Criterios diagnósticos y pautas para la prevención y atención de las problemáticas generadas por la vigorexia y la dependencia de sustancias esteroides y/o anabolizantes en diversos ámbitos del acondicionamiento físico

El presente trabajo es un estudio monográfico desde el cual se pretende establecer referentes teóricos conceptuales actuales concernientes al estudio de los contextos, motivos y efectos en la salud que inducen la Vigorexia y/o el consumo de sustancias Esteroides y/o Anabolizantes para mejorar el rendimiento físico; partiendo de este presupuesto se aspira establecer criterios diagnósticos y pautas que contribuyan en la prevención y atención de las problemáticas forjadas por la Vigorexia y la dependencia de sustancias esteroides y/o anabolizante

Patients’ verbal emotional expressions and their connection with the psychotherapeutic change: a multi-level analysis of the psychotherapeutic activity

Emotional expressions contribute to the activation and regulation of personal emotional experiences, and communicate something about internal states and intentions. These emotional expressions can be observed in the words we use in our speech. The growing interest in knowing what happens during the psychotherapeutic process has made researchers focus on the study of verbal patient-therapist interaction, considering a notion of performative language, in which language is not only understood as a simple reflection of reality, but as constitutive of it. The present Doctoral Thesis aims at studying the link between verbal emotional expressions and psychotherapeutic change, through the use of five levels of analysis of the psychotherapy: therapy, session, episode, speaking turn and word. The specific objectives that oriented this research were: (a) to determine the differential characteristics of the verbal emotional expression of patients and therapists during Change Episodes; (b) to determine the behavior of these verbal emotional expressions in Change and Stuck Episodes; (c) to determine the behavior of these verbal emotional expressions in each phase of the therapy and throughout the psychotherapeutic process; and (d) to determine which cognitive mechanisms are present in verbal emotional expressions during Change Episodes and throughout the psychotherapeutic process. A mixed methodology was used to analyze 38 Change Episodes (1016 speaking turns) and 19 Stuck Episodes (581 speaking turns) which were identified within two psychodynamic psychotherapeutic processes. Verbal expressions were analyzed using the Therapeutic Activity Coding System (TACS-1.0) which was built to respond to the need to conceptualize and study the verbal activity of patients and therapists. The present Doctoral Thesis is a dossier made up by seven articles that detail the results of each of the aforementioned studies, in order to: (a) identify the main characteristics of the therapeutic conversation during Change Episodes; (b) establish the existence of communicative patterns to work on emotional contents during Change Episodes; (c) determine temporal sequences of interaction between these patterns; (d) analyze the main communicative patterns in order to determine their behavior within Change Episodes, and throughout the different phases of the psychotherapeutic process; and (e) analyze the words verbalized during the use of the main communicative patterns in order to determine the cognitive mechanisms involved in the work of emotional contents during Change Episodes

Dosimetric studies through Monte Carlo methods in surface high-dose-rate electronic brachytherapy

Non-melanoma skin cancers are among the most common human malignancies, presenting a continuous increase in their incidence worldwide. Surface electronic brachytherapy (eBT) has become an effective treatment in this context, achieving excellent control rates and good cosmetic results. Surface eBT systems consist basically of two components: an x-ray tube and an applicator attached. The x-ray tube accelerates electrons in the energy range between 50 and 70 kV, producing flattened x-ray beams. The eBT applicator serves as a collimator positioned directly in contact with the skin, producing conical beams of 10 to 50 mm diameter. The use of low-energy photon beams introduces several experimental and theoretical challenges to the absorbed dose determination (e.g., depth dose measurement, beam calibrations, etc.). This thesis aims to characterize a clinical surface eBT device of 69.5 kV, using Monte Carlo (MC) methods while attempting to ameliorate some of the drawbacks appearing in the absorbed dose determination of low-energy photon beams. The MC model of the eBT unit here used generates depth-dose curves and dose profiles with differences, generally, < 5% with respect to the available experimental data. Such differences are within those published by other authors for different eBT units and MC systems. The data here reported show that some of the most relevant quantities used in radiation dosimetry of low-energy photons can be obtained with combined uncertainties within 0.5% (k = 2). These results represent a significant improvement regarding the uncertainties reported in other widely used dosimetric datasets, such as the TG-61, with 3% uncertainty (k = 2). This improvement can reduce by 40% the final uncertainty of a beam calibration procedure. The experimental uncertainties in the depth-dose measurements, here defined as the combination of the system alignment (eBT unit and detector), the manufacturing tolerances, and the detector response dependencies, have been obtained to be about 3%, when the recommended detector, the T34013 parallel-plate ionization chamber, is used. This value is lower than those reported elsewhere for beams of 50 kV, using the same detector. Several organizations recognize that using depth-dose measurements in low-energy photon beam calibrations, replacing the half-value layer (HVL) as beam quality index, is a desirable research path. Using the data obtained in this thesis, we have found that the use of depth-doses measurements avoids the downsides of the experimental HVL determination, with a negligible or nonexistent effect in the final calibration uncertainty

