Estudio y análisis de la accesibilidad para personas con discapacidad física en el acceso a comercios y locales de la ciudad de Murcia

With a worldwide percentage of people with disabilities around 15%, universal accessibility is a fundamental consideration in the habitable design of buildings. Moreover, due to the current aging of the population, especially in Spain, this will be a key factor of sustainability from the human point of view. This paper presents a case study of accessibility in the entrance to shops in the city of Murcia, Spain. First, the applicable accessibility regulations and the criteria of the users obtained from the Regional Federation FAMDIF are exposed, and then the extensive field work carried out is described; more than 650 commercial and service premises have been analyzed in situ by technical personnel. By volume, it is one of the largest studies to date. As a result, it has been obtained that only 1/5 of the premises are accessible in the entrance, while almost 3/4 do not comply with current regulations. We believe that this work will help raise awareness to improve physical accessibility in the future.Con un porcentaje mundial de personas con discapacidad del 15%, la accesibilidad universal resulta una consideración fundamental en el diseño habitable de los edificios. Además, debido al envejecimiento de la población, especialmente en España, este será un factor clave de la sostenibilidad desde el punto de vista humano. Este artículo presenta un caso de estudio de la accesibilidad en el acceso a comercios de la ciudad de Murcia. En primer lugar, se expone la normativa de accesibilidad aplicable y los criterios de los usuarios a través de la Federación Murciana FAMDIF, para después describir el extenso trabajo de campo llevado a cabo, donde se han analizado in situ más de 650 comercios y locales de servicios por personal técnico. Por su volumen, se trata de uno de los mayores estudios realizados hasta la fecha. Como resultado, se ha obtenido que solo 1/5 de los locales son accesibles en la entrada, mientras que casi 3/4 no cumplen las normativas vigentes. Creemos que este trabajo ayudará a concienciar y a mejorar la accesibilidad física en el futuro

Design and Development of a Mobile App for Accessible Beach Tourism Information for People with Disabilities

The global increase in the proportion of the population with disabilities has caused a greater awareness toward guaranteeing their use of public services. In particular, there is emphasis on the accessibility and inclusivity of tourism resources, to improve the enjoyment and well-being for people with motor disabilities. This paper presents a case study on accessibility to beaches in the Region of Murcia, Spain, which is one of the main tourist areas in the country. First, the most important elements that allow for the accessible use of beaches are analyzed and exposed in detail. Then, an extensive field-work in the area of interest has been carried out and its results are evaluated. Finally, the development of a new mobile app is described. The objective of this tool is to provide updated, accurate, and reliable accessibility information regarding the beaches. As a result, more than a third of the beaches analyzed had a high level of accessibility, while almost another third are totally inaccessible. The proposed application is a valuable tool, not only to help people with physical and motor disabilities, but also to raise awareness among local authorities to create and improve accessible services.This work was supported by the Spanish MICINN, as well as European Commission FEDER funds, under grants RTI2018-098156-B-C53 and RTI2018-098309-B-C33. The authors thank Manuel García-Hernández and Salvador Parada-Sarabia for their participation in the collection of data of the study, Khalil Merzouki for the contribution in the software development of the proposed system, and the Federation of Associations of People with Physical and Organic Disability of Murcia (FAMDIF) for the extensive support in carrying out this work

Predictors of Loss of Functional Independence in Parkinson’s Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up and Comparison with a Control Group

