Efectividad de un programa de educación para la salud en la intervención fisioterapéutica del paciente con dolor cervical crónico

Antecedentes El dolor cervical es una de las causas más frecuente de consulta médica en Atención Primaria y su posterior derivación a las unidades de Fisioterapia debido a la persistencia del dolor a pesar del tratamiento médico pautado. Un problema al que se enfrentan a diario las unidades de fisioterapia de Atención Primaria es el tratamiento del dolor crónico. Se utilizan diferentes técnicas y modalidades de tratamiento enfocadas a la disminución de la sintomatología. Los criterios para el abordaje de estos procesos, por los fisioterapeutas varían en base a su formación, especialización y experiencia profesional. El objetivo de la tesis que se presenta es conseguir la disminución del dolor, la discapacidad funcional y catastrofismo ante el dolor, así como aumento de la calidad de vida relacionado con la Salud de los sujetos con dolor cervical crónico a largo plazo. Para ello se ha desarrollado un programa de Educación para la Salud que contempla además de los factores físicos y cognitivos, otras variables hasta ahora poco tenidas en cuenta como son los factores emocionales, sentimientos, valores y creencias de los sujetos con dolor cervical crónico, a través de técnicas de reestructuración cognitiva, manejo de la atención y gestión de emociones. Sujetos y metodología Se ha realizado un ensayo clínico aleatorio controlado y multicéntrico con evaluación a terceros. La selección de los sujetos se realizó de forma consecutiva. Un total de 65 pacientes fueron seleccionados para participar en el estudio. Los participantes se distribuyeron en 25 en el grupo Grupo de Educación para la Salud (enfoque Bio-psico-social y ejercicio terapéutico) y 25 en el grupo de Fisioterapia Individual (TENS y ejercicio terapéutico). El seguimiento fue a seis meses. Resultados Finalizaron el estudio 50 sujetos, 9 hombres y 41 mujeres. En todas las variables resultado se encontraron diferencias estadísticamente significativas entre la medición basal y a los seis meses (p<0,001) excepto en la movilidad cervical en la lateroflexión izquierda y derecha (p<0,236). Los resultados obtenidos en la reducción del dolor y la discapacidad funcional fueron clínicamente relevantes y se mantuvieron hasta los seis meses siendo de 40 mm en la escala ana-lógica visual (EVA), para la reducción del dolor y de un 46,83% para la discapacidad funcional a favor del grupo educación para la Salud. También se ob-servaron diferencias estadísticamente significativas para el catastrofismo ante el dolor (p<0,005) y el resultados para la calidad de vida a los seis meses (p<0,001) siendo estos clínicamente relevante. En la movilidad articular cervical se observan datos estadísticamente significativos sin ser datos relevantes. Se observó una disminución en la ingesta de Fármacos mayor en el grupo experimental (p<0,044) con una reducción del 24%, 29% y del 52% en las tres últi-mas evaluaciones), que se mantuvieron a los seis meses. Conclusiones El Programa de Educación para la Salud, con un enfoque Bio-Psico-Social, se ha demostrado en este estudio más efectivo para la disminución del dolor, la discapacidad funcional, el catastrofismo y la calidad de vida a largo plazo que el tratamiento individual con TENS y ejercicio terapéutico

Los factores psicosociales en el dolor crónico. Intervención fisioterapéutica desde un enfoque biopsicosocial

El 80% de las consultas médicas son por dolor, de las cuales el 30% se refieren a dolor crónico. Frecuentemente, los pacientes con dolor crónico son derivados a las Unidades de Fisiotera-pia para su tratamiento. Se utilizan diferentes técnicas y modalidades de tratamiento enfocadas a la disminución de la sintomatología. Los criterios de elección para el abordaje de estos procesos varían en base a la formación, especialización y experiencia profesional del fisioterapeuta. El dolor, consi-derado como un síntoma, es tratado desde un enfoque fundamentalmente biomédico con métodos mecanicistas, lo que lleva en ocasiones a un pobre resultado terapéutico. En la actualidad ya se cuenta con estudios suficientes que permiten entender la influencia de los factores psicosociales y emocionales sobre la percepción del dolor crónico y la importancia de tenerlos en cuenta en los abordajes terapéuticos. En este sentido, el modelo biopsicosocial propone un tratamiento integral del sujeto, lo que contribuye a aumentar la calidad de la atención fisioterapéutica, mejorando la eficacia de los tratamientos, los resultados clínicos y la gestión de los recursos. Los programas de Educación para la Salud que contemplan, además de los factores físicos y cognitivos, también fac-tores emocionales a través de técnicas de reestructuración cognitiva, manejo de la atención, gestión de emociones y ejercicio terapéutico, proporcionan una herramienta muy valiosa al fisioterapeuta para el abordaje de estos procesos.80% of medical consultations have to do with pain, and 30% of them are specifically re-lated to chronic pain. Patients with chronic pain are often referred to Physiotherapy units for treat-ment. A variety of treatment techniques and modalities are used in order to mitigate the symptoms. The therapeutic approach to these chronic pain processes varies on the basis of several criteria, in-cluding the training, degree of specialization and professional experience of the physiotherapist in-volved in the treatment. Pain, considered merely as a symptom, is generally treated under a bio-medical framework, using mechanistic physiotherapy methods, with consequent poor therapeutic results. Today, there are enough studies available to understand the influence of emotional and psychosocial factors on the perception of chronic pain, as well as the importance of taking them into account when choosing the therapy approach. Thus, the biopsychosocial model recommends an integral treatment for the patient, which contributes to increase the quality of physiotherapy ser-vices, by improving the effectiveness of treatments, the clinical results and the management of the resources. Those Health Education Programs which take into account not only physical and cogni-tive factors, but also emotional factors through cognitive restructuring techniques, attention man-agement, emotion management and therapeutic exercise, provide a valuable tool for the physio-therapist to manage these pain processes

