Complex residencial i centre de dia per a gent gran a Barcelona

Aquest PFC tracta d’una residència per a gent gran, situada al costat de l’Arc de Triomf. Aquesta residència parteix del disseny del mòdul habitacional. Aquest mòdul habitacional neix de la recerca d’un model bàsic per tal que cada usuari es faci seu l’espai, i també d’una necessitat de distinció de zones, ja que la mateixa estança serà utilitzada durant tots els moments i necessitats del dia

Factores relacionados con la calidad de vida de los pacientes con enfermedad pulmonar obstructiva crónica

ResumenObjetivoDescribir la relación entre factores pronósticos, individuales o asociados en clasificaciones multidimensionales (BODE y ADO), y la calidad de vida relacionada con la salud (CVRS) de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC).DiseñoEstudio descriptivo transversal.EmplazamientoAtención primaria.ParticipantesMuestreo aleatorizado sistemático de 102 pacientes diagnosticados de EPOC. Excluidos aquellos con exacerbación aguda, demencia, enfermedad terminal o los que reciben atención domiciliaria.Mediciones principalesDatos demográficos, hábito tabáquico, índice de masa corporal y número de exacerbaciones. Comorbilidad. Grado de disnea. Prueba de función respiratoria. Capacidad de ejercicio. El índice BODE y ADO. Cuestionario EuroQol-5D (EQ-5D) y escala visual analógica (EVA).ResultadosEn EQ-5D: movilidad, 43,9%; cuidado personal, 13,3%; actividades cotidianas, 29,6%; dolor/malestar, 55,1%; ansiedad/depresión, 37,8%. El 34,7% EVA ≤ 60%.Exacerbaciones: movilidad, OR: 1,85 (IC 95%: 1,08-3,20); cuidado personal, OR: 2,12 (IC 95%: 1,03-4,76); actividades cotidianas, OR: 2,35 (IC 95%: 1,17-4,71); EVA, coeficiente regresión: −3,50 (IC 95%: −6,31- −0,70). Disnea: movilidad, OR: 4,47 (IC 95%: 1,39-14,42); actividades cotidianas, OR: 7,71 (IC 95%: 2,03-12,34)]; EVA, coeficiente regresión: −7,15 (IC 95%: −11,71- −2,59).BODE: movilidad, OR: 1,53 (IC 95%: 1,15-2,02); cuidado personal, OR: 2,08 (IC 95%: 1,40-3,11); actividades cotidianas, OR: 1,97 (IC 95%: 1,38-2,80); EVA, coeficiente regresión: −3,96 (IC 95%: −5,51- −2,42). ADO: movilidad, OR: 2,42 (IC 95%: 1,39-4,20); cuidado personal, OR: 3,21 (IC 95%: 1,67-6,18); actividades cotidianas, OR: 3,17 (IC 95%: 1,69-5,93); EVA, coeficiente regresión: −3,53 (IC 95%: −5,57- −1,49).ConclusionesLos índices BODE y ADO presentaron una importante asociación con la CVRS. Las exacerbaciones y la disnea fueron los factores individuales que mejor se relacionaron con la CVRS.AbstractObjectiveTo describe the relationship between individual or combined prognostic factors in the multidimensional classifications (BODE and ADO), and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD).DesignCross-sectional descriptive study.SettingPrimary care.ParticipantsSystematic random sample of 102 patients diagnosed with COPD, excluding those patients with acute exacerbation, dementia, terminal illness or those who receive home care.Main measurementsDemographics variables, smoking habits, body mass index and number of exacerbations. Comorbidity. Degree of dyspnea. Respiratory function tests. Exercise capacity. The BODE index and the ADO index. The EuroQol-5D questionnaire (EQ-5D), and visual analogue scale (VAS).ResultsEQ-5D: mobility: 43.9%; personal care: 13.3%; daily-life activities: 29.6%; pain/discomfort: 55.1%; anxiety/depression: 37.8%, and 34.7% VAS ≤ 60%.Exacerbations: Mobility, OR: 1.85 (95%CI: 1.08-3.20); personal care, OR: 2.12 (95%CI: 1.3-4.76); daily-life activities, OR: 2.35 (95%CI: 1.17-4.71); VAS, regression coefficient: −3.50 (95%CI: 6.31- −0.70). Dyspnea: mobility, OR: 4.47 (95%CI: 1.39-14.42); daily-life activities, OR: 7.71 (95%CI: 2.03-12.34); VAS, regression coefficient: −7.15 (95%CI: 11.71- −2.59).BODE: mobility, OR: 1.53 (95%CI: 1.15-2.02); personal care, OR: 2.08 (95%CI: 1.40-3.11); daily-life activities, OR: 1.97 (95%CI: 1.38-2.80); VAS, regression coefficient: −3.96 (95%CI: −5.51- −2.42). ADO: mobility, OR: 2.42 (95%CI: 1.39-4.20); personal care, OR: 3.21 (95%CI: 1.67-6.18); daily-life activities, OR: 3.17 (95%CI: 1.69-5.93); VAS, regression coefficient: −3.53 (95%CI: −5.57- −1.49).ConclusionsThe BODE index and the ADO index showed a significant association with HRQOL. Exacerbations and dyspnea were the best individual factors related to HRQoL

Detección de nistagmo en respuesta a la prueba de Dix-Hallpike en atención primaria: una comparación entre vértigo posicional paroxístico benigno subjetivo y objetivo