COPPADIS Study Group.[Background and objective] The aim of this study was to compare the progression of independence in activities of daily living (ADL) in Parkinson’s disease (PD) patients versus a control group, as well as to identify predictors of disability progression and functional dependency (FD).[Patients and Methods] PD patients and control subjects, who were recruited from 35 centers of Spain from the COPPADIS cohort between January 2016 and November 2017 (V0), were included. Patients and subjects were then evaluated again at the 2-year follow-up (V2). Disability was assessed with the Schwab & England Activities of Daily Living Scale (S&E-ADLS) at V0 and V2. FD was defined as an S&E-ADLS score less than 80%.[Results] In the PD group, a significant decrease in the S&E-ADLS score from V0 to V2 (N = 507; from 88.58 ± 10.19 to 84.26 ± 13.38; p < 0.0001; Cohen’s effect size = −0.519) was observed but not in controls (N = 124; from 98.87 ± 6.52 to 99.52 ± 2.15; p = 0.238). When only patients considered functional independent at baseline were included, 55 out of 463 (11.9%) converted to functional dependent at V2. To be a female (OR = 2.908; p = 0.009), have longer disease duration (OR = 1.152; p = 0.002), have a non-tremoric motor phenotype at baseline (OR = 3.574; p = 0.004), have a higher score at baseline in FOGQ (OR = 1.244; p < 0.0001) and BDI-II (OR = 1.080; p = 0.008), have a lower score at baseline in PD-CRS (OR = 0.963; p = 0.008), and have a greater increase in the score from V0 to V2 in UPDRS-IV (OR = 1.168; p = 0.0.29), FOGQ (OR = 1.348; p < 0.0001) and VAFS-Mental (OR = 1.177; p = 0.013) (adjusted R-squared 0.52; Hosmer and Lemeshow test = 0.94) were all found to be independent predictors of FD at V2.[Conclusions] In conclusion, autonomy for ADL worsens in PD patients compared to controls. Cognitive impairment, gait problems, fatigue, depressive symptoms, more advanced disease, and a non-tremor phenotype are independent predictors of FD in the short-term.Fundación Curemos el Parkinson (www.curemoselparkinson.org).Peer reviewe

Staging Parkinson’s Disease According to the MNCD (Motor/Non-motor/Cognition/Dependency) Classification Correlates with Disease Severity and Quality of Life

Background: Recently, a novel simple classification called MNCD, based on 4 axes (Motor; Non-motor; Cognition; Dependency) and 5 stages, has been proposed to classify Parkinson's disease (PD). Objective: Our aim was to apply the MNCD classification in a cohort of PD patients for the first time and also to analyze the correlation with quality of life (QoL) and disease severity. Methods: Data from the baseline visit of PD patients recruited from 35 centers in Spain from the COPPADIS cohort from January 2016 to November 2017 were used to apply the MNCD classification. Three instruments were used to assess QoL: 1) the 39-item Parkinson's disease Questionnaire [PDQ-39]); PQ-10; the EUROHIS-QOL 8-item index (EUROHIS-QOL8). Results: Four hundred and thirty-nine PD patients (62.05 +/- 7.84 years old; 59% males) were included. MNCD stage was: stage 1, 8.4% (N = 37); stage 2, 62% (N = 272); stage 3, 28.2% (N = 124); stage 4-5, 1.4% (N = 6). A more advanced MNCD stage was associated with a higher score on the PDQ39SI (p < 0.0001) and a lower score on the PQ-10 (p < 0.0001) and EUROHIS-QOL8 (p < 0.0001). In many other aspects of the disease, such as disease duration, levodopa equivalent daily dose, motor symptoms, non-motor symptoms, and autonomy for activities of daily living, an association between the stage and severity was observed, with data indicating a progressive worsening related to disease progression throughout the proposed stages. Conclusion: Staging PD according to the MNCD classification correlated with QoL and disease severity. The MNCD could be a proper tool to monitor the progression of PD

Falls Predict Acute Hospitalization in Parkinson's Disease

[Background] There is a need for identifying risk factors for hospitalization in Parkinson’s disease (PD) and also interventions to reduce acute hospital admission.[Objective] To analyze the frequency, causes, and predictors of acute hospitalization (AH) in PD patients from a Spanish cohort.[Methods] PD patients recruited from 35 centers of Spain from the COPPADIS-2015 (COhort of Patients with PArkinson’s DIsease in Spain, 2015) cohort from January 2016 to November 2017, were included in the study. In order to identify predictors of AH, Kaplan-Meier estimates of factors considered as potential predictors were obtained and Cox regression performed on time to hospital encounter 1-year after the baseline visit.[Results] Thirty-five out of 605 (5.8%) PD patients (62.5±8.9 years old; 59.8% males) presented an AH during the 1-year follow-up after the baseline visit. Traumatic falls represented the most frequent cause of admission, being 23.7% of all acute hospitalizations. To suffer from motor fluctuations (HR [hazard ratio] 2.461; 95% CI, 1.065–5.678; p = 0.035), a very severe non-motor symptoms burden (HR [hazard ratio] 2.828; 95% CI, 1.319–6.063; p = 0.008), falls (HR 3.966; 95% CI 1.757–8.470; p = 0.001), and dysphagia (HR 2.356; 95% CI 1.124–4.941; p = 0.023) was associated with AH after adjustment to age, gender, disease duration, levodopa equivalent daily dose, total number of non-antiparkinsonian drugs, and UPDRS-IIIOFF. Of the previous variables, only falls (HR 2.998; 95% CI 1.080–8.322; p = 0.035) was an independent predictor of AH.[Conclusion] Falls is an independent predictor of AH in PD patients.Peer reviewe