Método de selección de variables para mejorar la discriminación en el análisis de eficiencia aplicando modelos dea

El Análisis y Encapsulamiento de Datos (DEA) es una técnica basada en programación lineal, que permite determinar la eficiencia relativa de un conjunto de unidades de toma de decisiones, las cuales consumen múltiples entradas para producir múltiples salidas. Por esta razón, una etapa importante cuando se realiza un análisis de eficiencia aplicando modelos de DEA, corresponde a la selección de las variables de entrada y de salida a utilizar en el análisis, pues éstas tienen un impacto directo en la puntuación de eficiencia. Al seleccionar las variables, se busca obtener una buena discriminación entre las unidades eficientes e ineficientes, y una frontera que se ajuste de la mejor forma posible a los datos observados. En este trabajo se propone un método secuencial de selección de variables de entrada y salida que considere estos criterios y que sea adecuado en los casos donde el número de observaciones, o unidades de toma de decisiones, es mucho mayor que el número de variables potenciales para realizar el análisis de eficiencia. Este método es aplicado a un caso de estudio donde se muestra su efectividad en la detección de variables con alto impacto en los resultados de los modelos de DEA.Data Envelopment Analysis (DEA) is a linear programming technique that allows determining the relative efficiency of a set of decision making units (DMUs), which consume multiple inputs to pro-duce multiple outputs. For this reason, the selection of inputs and outputs used in DEA models is an important stage in the efficiency analysis. The selection of these variables has a direct impact in the DMUs’ efficiency scores. The main criteria considered for selecting inputs and outputs are to obtain a good discrimination among the efficient and inefficient DMUs and to obtain an efficient frontier adjusted the best way as possible to observed data. In this work, we propose a sequential method for selecting inputs and outputs variables that considers the mentioned criteria and it is suitable for cases when the number of observations is much larger than the number of potential inputs and outputs available for carrying out the efficiency analysis. This method is applied to a study case where its effectiveness for detecting variables with high impact in the efficiency scores is demonstrated. método de selección de variables para mejorar la discriminación en el análisis de eficiencia aplicando modelos de

Association between Striatal Brain Iron Deposition, Microbleeds and Cognition 1 Year After a Minor Ischaemic Stroke

Brain iron deposits (IDs) are inversely associated with cognitive function in community-dwelling older people, but their association with cognition after ischemic stroke, and whether that differs from microbleeds, is unknown. We quantified basal ganglia IDs (BGID) and microbleeds (BMBs) semi-automatically on brain magnetic resonance images from patients with minor stroke (NIHSS &lt; 7), at presentation and 12 months after stroke. We administered the National Adult Reading Test (NART, estimates premorbid or peak adult cognition) and the Revised Addenbrooke&rsquo;s Cognitive Examination (ACE-R; current cognition) at 1 and 12 months after stroke. We adjusted analyses for baseline cognition, age, gender, white matter hyperintensity (WMH) volume and vascular risk factors. In 200 patients, mean age 65 years, striatal IDs and BMBs volumes did not change over the 12 months. Baseline BGID volumes correlated positively with NART scores at both times (&rho; = 0.19, p &lt; 0.01). Baseline and follow-up BGID volumes correlated positively with age (&rho; = 0.248, p &lt; 0.001 and &rho; = 0.271, p &lt; 0.001 respectively), but only baseline (and not follow-up) BMB volume correlated with age (&rho; = 0.129, p &lt; 0.05). Both smoking and baseline WMH burden predicted verbal fluency and visuospatial abilities scores (B = &minus;1.13, p &lt; 0.02 and B = &minus;0.22, p = 0.001 respectively) at 12 months after stroke. BGIDs and BMBs are associated differently with cognition post-stroke; studies of imaging and post-stroke cognition should adjust for premorbid cognition. The positive correlation of BGID with NART may reflect the lower premorbid cognition in patients with stroke at younger vs older ages

Caracterización clínico epidemiológica del cáncer laríngeo en la provincia de Pinar del Río

