La negociación colectiva ante el proceso de derogación de las ordenanzas laborales.

Sin resume

Underuse of indicated medications in elderly

Introduction: Treatment omissions are very important to value the quality of pharmacological therapy. In fact, suboptimal prescribing has been defined as overuse (polypharmacy), inappropriate prescribing (drug whose risks are greater than the benefits in older adults) and underuse of indicated medications. This omission of drug therapy may be linked to certain health outcomes in older patients, such as, for instance, the greater risk of cardiovascular events and mortality Material and methods: A cross-sectional study was performed. The study population comprised 407 community-dwelling residents over the age of 65 on Lanzarote (Canary Islands, Spain), where there are 15 primary healthcare centres. Data recorded included socio-demographic characteristics, clinical status, functional and cognitive assessment, and complete information about drugs intake. Potential prescribing omissions (PPO) were evaluated according to Screening Tool to Alert doctors to Right Treatment (START). Results: A total of 1844 medications were prescribed to the patients included in our study (median number per patient: 4.5 drugs; range: 0-14: polypharmacy prevalence: 45%). Omeprazole was the most frequently used drug followed by aspirin, furosemide and enalapril. START identified PPO in 170 (41.8%) subjects. Sixteen of the 22 START criteria (72.7%) were used to identify these PPO. The endocrine system accounted for over half the omissions (51.8%), followed by the cardiovascular system (26.7%), where the main omission was anticoagulants in the presence of chronic atrial fibrillation. Multiple logistic regression analysis revealed that the risk of PPO increased by 60% for every additional point in the Charlson Comorbidity Index (OR 1.60, 95% CI 1.35-1.91). Increasing numbers of medications also independently predicted the odds of at least one PPO according to START criteria (OR 2.19, 95% CI 1.36-3.55). Conclusions: Our findings show high rates of polypharmacy and PPO, as well as a clear relationship between these two concepts.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tec

Postoperative pain and morphine consumption after ultrasound-guided femoral and sciatic combined nerve block versus neurostimulation for femoral and sciatic combined nerve block or neurostimulation for femoral nerve block in primary elective total knee arthroplasty.

Abstract Congreso XXXVII National Meeting of the Spanish Society of Pharmacology with guest society: The British Pharmacological SocietyBackground and Aims: Total knee arthroplasty injuries are extremely painful and merit prompt attention to adequate postoperative analgesia. We aim to compare femoral and sciatic ultrasound-guided combined nerve block vs. neurostimulation for femoral and sciatic combined nerve block or for femoral nerve block in postoperative pain in primary elective total knee prosthesis. Summary of work and outcomes: A three arms, prospective longitudinal study of patients having primary elective unilateral knee prosthesis and randomly assigned to catheter insertion guided by ultrasound or neurostimulation was done: 1) Ultrasound-guided femoral and sciatic combined nerve block (USFSCN) (N=15); 2) Neurostimulation for femoral and sciatic combined nerve block (NSFSCN) (N=17); 3) Neurostimulation for femoral nerve block (NSFN) (N=11). Total analgesia (morphine) consumption after 48 hours was the primary endpoint. The postoperative pain intensity (visual analogue pain scale (VAS)) at post-anaesthetic recovery unit (PARU), 6, 24, 48 h, and during movement and postoperative complications were secondary outcomes. Results and discussion: 43 patients (68.3±8 years old, 77% female) subjected to elective unilateral knee prosthesis were enrolled. There were no differences in the demographic, anaesthetic and surgical variables between groups. Pain intensity was lower in the USFSCN group compared with NSFSCN and NSFN during the first 48 h post-surgery (% of intense pain at PARU/6h/24h/48h): USFSCN 0.8/1.4/3.2/1.6; NSFSCN 5.6/8.3/7.5/3; NSFN 7.2/5.3/6.4/5.4. The average consumption of morphine within 48 h after surgery was similar in the groups USFSCN and NSFSCN (3 mg vs. 3.11 mg), and significantly lower than NSFN (4.19 mg) (p<0.05). And the number of complications was significantly lower in the USFSCN group compared with NSFSCN and NSFN during the first 48 h of postoperative. Conclusion: Ultrasound-guided femoral and sciatic combined nerve block presented better analgesia and was more safety than neurostimulation for femoral and sciatic combined nerve block or for femoral nerve block in primary elective total knee arthroplasty.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