Herramientas informáticas para la accesibilidad de personas con discapacidad

Según la Organización Mundial de la Salud, se estima que aproximadamente el 15% de la población mundial tiene algún tipo de discapacidad física o motora que dificulta el desarrollo de su actividad cotidiana, precisando de un entorno urbano y edificado accesible. Es más, cualquier mejora para el colectivo de las personas con discapacidad física lo es también para el conjunto de la sociedad en general; esto incluye a las personas mayores, en un contexto donde es cada vez más grande su peso en la pirámide poblacional del mundo occidental; o, por ejemplo, a cualquiera que use un carro de la compra o un carrito de bebé, sin olvidar las discapacidades temporales a las que todos estamos expuestos. En consecuencia, el objetivo fundamental de la investigación llevada a cabo en esta tesis doctoral ha sido el análisis de la situación actual y el diseño y desarrollo de nuevas soluciones tecnológicas en accesibilidad para personas con discapacidad física desde una perspectiva interdisciplinar que une la arquitectura, el urbanismo y la ingeniería informática. Para ello, a lo largo de los artículos que componen esta tesis doctoral, presentada en la modalidad de compendio de publicaciones, se exponen una serie de ejemplos de cómo las herramientas informáticas pueden servir para mejorar la calidad de vida de las personas con discapacidad física y motora, a la vez que se analiza mediante exhaustivos trabajos de campo llevados a cabo desde FAMDIF (Federación de Asociaciones Murcianas de Personas con Discapacidad Física y Orgánica) la accesibilidad a los comercios de la ciudad de Murcia, y la accesibilidad a las playas de la Región de Murcia. El cumplimiento del objetivo principal queda plasmado en las tres publicaciones que forman el compendio de la presente tesis: • El primer artículo analiza la accesibilidad a comercios y locales públicos de la ciudad de Murcia, enfocado desde la perspectiva arquitectónica. Este trabajo incluye un detallado análisis de los aspectos urbanísticos que definen la accesibilidad física de los edificios, las leyes, decretos y normativas aplicables tanto en el ámbito nacional como en el regional, y un extenso trabajo de campo en 669 comercios y locales de la ciudad de Murcia. El análisis estadístico de este estudio reflejó que prácticamente el 72% de los comercios estudiados no cumplen la normativa vigente. También se observaron disparidades entre los criterios normativos y los criterios de accesibilidad aportados por los usuarios. • Una vez analizada la situación actual, el segundo artículo presenta el desarrollo de una herramienta informática enfocada en la accesibilidad a comercios y establecimientos públicos. De esta forma, la información obtenida se trasladó a una aplicación móvil que permite a los usuarios conocer el grado de accesibilidad en la entrada de las tiendas que pretenden visitar, además de geolocalizar las tiendas y distinguirlas por usos. De esta forma se pone en valor la importancia de las herramientas informáticas en la mejora de la calidad de vida de las personas con discapacidad para tener la información a priori, puesto que solo la cuarta parte de los establecimientos son accesibles de manera autónoma, un 40% de los mismos precisan ayuda en el acceso, y el resto son comercios no accesibles. • El tercer artículo continúa la misma línea de investigación (estudio normativo, trabajo de campo, análisis de la situación y desarrollo de una aplicación móvil), en este caso aplicada al turismo y, en concreto, a la accesibilidad a las playas de la Región de Murcia. La accesibilidad universal es un importante factor de calidad de estos servicios, considerando que en nuestra región son un recurso turístico de primer nivel, sin perder de vista la accesibilidad al entorno y al destino turístico que representan la playa y los establecimientos y equipamientos ligados a ellas. El estudio de la parte arquitectónica y urbanística se plasma en otra nueva aplicación móvil que recoge los parámetros de accesibilidad de la playa y permite que los potenciales usuarios con discapacidad puedan conocer a priori tanto las condiciones de accesibilidad de la playa, como el equipamiento, servicios de ayuda al baño disponibles, etc. Fruto de este trabajo se observó que, en la fecha de estudio, una tercera parte de las playas analizadas poseían buenas condiciones de accesibilidad, mientras que casi otro tercio de las playas estudiadas eran inaccesibles. Por lo tanto, todos los trabajos tienen valor científico por sí y, al mismo tiempo, configuran una unidad científica, siguiendo una línea de investigación coherente donde se hace un análisis y estudio de la situación actual, se proponen soluciones y se validan mediante su implementación y difusión. La creación de las aplicaciones informáticas permite a los usuarios con discapacidad conocer a priori toda la información de accesibilidad, en este caso a playas y comercios, obtenida por personal cualificado del campo de la arquitectura. El uso de apps móviles ofrece funcionalidades asociadas a la geolocalización, como la búsqueda por proximidad y la consulta de rutas; además, las aplicaciones posibilitan la realimentación por parte del usuario, para permitir una actualización continua de la información. Como conclusión, se pone de manifiesto la ventaja que supone para un usuario con discapacidad física el uso de las herramientas que proporciona la tecnología y que permiten mejorar su calidad de vida. De esta manera, los usuarios de la aplicación disponen de información fiable y actualizada recopilada