Revisión de procesos de fractura de cadera 2014

24 páginas.Trabajo de Curso de Experto Universitario en Atención al Trauma Grave (2014). Director/Tutor: Manuel García del Río. La fractura de cadera sigue siendo una de las patologías más frecuentes en pacientes mayores, 9 de cada 10 con fractura de cadera tienen 65 años de edad o más y múltiples problemas médicos. La fractura de cadera, entre todas las osteoporóticas, resulta de gran interés, ya que crea un problema de importancia asistencial, de gestión hospitalaria, económico, social y sanitario. Además, es causa de una mortalidad elevada. En esta población se detectan como factores pronósticos de mortalidad en el primer año: la edad, el sexo masculino, la puntuación ASA y menor puntuación en las escalas de valoración MiniMental e Índice de Barthel. Su frecuencia va en aumento de forma paralela al incremento de la expectativa de vida de la población mayor de 65 años. Son factores de riesgo para su producción: la involución producida por la edad, que disminuye la coordinación neuromuscular, la visión, la audición y los sistemas de alerta autónomos; comorbilidades y la disminución de la capacidad cognitiva que disminuye el estado reactivo ante la marcha y el desequilibrio; el aumento de la utilización de fármacos en los ancianos, especialmente los psicótropos, que alteran aún más estas discapacidades facilitando la caída y la fractura. El tratamiento considerado más idóneo de la fractura de cadera comienza desde el momento de la atención inicial, con la evaluación y adecuado control de las enfermedades médicas previas, y que es necesario corregir antes de la intervención quirúrgica. Conseguirlo en las primeras 24 horas es posible y, ha demostrado que reduce la incidencia de complicaciones y mortalidad temprana. También se han identificado un elevado número de buenas prácticas en el período perioperatorio. Todas estas medidas van encaminadas a mejorar los resultados a corto plazo de forma coste-efectiva al disminuir las numerosas complicaciones que acechan a esta frágil población de riesgo, acortando su estancia hospitalaria y fomentando un retorno a la comunidad en las mejores condiciones para optar al mayor grado de recuperación posible

Actualización y puesta al día en diabetes mellitus tipo II

53 páginasCurso de Experto Universitario en Medicina de Urgencias y Emergencias (2013). Director: Manuel García del Río. La diabetes mellitus (DM) es una enfermedad crónica que requiere una continua atención médica y autogestión por parte del paciente para evitar complicaciones agudas y para reducir el riesgo de complicaciones a largo plazo. La diabetes es una enfermedad con riesgos multifactoriales complejos y requiere estrategias de reducción del riesgo más allá del control glucémico

OptBPPlanner: Automatic Generation of Optimized Business Process Enactment Plans

Unlike imperative models, the specifi cation of business process (BP) properties in a declarative way allows the user to specify what has to be done instead of having to specify how it has to be done, thereby facilitating the human work involved, avoiding failures, and obtaining a better optimization. Frequently, there are several enactment plans related to a specifi c declarative model, each one presenting specifi c values for different objective functions, e.g., overall completion time. As a major contribution of this work, we propose a method for the automatic generation of optimized BP enactment plans from declarative specifi cations. The proposed method is based on a constraint-based approach for planning and scheduling the BP activities. These optimized plans can then be used for different purposes like simulation, time prediction, recommendations, and generation of optimized BP models. Moreover, a tool-supported method, called OptBPPlanner, has been implemented to demonstrate the feasibility of our approach. Furthermore, the proposed method is validated through a range of test models of varying complexity.Ministerio de Ciencia e Innovación TIN2009-1371

Self-regulation in family foster children

This poster presents research on foster children’s capacities for self-regulation and its relation to adversity history. Children in family foster care are a vulnerable population due to their experiences of maltreatment and separation from primary caregivers. Research has shown high rates of behavioral problems and impulsivity in these children, as well as other difficulties such as poor academic adjustment. Recent theory and research advances suggest some of these problems are due to deficits in self-regulatory capacities, such as executive functions or emotion regulation. Early adversity in key developmental stages, like that suffered by many foster children, can undermine the normative development of these capacities and, consequently, their psychosocial adjustment. This study explores this topic in a sample of foster children between 4 and 8 years old who were living in non-relative foster families for at least six months in Southern Spain. We used the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000), a widely used parent-reported questionnaire, to assess self-regulation in the foster children. The BRIEF was answered by the primary foster caregiver during a home visit. The information regarding adverse events and trajectory in the child protection services was obtained through case records in collaboration with caseworkers. The results of this study show us information about the capacities of self-regulation of children in family foster care. Due to the centrality of self-regulation in development and the fact that it remains responsive to well-designed interventions beyond early childhood, interventions for foster children and families should consider targeting this dimension to improve their outcomes

Towards a new Tool for Managing Declarative Temporal Business Process Models

Business processes which require a high flexibility are com- monly specified in a declarative (e.g., constraint-based) way. In general, offering operational support (e.g., generating possible execution traces) to declarative business process models entails more complexity when compared to imperative modeling alternatives. Such support becomes even more complex in many real scenarios where the management of complex temporal relations between the process activities is crucial (i.e., the temporal perspective should be managed). Despite the needs for enabling process flexibility and dealing with temporal constraints, most existing tools are unable to manage both. In a previous work, we then proposed TConDec-R, which is a constraint-based process modeling lan- guage which allows for the specification of temporal constraints. In this paper we introduce the basis and a prototype of a constraint-based tool with a client/server architecture for providing operational support to TConDec-R process models.Ministerio de Economía y Competitividad TIN2016-76956-C3-2-

Suicidal ideation and the risk of suicide in patients with fibromyalgia: a comparison with non-pain controls and patients suffering from low-back pain