Introduction: Laryngeal cancer has a considerably high frequency, the affection of the main organ of phonation entails important psychological and socioeconomic repercussions, since the ability to communicate is affected.Objective: To clinically and epidemiologically characterize larynx cancer in the province of Pinar del Río.Methods: An observational, descriptive, cross-sectional, descriptive study was carried out on patients with a diagnosis of laryngeal cancer seen in the outpatient clinic of Otorhinolaryngology in the province of Pinar del Río, in the period between 2018-2020, we worked with the entire universe, descriptive statistics were used. Results: the most affected sex was male (65 %), the age group with the highest incidence of this disease was 70-79 (31,7 %), the main risk factor presented by these patients was smoking (90 %), the predominant symptoms were dysphonia (50 %), dyspnea (26 %) and dysphagia (24 %), according to the anatomical location the cancer of the glottic region (60 %) had a higher incidence in stage I (51,6 %).Conclusions: Laryngeal cancer constitutes a current health problem for the world, the earlier the diagnosis is made, the more chances of survival for patients.Introducción: el cáncer de laringe tiene una frecuencia considerablemente alta, la afección del principal órgano de la fonación conlleva importantes repercusiones psicológicas y socioeconómicas, pues se afecta la capacidad de comunicación.Objetivo: caracterizar clínica y epidemiológicamente el cáncer de laringe en la provincia de Pinar del Río.Métodos: se realizó un estudio observacional, descriptivo de corte transversal a los pacientes con diagnóstico de cáncer laríngeo atendidos en consulta externa de Otorrinolaringología en la provincia de Pinar del Río, en el período comprendido entre el 2018-2020, se trabajó con todo el universo, se utilizó la estadística descriptiva.  Resultados: el sexo más afectado fue el masculino (65 %), el grupo etario donde mayor incidencia tuvo esta enfermedad fue el de 70-79 (31,7 %), el principal factor de riesgo que presentaron estos pacientes fue el hábito de fumar (90 %), los síntomas que predominaron fueron la disfonía (50 %), la disnea (26 %) y la disfagia (24 %), según la localización anatómica el cáncer de la región glótica (60 %) tuvo mayor incidencia en un estadío I (51,6 %).Conclusiones: el cáncer de laringe constituye un problema de salud actual para el mundo, mientras más temprano se haga el diagnóstico, más posibilidades de sobrevida tienen los pacientes

Seasonal Behavior of Fasciola hepatica in Sacrificed Bovines at Chacuba Slaughterhouse, Camagüey, Cuba.

To determine the existence of seasonal patterns for  Fasciola hepatica infestation in bovines slaughtered in the province of Camaguey, Cuba, information  gathered from  13 059 bovines  sacrificed  at the Chacuba slaughterhouse (Terso Livestock Basic Marketing Company, Maraguan Livestock Company),  between 2008 and 2014, was used. The study included 2 387 animals affected by F. hepatica, according to  the  anatomical and pathological diagnostic made at the slaughterhouse.  Prevalence calculations were based on the sacrificed and affected  animals  (18.27%) for the entire period. The seasonal decomposition process was based on additive model. It revealed the existence of sea-sonal behavior for the animals affected by  Fasciola hepatica  and its prevalence. The seasonal patterns  had peaks in February, October and December for the two variables studied. Evaluation of intermediate hosts dynamics and larval F. hepatica stages were associated to the seasonal patterns observed

Renewal-anomalous-heterogeneous files

Renewal-anomalous-heterogeneous files are solved. A simple file is made of Brownian hard spheres that diffuse stochastically in an effective 1D channel. Generally, Brownian files are heterogeneous: the spheres' diffusion coefficients are distributed and the initial spheres' density is non-uniform. In renewal-anomalous files, the distribution of waiting times for individual jumps is exponential as in Brownian files, yet obeys: {\psi}_{\alpha} (t)~t^(-1-{\alpha}), 0<{\alpha}<1. The file is renewal as all the particles attempt to jump at the same time. It is shown that the mean square displacement (MSD) in a renewal-anomalous-heterogeneous file, , obeys, ~[_{nrml}]^{\alpha}, where _{nrml} is the MSD in the corresponding Brownian file. This scaling is an outcome of an exact relation (derived here) connecting probability density functions of Brownian files and renewal-anomalous files. It is also shown that non-renewal-anomalous files are slower than the corresponding renewal ones.Comment: Accepted for publication (August, 2010

Morbimortalidad por Diabetes Mellitus

Se realizó un estudio prospectivo de 995 pacientes diabéticos, quienes ingresaron en el Servicio de Medicina Interna, Unidad de Cuidados Polivalentes y Unidad de Cuidados Intensivos del Hospital Enrique Cabrera en el período comprendido del 1º de febrero de 1998 al 31 de diciembre de 1999; 586 del total de pacientes correspondía al sexo femenino para 58.9 % y 409 al sexo masculino para 41.1%. Durante el estudio, se observó un predominio del grupo etáreo de 45-64 años con 35.5 % y la Diabetes Mellitus tipo 2 con 93%. La duración clínica de la enfermedad fue mayor en el grupo de 0-4años con 30.5%. Las causas más frecuentes de ingreso hospitalario fueron la Diabetes Mellitus descompensada, para una tasa de 0.99 x 10,000; la Bronconeumonía para una tasa de 0.94x 10,000; la Cardiopatía Isquémica para una tasa de 0.49 x 10,000; el Infarto del Miocardio para una tasa de 0.39x10,000 y la Insuficiencia Cardíaca Congestiva para una tasa de 0.37x 10,000. Como se puede observar, predominaron las afecciones cardiovasculares. El tratamiento más utilizado fue el de los compuestos hipoglicemiantes orales con 52.4 % y la insulina con el 22,9%.Es de resaltar que 112 pacientes, 15.3%, no tenían tratamiento alguno. La tasa de letalidad se encuentra en 3,24 x 100 y la de morbilidad al ingreso de 5.29x 1000.Palabras clave : Diabetes Mellitus / Morbilidad al ingreso/ Tratamiento /Causas de muerte.</p