por arquitectos, lo que les permite disponer de datos rigurosos, hecho que lo diferencia de otros trabajos en los que la información la aportan o los propios usuarios o los gestores de los locales, con la incertidumbre que ello genera.According to the World Health Organization, it is estimated that approximately 15% of the world population has some type of physical or motor disability that hinders the development of their daily activities, requiring an accessible urban and built environment. Moreover, any improvement for this group of people with physical disabilities is also an improvement for all society in general. This includes the elderly, in a context where their weight is increasing in the population pyramid of the western world; or, for example, to anyone who uses a shopping cart or a baby carriage, not to mention the temporary disabilities to which we are all exposed. Consequently, the main objective of the research carried out in this doctoral thesis has been the analysis of the current situation and the design and development of new technological solutions in accessibility for people with physical disabilities, from an interdisciplinary perspective that unites architecture, urban planning and computer science. For this purpose, throughout the articles that make up this doctoral thesis, presented in the modality of compendium of publications, a series of examples of how computer tools can serve to improve the quality of life of people with physical and motor disabilities, while we analyze through exhaustive field works carried out by FAMDIF (Federation of Murcian Associations of People with Physical and Organic Disabilities) the accessibility to the shops in the city of Murcia, and the accessibility to the beaches of the Region of Murcia. The fulfillment of this main objective is reflected in the three publications that form the compendium of this thesis: • The first article analyzes the accessibility to shops and premises in the city of Murcia from an architectural perspective. This work includes a detailed analysis of the urban aspects that define the physical accessibility to the buildings, the applicable laws, decrees and regulations both nationally and regionally, and an extensive field work in 669 shops and premises of Murcia. The statistical analysis of this study showed that almost 72% of the businesses studied do not comply with current regulations. Disparities were also observed between the normative criteria and the accessibility criteria provided by the users. • After analyzing the current situation, the second article presents the development of a computer tool focused on accessibility to shops and premises. In this way, the information obtained was transferred to a mobile application that allows users to know the degree of accessibility at the entrance of the shops they intend to visit, in addition to geolocating the stores and distinguishing them by use. In this way, the importance of computer tools in improving the quality of life of people with disabilities is emphasized in order to have a priori information, since only a quarter of the premises are easily accessible, 40% of them require access assistance, and the rest are non-accessible shops. • The third article continues the same line of research (normative study, field work, analysis of the situation and development of a mobile application), in this case applied to tourism and, specifically, to the accessibility to the beaches of the Region of Murcia. Universal accessibility is an important factor in the quality of these services, considering that in our region they are a first-class tourist resource, without losing sight of the accessibility to the environment and the tourist destination represented by the beach and the establishments and equipment linked to them. The study of the architectural and urban planning part is reflected in another new mobile application that gathers the accessibility parameters of the beaches and allows potential users with disabilities to know a priori both the accessibility conditions of the beach, as well as the equipment, bath assistance services available, etc. As a result of this work, it was observed that, on the date of the study, a third of the analyzed beaches had good accessibility conditions, while almost another third of the studied beaches were inaccessible. Therefore, all the publications have scientific value per se and, at the same time, they form a scientific unit, following a coherent line of research where an analysis and study of the current situation is made, and then solutions are proposed and validated through their implementation and diffusion. The development of computer applications allows users with disabilities to know a priori all accessibility information, in this case to beaches and shops, obtained by qualified personnel in the field of architecture. The use of mobile apps offers features associated with geolocation, such as proximity search and route query. In addition, the applications make possible the feedback by the user, to allow a continuous update of the information. As a conclusion, this thesis shows the benefits of using the tools provided by technology in order to improve the quality of life for the users with physical disability. In this way, the users of the application have reliable and updated information collected by architects, which allows them to have rigorous data, a fact that differentiates it from other research works in which the information is provided by either the users themselves or the managers of the premises, with the uncertainty that this generates