El miedo al contacto en el voleibol. Percepciones del alumnado de Educación Física

Este artículo examina el miedo al contacto percibido por el alumnado en tareas de iniciación al voleibol. Se realizó un análisis de contenido de los diarios de prácticas de 10 alumnos/as de primero de Educación Secundaria Obligatoria 12-13 años del Instituto de Educación Secundaria Ramón y Cajal de Huesca (España). El tratamiento de la información se realizó con el software NVIVO 10. Los resultados indican que el alumnado siente miedo al contacto en las tareas de voleibol; y que a mayor nivel de impacto de las tareas, mayor es el temor percibido. Se concluye que los programas de intervención de iniciación a los deportes (considerados de contacto o no) deben secuenciar las tareas según su nivel de rudeza para facilitar la autorregulación emocional del alumnado, y así, proveer de escenarios aptos para los procesos de enseñanza-aprendizaje.This article examines the fear of contact perceived by students learning to play the sport of volleyball. The study is based on a content analysis of the student journals of 10, first-year, secondary school students of physical education (aged 12-13) at the Ramón y Cajal Institute of Secondary Education, in Huesca, Spain. Data was analysed using NVIVO 10 software. Results demonstrate that students feel fear on being faced with the possibility of contact when playing volleyball, furthermore, the higher the level of impact involved in the sport, the greater is the perception of fear. We conclude that intervention programmes for initiation to contact sports (whether contact sports or not) should sequence the activities in line with the levels of contact in order to facilitate the emotional self-regulation of the student, thereby offering more suitable scenarios for teaching-learning processes

Risk and protective factors for release in outpatients with schizophrenia

eposterWe aim to determine risk and protective factors influencing relapse incidence in outpatient with schizophrenia. A longitudinal, observational study was done with outpatients with schizophrenia (F20) or schizoaffective disorder (F25)(DMS-IV and ICD-10), without hospitalization during the previous 6 months. The patients were consecutively included into the study to received oral (O-A) or long-acting injectable (depot-A) antipsychotics. Clinical stage evolution, compliance, efficacy and safety assessments (including PANSS, CGI-SSI, hospitalization rates, and adverse events) were recorded before and after 6 and 12 months of treatment. Results: 60 outpatients (aged 34.5±8.9, male 73%), 75% schizophrenia and 25% schizoaffective disorder diagnosis, 68.3% fewer than 15 years of schizophrenia evolution, 76.7% fewer than 5 times previous hospitalizations were treated with O-A (41.7%) or depot-A (58.3%) antipsychotics for at least one year. Depot-A treated patients showed a significant higher compliance compared to O-A patients during the all following time, lower PANSS (total, positive and negative) scores and CGI-SSI score (p<0.01), and a delayed relapse incidence and re-hospitalization to more than 1 year in the 48% of patients (relapse % depot/% oral) after 6 months 22.9%/52.0%, and after 12 months 48.6%/4.0%. Conclusion: There were protective factors which delayed relapse incidence in schizophrenia: Use of sustained-release preparations, family support. There were risk factors for occurrence of relapse in schizophrenia: cocaine, heroin and alcohol consumption, absence of family support, greater severity of patients assessed through CGI-SI, male sex, age older than 25 years and long-term evolution of the disorder.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Flipped classroom based on objective structured clinical examinations analysis by undergraduate students of Pharmacology course from the Podiatry Degree improve their learning and assessment communication skills about medicines