Explorando saberes: la etnobotánica a través del registro audiovisual como instrumento de innovación docente para el aprendizaje significativo y la acción social del desarrollo sostenible

Memoria ID-170. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2019-2020

El desarrollo sostenible, la acción social y la justicia social, como búsqueda de una sociedad inclusiva desde la comunicación, la educación y las ciencias sociales: elaboración de materiales audiovisuales

Memoria ID-033. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2021-2022

Estrategias docentes para el desarrollo de competencias profesionales en la nueva mención de Gestión del Ocio y la Cultura del Grado en Turismo

Memoria ID-0324. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2014-2015

Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain

This study investigated effectiveness of manual therapy (MT) with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder (MND). A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage, 47 patients received MT and 43 TENS. The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale (VAS). Also disability, quality of life, adverse effects and sociodemographic and prognosis variables were measured. Three evaluations were performed (before, when the procedure ?nished and six months after). Seventy-one patients (79%) completed the follow-up measurement at six months. In more than half of the treated patients the procedure had a clinically relevant ?short term? result after having ended the intervention, when either MT or TENS was used. The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.Ministerio de SanidadInstituto de Salud Carlos II

Programa propio de calidad en la enseñanza

Memoria ID12-0056. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2012-2013

Overview of the SLOPE I and II campaigns: aerosol properties retrieved with lidar and sun–sky photometer measurements

Jose Antonio Benavent-Oltra is funded by the University of Granada through "Plan Propio. Programa 7, Convocatoria 2019". Roberto Roman is funded by MINECO under the postdoctoral programme Juan de la Cierva-Incorporacion (IJCI2016-30007). Juan Andres Casquero-Vera is funded by MINECO under the predoctoral programme FPI (BES-2017-080015). Maria J. Granados-Munoz received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 796539. Oleg Dubovik was supported by the Labex CaPPA project, which is funded by the French National Research Agency under contract "ANR-11-LABX0005-01". This work was also supported by the Spanish Ministry of Economy and Competitiveness (projects CMT2015-66742-R, CGL2016-81092-R, CGL2017-85344-R, RTI2018-097864-B-I00 and CGL2017-90884-REDT), by the Andalusia Regional Government through project P18-RT-3820 and the Unity of Excellence "Maria de Maeztu" (project MDM-2016-0600) financed by the Spanish State Research Agency (AEI). The authors thankfully ac-knowledge the FEDER programme for the instrumentation used in this work, the University of Granada, which supported this study through the Excellence Units Program, and the Sierra Nevada National Park. We also thank Dr. Grisa Monick who provided the Aethalometer AVIO AE-33 installed on the aircraft. Thanks to AERONET and ACTRIS/AERONET Europe for the scientific and technical support. Finally, the authors would like to acknowledge the use of the GRASP inversion algorithm software (http://www.grasp-open.com, last access: 1 April 2020), in this work.The Sierra Nevada Lidar aerOsol Profiling Experiment I and II (SLOPE I and II) campaigns were intended to determine the vertical structure of aerosols by remote sensing instruments and test the various retrieval schemes for obtaining aerosol microphysical and optical properties with in situ measurements. The SLOPE I and II campaigns were developed during the summers of 2016 and 2017, respectively, combining active and passive remote sensing with in situ measurements at stations belonging to the AGORA observatory (Andalusian Global ObseRvatory of the Atmosphere) in the Granada area (Spain). In this work, we use the in situ measurements of these campaigns to evaluate aerosol properties retrieved by the GRASP code (Generalized Retrieval of Atmosphere and Surface Properties) combining lidar and sun-sky photometer measurements. We show an overview of aerosol properties retrieved by GRASP during the SLOPE I and II campaigns. In addition, we evaluate the GRASP retrievals of total aerosol volume concentration (discerning between fine and coarse modes), extinction and scattering coefficients, and for the first time we present an evaluation of the absorption coefficient. The statistical analysis of aerosol optical and microphysical properties, both column-integrated and vertically resolved, from May to July 2016 and 2017 shows a large variability in aerosol load and types. The results show a strong predominance of desert dust particles due to North African intrusions. The vertically resolved analysis denotes a decay of the atmospheric aerosols with an altitude up to 5 km a.s.l. Finally, desert dust and biomass burning events were chosen to show the high potential of GRASP to retrieve vertical profiles of aerosol properties (e.g. absorption coefficient and single scattering albedo) for different aerosol types. The aerosol properties retrieved by GRASP show good agreement with simultaneous in situ measurements (nephelometer, aethalometer, scanning mobility particle sizer, and aerodynamic particle sizer) performed at the Sierra Nevada Station (SNS) in Granada. In general, GRASP overestimates the in situ data at the SNS with a mean difference lower than 6 mu m(3) cm(-3) for volume concentration, and 11 and 2 Mm(-1)for the scattering and absorption coefficients. On the other hand, the comparison of GRASP with airborne measurements also shows an overestimation with mean absolute differences of 14 +/- 10 and 1.2 +/- 1.2 Mm(-1) for the scattering and absorption coefficients, showing a better agreement for the absorption (scattering) coefficient with higher (lower) aerosol optical depth. The potential of GRASP shown in this study will contribute to enhancing the representativeness of the aerosol vertical distribution and provide information for satellite and global model evaluation.University of GranadaMINECO under the postdoctoral programme Juan de la Cierva-Incorporacion IJCI2016-30007MINECO under the predoctoral programme FPI BES-2017-080015European Commission 796539French National Research Agency (ANR) ANR-11-LABX0005-01Spanish Ministry of Economy and Competitiveness CMT2015-66742-R CGL2016-81092-R CGL2017-85344-R RTI2018-097864-B-I00 CGL2017-90884-REDTAndalusia Regional Government P18-RT-3820Spanish State Research Agency (AEI) MDM-2016-0600Excellence Units ProgramSierra Nevada National Par