Sustainable Accessibility: A Mobile App for Helping People with Disabilities to Search Accessible Shops

People with motor disabilities must face many barriers and obstacles in their daily lives, making it difficult to perform everyday tasks. The purpose of this work is to improve their living conditions by providing an app with accessibility information in an updated, reliable and friendly form. The development of the system integrates national and regional accessibility regulations, architectural aspects, with an extensive field work, and a sustainable software process. The levels of accessibility and the requirements of the application are defined in the first phases of the project. The field work included the evaluation of 357 commercial establishments in the city of Murcia, Spain, showing that only 25% have a good accessibility, 40% are practicable with help, and 35% are inaccessible shops. The proposed system achieves its objectives of being sustainable and helping in the accessibility. Besides, the system can be a great incentive for businesses to improve their accessibility conditions. In conclusion, new technologies must have a much more active role in the promotion of universal accessibility. These tools must also consider the necessary requirements of sustainable development

Biotrauma during ultra-low tidal volume ventilation and venoarterial extracorporeal membrane oxygenation in cardiogenic shock:a randomized crossover clinical trial

BACKGROUND: Cardiogenic pulmonary oedema (CPE) may contribute to ventilator-associated lung injury (VALI) in patients with cardiogenic shock. The appropriate ventilatory strategy remains unclear. We aimed to evaluate the impact of ultra-low tidal volume ventilation with tidal volume of 3 ml/kg predicted body weight (PBW) in patients with CPE and veno–arterial extracorporeal membrane oxygenation (V–A ECMO) on lung inflammation compared to conventional ventilation. METHODS: A single-centre randomized crossover trial was performed in the Cardiac Intensive Care Unit (ICU) at a tertiary university hospital. Seventeen adults requiring V–A ECMO and mechanical ventilation due to cardiogenic shock were included from February 2017 to December 2018. Patients were ventilated for two consecutive periods of 24 h with tidal volumes of 6 and 3 ml/kg of PBW, respectively, applied in random order. Primary outcome was the change in proinflammatory mediators in bronchoalveolar lavage fluid (BALF) between both ventilatory strategies. RESULTS: Ventilation with 3 ml/kg PBW yielded lower driving pressures and end-expiratory lung volumes. Overall, there were no differences in BALF cytokines. Post hoc analyses revealed that patients with high baseline levels of IL-6 showed statistically significant lower levels of IL-6 and IL-8 during ultra-low tidal volume ventilation. This reduction was significantly proportional to the decrease in driving pressure. In contrast, those with lower IL-6 baseline levels showed a significant increase in these biomarkers. CONCLUSIONS: Ultra-low tidal volume ventilation in patients with CPE and V–A ECMO may attenuate inflammation in selected cases. VALI may be driven by an interaction between the individual proinflammatory profile and the mechanical load overimposed by the ventilator. Trial registration The trial was registered in ClinicalTrials.gov (identifier NCT03041428, Registration date: 2nd February 2017). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13613-021-00919-0