Fibromyalgia is associated with an increased rate of mortality from suicide. In fact, this disease is associated with several characteristics that are linked to an increased risk of suicidal behaviors, such as being female and experiencing chronic pain, psychological distress, and sleep disturbances. However, the literature concerning suicidal behaviors and their risk factors in fibromyalgia is sparse. The objectives of the present study were to evaluate the prevalence of suicidal ideation and the risk of suicide in a sample of patients with fibromyalgia compared with a sample of healthy subjects and a sample of patients with chronic low-back pain. We also aimed to evaluate the relevance of pain intensity, depression, and sleep quality as variables related to suicidal ideation and risks. Logistic regression was applied to estimate the likelihood of suicidal ideation and the risk of suicide adjusted by age and sex. We also used two logistic regression models using age, sex, pain severity score, depression severity, sleep quality, and disease state as independent variables and using the control group as a reference. Forty-four patients with fibromyalgia, 32 patients with low-back pain, and 50 controls were included. Suicidal ideation, measured with item 9 of the Beck Depression Inventory, was almost absent among the controls and was low among patients with low-back pain; however, suicidal ideation was prominent among patients with fibromyalgia (P,0.0001). The risk of suicide, measured with the Plutchik Suicide Risk Scale, was also higher among patients with fibromyalgia than in patients with low-back pain or in controls (P,0.0001). The likelihood for suicidal ideation and the risk of suicide were higher among patients with fibromyalgia (odds ratios of 26.9 and 48.0, respectively) than in patients with low-back pain (odds ratios 4.6 and 4.7, respectively). Depression was the only factor associated with suicidal ideation or the risk of suicide

Sense of coherence and substance use in Spanish adolescents. Does the effect of SOC depend on patterns of substance use in their peer group?

Los objetivos de este trabajo fueron analizar las relaciones entre el sentido de coherencia (SOC) y el consumo de sustancias en los adolescentes españoles y el potencial efecto moderador de los patrones de consumo de sustancias en el grupo de iguales en dicha relación. La muestra constaba de 5475 adolescentes españoles de 15 a 18 años, participantes en la edición 2010 del estudio Health Behaviour in School-aged Children (HBSC). Los análisis estadísticos consistieron en análisis de cluster, para identificar grupos de adolescentes según los patrones de consumo de sustancias en su grupo de iguales, y regresión logística, con el SOC y los patrones de consumo en el grupo de iguales como predictores del consumo actual de tabaco y alcohol, episodios de embriaguez alguna vez en la vida y en la actualidad. Los resultados mostraron que un fuerte SOC parecía reducir la probabilidad de consumo de tabaco y episodios de embriaguez, pero no se asoció con el consumo actual de alcohol. Además, el efecto protector del SOC estaba moderado por los patrones de consumo del grupo de iguales. En concreto, el SOC tuvo un efecto protector significativo en los adolescentes cuyo grupo de iguales mostraba un patrón de no consumo o de frecuente consumo de alcohol y episodios de embriaguez ocasionales, pero el efecto del SOC desapareció si el patrón de consumo de los iguales incluía drogas ilegales. En conclusión, el SOC tiende a actuar como un factor protector individual respecto al consumo de sustancias durante la adolescencia, pero la influencia del grupo de iguales parece moderar dicho efecto protector del SOC.The aims of this work were to analyse the relationships between sense of coherence (SOC) and substance use among Spanish adolescents and to examine the potential moderator effect of the patterns of substance use in the peer group. Sample consisted of 5475 Spanish adolescents aged 15 to 18 from the 2010 edition of the Health Behaviour in School-aged Children (HBSC) study. Statistical analysis included cluster analysis to identify groups of adolescents according to their peer group’s patterns of substance use and logistic regression with SOC and peers’ pattern of consumption as predictors of current tobacco use, current alcohol use, life-time drunkenness and current drunkenness. The results showed that a strong SOC seemed to reduce the adolescents’ likelihood of involving in tobacco use and drunkenness, but it was not associated with being a current drinker. In addition, the protective effect of SOC was moderated by peers’ patterns of substance use. Specifically, SOC had a significant protective influence in adolescents whose peer group showed either a nonconsumption pattern or a pattern of frequent alcohol use and occasional drunkenness; but the protective effect of SOC disappeared if peers showed a pattern of consumption that included illegal drugs. In conclusion, SOC tends to act as a protective personal variable with respect to substance use during adolescence, but the influence exerted by the peer group seems to moderate the aforementioned protective effect of SOC

Parent–child relationships and adolescents' life satisfaction across the first decade of the new millennium

Objective To examine whether changes occurred in parent–child relationships (maternal and paternal affection, ease of communication with the mother and father, maternal and paternal knowledge, and family activities) between 2002 and 2010 in boys and girls and to examine the contributions of these family dimensions to life satisfaction. Background Although parent–child relationships may be affected by social change, there are few investigations of change in parent–child relationships over time. Method The sample consisted of 46,593 adolescents between 11 to 18 years of age who participated in the 2002, 2006, or 2010 editions of the Health Behaviour in School-aged Children (HBSC) study in Spain. Trend analysis including univariate analyses of variance (ANOVAs) and factorial ANOVAs were conducted separately for boys and girls, and effect size tests were calculated. Results Communication with fathers and family activities statistically increased across HBSC editions and parent–child relationships were positively associated with life satisfaction across the examined period. Conclusion There were small positive changes in some family dimensions, and some of them were increasingly important for adolescent life satisfaction over time. Implications Interventions for strengthening parent–child relationships and promoting adolescent well-being should include mothers and fathers and emphasize affection, communication, and family activities.Ministerio de Educación FPU2009-097