Comunicación cartel con defensa oralWe aim to evaluate the impact of the individual and in-group analysis of OSCEs (filmed by other students) looking for correct and incorrect behaviours and contents in their learning of pharmacology. Summary of work and outcomes: A 5-year prospective study in which students of Pharmacology course from the Podiatry Degree analysed filmed OSCEs individually and in a group in a flipped classroom. Each group (max 5 students) analysed along 1 week a filmed OSCE, prepare a summary of correct and incorrect items related to clinical events, medicines uses, and people behaviours. The students presented their analysis results to the rest of the class. After each presentation, the other students of the class were encouraged to ask questions and after that, the students voluntarily answered a satisfaction survey. Result and Discussion: 405 students, 65.2% female, 20±5.3 years old were included. Students spend 13.4±5.4 h on making the filmed-OSCE analysis. The percentage of students satisfied with this way of studying pharmacology was 96.5%. OSCEs analysis by students increased their percentage of success in the final assessment in both OSCEs-related and OSCEs-non-related questions (+18.5% and +10.1%). Conclusion: Filmed Objective Structured Clinical Examinations analysis by undergraduate students on the Pharmacology course of Podiatry Degree improved their knowledge about medicines use and their communication skills during the assessment.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

La enseñanza de la lengua inglesa oral en ciclo superior de educación primaria

[spa] La lengua inglesa se enseña de manera oral en Educación Infantil y en Ciclo Inicial de Educación Primaria. A medida que los alumnos crecen, se tiende más a la enseñanza escrita y cuesta encontrar materiales para poder trabajar la lengua inglesa de manera oral. La presente tesis se centra en una propuesta didáctica para trabajar la lengua inglesa de manera oral en Ciclo Superior de Educación Primaria. La experiencia personal de la investigadora como maestra especialista en lengua inglesa en Educación Primaria es la que la ha llevado a plantearse esta propuesta didáctica y su investigación en el aula. En primer lugar, se pretende demostrar que se puede usar la lengua inglesa como LE usando un enfoque oral dentro del aula en ciclo superior de educación primaria. El enfoque oral es una metodología basada en tareas orales concretas que, una vez realizadas, acaban siendo un proyecto anual. Las tareas y proyectos son un buen método de enseñanza porque involucran a los alumnos a comprender, manipular, producir e interactuar en la lengua inglesa, centrándose en su significado, no en su forma. Además son muy flexibles y variadas y permiten tanto cualquier agrupación con los estudiantes (trabajo individual, en parejas, en pequeños grupos, con el grupo-clase), como trabajar los contenidos que estimemos más oportunos, sea porque los marca el currículum o por el propio interés de los alumnos. En segundo lugar, se ha revisado la propuesta didáctica basada en el enfoque oral realizada por la investigadora en su proyecto de tesis y se ha adaptado a la legislación vigente. En tercer lugar, se ha implementado esta propuesta didáctica mediante una investigación acción. Se ha escogido esta metodología porque se lleva a cabo dentro de una situación real, sus objetivos se definen a partir de una situación global concreta que ofrece alguna problemática y se buscan soluciones reales a este problema. La investigadora trabaja dentro de un contexto real y es ella misma quien realiza la investigación. Se han usado tres instrumentos para la recogida de datos. El diario de aula, realizado por la investigadora, se ha usado para analizar las sesiones desde diferentes puntos de vista, tanto objetivos como subjetivos. Los tests, que consistieron en unas grabaciones realizadas a los alumnos al inicio y al final del curso escolar en las cuales debían decir frases sobre una imagen que incluía el vocabulario trabajado en las propuestas, han permitido analizar la mejora en la competencia oral de los estudiantes a lo largo del curso. Los cuestionarios realizados por los alumnos de manera anónima han servido para saber el grado de satisfacción tanto de las dinámicas de clase –trabajo en grupo y exposiciones orales- como de las dinámicas de juego –actividades planteadas y nivel de motivación-, así como para conocer sus propuestas de mejora. Después de analizar todos los datos recogidos mediante los instrumentos descritos, se ha procedido a la triangulación de los mismos considerando la acción didáctica llevada a cabo y el marco teórico descrito. Con todo ello, hemos podido evaluar la eficacia del enfoque oral planteado, demostrando que la enseñanza-aprendizaje de una lengua extranjera a través de este enfoque oral, ayuda a mejorar la pronunciación y la fluidez en dicha lengua y facilita notablemente la adquisición de la misma, a la vez que fomenta la creatividad de los aprendices. Asimismo, esta propuesta didáctica se puede llevar a cabo con pocos recursos humanos y materiales y dentro del horario asignado a la lengua inglesa, lo cual permite su implementación en cualquier escuela pública de Cataluña.[eng] This thesis focuses on a didactic proposal to work the English language orally in Upper Cycle of Primary Education. Firstly, we want to demonstrate that it is possible to teach English as a second language using an oral approach in the classroom in upper primary education. The oral approach is a methodology based on specific oral tasks that eventually become an annual project. The tasks and projects are a good teaching method that engage students to understand, manipulate, produce and interact in the English language, focusing on its meaning, not on its form. They are very flexible and varied, allowing any type of grouping with students (individual work, in pairs, in small groups, in class group) and being favourable to work any appropriate content. Secondly, we reviewed the didactic proposal based on the oral approach design by the researcher in her thesis project and we adapted it to current legislation. Thirdly, we implemented this methodological approach through action research. We chose this approach because it takes place in a real context, the researcher is who carry out the investigation and the objectives are defined from a specific situation offering real solutions to a problem. We collected the data using three different instruments. The classroom diary, written by the researcher, was used to analyse the sessions from different points of view, both objective and subjective. The tests allowed us to analyse the improvement in the oral proficiency of students along the course. The tests consisted of some recordings to students at the beginning and at the end of the school year. The questionnaires completed by students anonymously gave us feedback about their satisfaction on class dynamics –oral expositions and work group- and game dynamics –type of activities and level of motivation. After analysing the data collected, we triangulated the information according to the didactic action carried out and the theoretical framework described. Finally, we evaluated the efficiency of the oral approach proposed, showing that teaching a foreign language through this oral approach helps students to improve their pronunciation and their fluency in that language and encourages them to be creative