Can the Cytokine Profile According to ABO Blood Groups Be Related to Worse Outcome in COVID-19 Patients? Yes, They Can

Producción CientíficaSevere status of coronavirus disease 2019 (COVID-19) is extremely associated to cytokine release. Moreover, it has been suggested that blood group is also associated with the prevalence and severity of this disease. However, the relationship between the cytokine profile and blood group remains unclear in COVID-19 patients. In this sense, we prospectively recruited 108 COVID-19 patients between March and April 2020 and divided according to ABO blood group. For the analysis of 45 cytokines, plasma samples were collected in the time of admission to hospital ward or intensive care unit and at the sixth day after hospital admission. The results show that there was a risk of more than two times lower of mechanical ventilation or death in patients with blood group O (log rank: p = 0.042). At first time, all statistically significant cytokine levels, except from hepatocyte growth factor, were higher in O blood group patients meanwhile the second time showed a significant drop, between 20% and 40%. In contrast, A/B/AB group presented a maintenance of cytokine levels during time. Hepatocyte growth factor showed a significant association with intubation or mortality risk in non-O blood group patients (OR: 4.229, 95% CI (2.064–8.665), p < 0.001) and also was the only one bad prognosis biomarker in O blood group patients (OR: 8.852, 95% CI (1.540–50.878), p = 0.015). Therefore, higher cytokine levels in O blood group are associated with a better outcome than A/B/AB group in COVID-19 patients.Instituto de Salud Carlos III (grant COV20/00491)Junta de Castilla y León (grant 18IGOF

Effect of viral storm in patients admitted to intensive care units with severe COVID-19 in Spain: a multicentre, prospective, cohort study

Background: The contribution of the virus to the pathogenesis of severe COVID-19 is still unclear. We aimed to evaluate associations between viral RNA load in plasma and host response, complications, and deaths in critically ill patients with COVID-19. Methods: We did a prospective cohort study across 23 hospitals in Spain. We included patients aged 18 years or older with laboratory-confirmed SARS-CoV-2 infection who were admitted to an intensive care unit between March 16, 2020, and Feb 27, 2021. RNA of the SARS-CoV-2 nucleocapsid region 1 (N1) was quantified in plasma samples collected from patients in the first 48 h following admission, using digital PCR. Patients were grouped on the basis of N1 quantity: VIR-N1-Zero ([removed]2747 N1 copies per mL). The primary outcome was all-cause death within 90 days after admission. We evaluated odds ratios (ORs) for the primary outcome between groups using a logistic regression analysis. Findings: 1068 patients met the inclusion criteria, of whom 117 had insufficient plasma samples and 115 had key information missing. 836 patients were included in the analysis, of whom 403 (48%) were in the VIR-N1-Low group, 283 (34%) were in the VIR-N1-Storm group, and 150 (18%) were in the VIR-N1-Zero group. Overall, patients in the VIR-N1-Storm group had the most severe disease: 266 (94%) of 283 patients received invasive mechanical ventilation (IMV), 116 (41%) developed acute kidney injury, 180 (65%) had secondary infections, and 148 (52%) died within 90 days. Patients in the VIR-N1-Zero group had the least severe disease: 81 (54%) of 150 received IMV, 34 (23%) developed acute kidney injury, 47 (32%) had secondary infections, and 26 (17%) died within 90 days (OR for death 0·30, 95% CI 0·16–0·55; p<0·0001, compared with the VIR-N1-Storm group). 106 (26%) of 403 patients in the VIR-N1-Low group died within 90 days (OR for death 0·39, 95% CI 0·26–0·57; p[removed]11 página