplantation and related factors. A secondary objective will be to examine the ability of standard cardiovascular risk scores (Framingham, REGICOR, SCORE, and DORICA) to predict post-transplantation cardiovascular events in renal transplant recipients, and to develop a new score for predicting the risk of CVD after kidney transplantation. Methods/design: Observational prospective cohort study of all kidney transplant recipients in the A Coruna Hospital (Spain) in the period 1981-2008 (2059 transplants corresponding to 1794 patients). The variables included will be: donor and recipient characteristics, chronic kidney disease-related risk factors, pre-transplant and post-transplant cardiovascular risk factors, routine biochemistry, and immunosuppressive, antihypertensive and lipid-lowering treatment. The events studied in the follow-up will be: patient and graft survival, acute rejection episodes and cardiovascular events (myocardial infarction, invasive coronary artery therapy, cerebral vascular events, new-onset angina, congestive heart failure, rhythm disturbances and peripheral vascular disease). Four cardiovascular risk scores were calculated at the time of transplantation: the Framingham score, the European Systematic Coronary Risk Evaluation (SCORE) equation, and the REGICOR (Registre Gironi del COR (Gerona Heart Registry)), and DORICA (Dyslipidemia, Obesity, and Cardiovascular Risk) functions. The cumulative incidence of cardiovascular events will be analyzed by competing risk survival methods. The clinical relevance of different variables will be calculated using the ARR (Absolute Risk Reduction), RRR (Relative Risk Reduction) and NNT (Number Needed to Treat). The ability of different cardiovascular risk scores to predict cardiovascular events will be analyzed by using the c index and the area under ROC curves. Based on the competing risks analysis, a nomogram to predict the probability of cardiovascular events after kidney transplantation will be developed. Discussion: This study will make it possible to determine the post-transplant incidence of cardiovascular events in a large cohort of renal transplant recipients in Spain, to confirm the relationship between traditional and transplant-specific cardiovascular risk factors and CVD, and to develop a score to predict the risk of CVD in these patients.Instituto de Salud Carlos III; PI070986Xunta de Galicia; PS09/26Insituto de Salud Carlos III; G03/170Instituto de Salud Carlos III; RD06/ 001

Correlation Between Respiratory Accessory Muscles and Diaphragm Pillars MRI and Pulmonary Function Test in Late-Onset Pompe Disease Patients

Objectives: Pompe disease is a rare genetic disease produced by mutations in the GAA gene leading to progressive skeletal and respiratory muscle weakness. T1-weighted magnetic resonance imaging is useful to identify fatty replacement in skeletal muscles of late-onset Pompe disease (LOPD) patients. Previous studies have shown that replacement by fat correlates with worse results of muscle function tests. Our aim was to investigate if fat replacement of muscles involved in the ventilation process correlated with results of the spirometry and predicted respiratory muscle impairment in LOPD patients over time. Materials and Methods: We studied a cohort of 36 LOPD patients followed up annually in our center for a period of 4 years. We quantified muscle fat replacement using Mercuri score of the thoracic paraspinal and abdominal muscles and the pillars of the diaphragm. We correlated the combined Mercuri scores of these areas with spirometry results and the need of respiratory support. Results: We found a statistically significant correlation (Spearman test, p 0.6) between forced vital capacity seated and lying and fat fraction score of all muscle groups studied. The group of patients who needed respiratory support had higher fat fraction scores than patients not requiring ventilatory support. Higher fat replacement in these areas correlated with worse progression in spirometry values over time. Conclusions: Fat replacement of paraspinal, abdominal, and trunk muscles correlates with results of spirometry and is able to predict worsening in respiratory muscle function tests that could lead to an emerging ventilatory dysfunction. Therefore, the identification of fat replacement in these muscle groups should lead to a closer monitorization of patients. Radiologic evaluation of diaphragm pillars in T1-weighted imaging axial sequences could also be helpful to predict respiratory insufficiency

Randomized Clinical Trial to Determine the Effectiveness of CO-Oximetry and Anti-Smoking Brief Advice in a Cohort of Kidney Transplant Patients who Smoke

[Abstract] Background: measure the efficacy of exhaled carbon monoxide (CO) measurement plus brief advisory sessions to reduce smoking exposure and smoking behaviour in kidney transplant recipients. Methods: Randomized, controlled, open-label clinical trial at a Spanish hospital.Smoking kidney transplant recipients giving their consent to participate were randomized to control (brief advice, n=63) or intervention group (brief advisory session plus measuring exhaled CO, n=59). Measurements: Sociodemographic characteristics, cardiovascular risk factors, treatment, rejection episodes, infections, self-reported smoking, drug use, level of dependence and motivation to stop smoking (Fagerström's and Richmond's test) and stage of change (Prochaska and DiClemente's Stages). Efficacy was assessed at 3, 6, 9 and 12 months as: cotinine test, CO levels in exhaled air, nicotine dependence, motivational stages of change, motivation to stop smoking, pattern of tobacco use and smoking cessation rates. Logistic regression models were computed. Results: At 12 months of follow-up, differences were found in exhaled CO between the intervention and control group(6.1±6.8vs.10.2±9.7ppm;p=0.028). Carboxyhemoglobin levels were lower in the intervention group as well as the positive cotinine test (1.2±1.2%vs.2.0±2.4%;p=0.039),(53.4%vs.74.2%). At 12 months, intervention reduces the probability of a positive urine test by 28%. Conclusions: Co-oximetry is a clinically relevant intervention for reduction of tobacco exposure in kidney transplant recipients.Instituto de Salud Carlos III; PI11 /0135