Neurofeedback and treatment adherence in ADHD

Adherence and therapeutic abandonment are causes for concern in the clinical setting due to the consequences and adverse effects mainly involving for patients. Those who discontinue the treatment or refuse to start do not achieve the desired therapeutic effects, increasing the likelihood of relapse and developing low expectations of improvement, while seeking new resources for mental health and increasing health costs. Different research in the field of behavioural disorders estimated that 38% of children unjustifiably terminate the intervention. The aim of this paper is to analyse the therapeutic adherence and the abandonment in a sample of 92 children aged between 7 and 14, diagnosed with Attention Deficit Disorder and randomly assigned to three treatment conditions: Neurofeedback, Behaviour Therapy and Pharmacologic Therapy. The results show that 84.21% of children who received Neurofeedback ended the treatmentLa adherencia terapéutica y los abandonos terapéuticos constituyen motivo de preocupación en el ámbito clínico por las consecuencias y efectos adversos que conllevan principalmente para los pacientes. Quienes abandonan el tratamiento o rehúsan iniciarlo no logran los efectos terapéuticos esperados, aumentando la probabilidad de recaídas y desarrollando escasas expectativas de mejoría, al tiempo que solicitan nuevos recursos de salud mental y se incrementan los costes sanitarios. Distintas investigaciones realizadas en el ámbito de los trastornos del comportamiento estiman que el 38% de los menores cesan injustificadamente la intervención. El objetivo de este trabajo es analizar la adherencia y abandonos terapéuticos en una muestra de 92 niños con edades entre 7 y 14 años diagnosticados con Trastorno por Déficit de Atención y asignados aleatoriamente a tres condiciones terapéuticas Neurofeedback, Terapia de Conducta y Tratamiento Farmacológico. Los resultados muestran que el 84,21% de los menores que recibieron Neurofeedback finalizaron la intervención

Filmed clinical cases improved communication skills of student of Pharmacology in Podiatry degree

Solving clinical case by writing-report lacks of students sympathies and interest in many cases. Make a short film is a novelty that really like to the students and may improve their arguing and planning capacities and their communication skills. Aim: To evaluate the impact of presenting and resolving clinical cases through filming a short-film in the communication skills development and in the learning of medicines in Podiatry undergraduate students. Methods: A two-year study in which students were invited to voluntarily form groups (3 students maximum). Each group has to design and film a short-film (8 min maximum) showing a clinical case in which medicines’ use was needed to treat feet pathology. A camera, a mobile-phone's video editor or whatever they may use was allowed. The job of each group was supervised and helped by a teacher. The students were invited to present their work to the rest of the class. After each short-film projection the students were encouraged to ask questions if they wanted to do it. After all the projections the students voluntarily answered a satisfaction survey. Results: Students of Pharmacology of Podiatry Degree, N=101, 55.6% female, 20±1.3 years old were enrolled. 37 short-films showing a clinical case were made. The average time spent by students in making the film was 12.4±8 h. The percentage of students which were satisfied with this way of presentation of the clinical cases was 75.2%. Conclusion: Filmed clinical cases performed by student of Pharmacology of the Podiatry Degree improved their communication skills.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. Convocatoria de Ayudas de la Universidad de Málaga a Proyectos de Innovación Educativa, convocatoria 2013-2015, PIE 13-156 en Área de Ciencias de la Salud

Validez de la evaluación electroencefalográfica en la identificación del Trastorno por Déficit de Atención con Hiperactividad

Referencia de la publicación original: Moreno García, I., Lora Muñoz, J.A. y Sánchez Blanco, J. (2011). Validez de la evaluación electroencefalográfica en la identificación del Trastorno por Déficit de Atención con Hiperactividad. Apuntes de Psicología, 29 (2), 227-242.En este trabajo se analiza la validez del EEG como prueba añadida en el diagnóstico del TDAH así como de la SNAP-IV, instrumento empleado con frecuencia en atención primaria para la detección de este trastorno. Han participado 108 niños con edades comprendidas entre 7 y 14 años, derivados por presentar sintomatología hiperactiva– atencional. La validez del EEG se ha estimado a partir de la ratio theta/beta y considerando las variables tarea realizada (mirar un punto fijo, leer, escuchar y dibujar) mientras se realizaba la evaluación y grupo de edad de los menores que han participado. Los resultados muestran índices de sensibilidad y especificidad entre el 70% y el 80%, con una eficacia en la clasificación real superior al 75%. La edad se establece como un criterio fundamental tanto a la hora de seleccionar la ratio theta/beta más adecuada, como las tareas a emplear durante la evaluación. Estos datos avalan la utilidad del EEG en el diagnóstico del TDAH.This paper examines the validity of the EEG as an additional diagnostic test of ADHD as well as the SNAP-IV, an instrument ofien used in primary care screening for this disorder. It has be en included a total of 108 children, aged between 7 and 14 years, with hyperactive–attention symptomatology. The validity of the EEG has been estimated from the ratio of theta / beta variables and considering the work done (look at a fixed point, reading, listening and drawing) while performing the evaluation and age group of children who participated. The results show sensitivity and specificity rates between 70% and 80%, with an efficacy in the real c1assification aboye 75%. The age is a fundamental criterion for selecting the adequate ratio theta/ beta and the tasks used during the evaluation.These data support the utility of EEG in the diagnosis of ADHD