Patients who experience both vertigo and nystagmus in the Dix-Hallpike test (DHT) are diagnosed with objective benign paroxysmal positional vertigo (BPPV). This test provokes only vertigo in between 11% and 48% of patients, who are diagnosed with subjective BPPV. Detection of nystagmus has important diagnostic and prognostic implications. To compare the characteristics of patients diagnosed with objective and subjective BPPV in primary care. Cross-sectional descriptive study. Two urban primary care centers. Adults (≥18 years) diagnosed with objective or subjective BPPV between November 2012 and January 2015. DHT results (vertigo or vertigo plus nystagmus; dependent variable: nistagmus as response to DHT), age, sex, time since onset, previous vertigo episodes, self-reported vertigo severity (Likert scale, 0-10), comorbidities (recent viral infection, traumatic brain injury, headache, anxiety/depression, hypertension, diabetes mellitus, dyslipidemia, cardiovascular disease, altered thyroid function, osteoporosis, cervical spondylosis, neck pain). In total, 134 patients (76.1% women) with a mean age of 52 years were included; 59.71% had subjective BPPV. Objective BPPV was significantly associated with hypertension, antihypertensive therapy, and cervical spondylosis in the bivariate analysis and with cervical spondylosis (OR = 3.94, p = 0.021) and antihypertensive therapy (OR 3.02, p = 0.028) in the multivariate analysis. Patients with subjective BPPV were more likely to be taking benzodiazepines [OR 0.24, p = 0.023]. The prevalence of subjective BPPV was higher than expected. Cervical spondylosis and hypertensive therapy were associated with objective BPPV, while benzodiazepines were associated with subjective BPPV

Effectiveness of a training intervention to improve the management of vertigo in primary care: a multicentre cluster-randomised trial, VERTAP

Background: Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. While BPPV is best treated with canalicular repositioning manoeuvres, they are not routinely performed in primary care (PC). Methods: To evaluate the effectiveness of blended training (online and face-to-face) on the diagnosis and management of vertigo to improve adherence of family doctors to clinical practice guidelines, we designed a community multicentre cluster-randomised open-label trial with an intervention (IG) and a control (GC) group of 10 primary care teams (PCT) each. Outcome variables will be ICD-10 diagnostic codes (proportion of nonspecific diagnoses such as dizziness and vertigo versus specific diagnoses such as BPPV, vestibular neuritis, and Meniere's disease); number of referrals to ENT or neurology specialists; prescription of antivertigo agents; and duration of sick leave due to vertigo. The baseline comparability of the two study groups will be analysed to ensure homogeneity. A description of all baseline variables will be performed. Student's t-test will be used to evaluate the differences between the groups. Logistic regression multivariate analysis will be performed to study the relationship between baseline variables of professionals and centres with outcome variables. Discussion: With the improvement of the diagnosis and management of vertigo by family doctors after this training, we expect an increase in the proportion of specific diagnoses, a decrease in the prescription of antivertigo agents, a decrease in referrals to ENT or neurology specialists and a reduction in the duration of sick leave due to temporary disability. The blended training will be easily expanded within primary care services, since it is mainly delivered online, with a single face-to-face session to ensure that the manoeuvres have been adequately learned

Effectiveness of the Epley’s maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial

BACKGROUND: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley’s maneuver performed by general practitioners (GPs) in the treatment of BPPV. METHODS/DESIGN: This study is a randomized clinical trial conducted in the primary care setting. The study’s scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley’s maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients’ report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher’s exact test will be conducted to compare categorical measures and Student’s t-test or Mann–Whitney U-test will be used for intergroup comparison variables. DISCUSSION: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01969513

Effectiveness of the Epley's maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial

Background: Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. Methods/Design: This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. We will use descriptive statistics of all variables collected. Groups will be compared using the intent-to-treat approach and either parametric or nonparametric tests, depending on the nature and distribution of the variables. Chi-square test or Fisher's exact test will be conducted to compare categorical measures and Student's t-test or Mann-Whitney U-test will be used for intergroup comparison variables. Discussion: Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients

Document de consens sobre la malaltia celíaca a Catalunya

Malaltia celíaca; Diagnòstic precoç; AlimentsEnfermedad celíaca; Diagnóstico precoz; AlimentosCeliac Disease; Early Diagnosis; FoodDocumento que revisa las distintas formas clínicas de presentación de la enfermedad celíaca, establece los criterios y el proceso diagnóstico de esta des de la sospecha clínica hasta el diagnóstico definitivo; ofrece recomendaciones específicas sobre el tratamiento de la enfermedad celíaca, promueve el seguimiento adecuado del paciente que la sufre y define los criterios de derivación a la atención especializada. Su objetivo principal es incrementar el diagnóstico precoz de la enfermedad celíaca en niños y adultos.Document que revisa les diverses formes clíniques de presentació de la malaltia celíaca, estableix els criteris i el procés diagnóstic d’aquesta des de la sospita clínica fins al diagnòstic definitiu; ofereix recomanacions específiques sobre el tractament de la malaltia celíaca, promou el seguiment adequat del pacient que la pateix i defineix criteris de derivació a l’atenció especialitzada. El seu objectiu principal és incrementar el diagnòstic precoç de la malaltia celíaca en infants i en adults

Diseño para el desarrollo sustentable y la habitabilidad segura e incluyente

Este libro se divide en dos partes que permiten permear en el campo de la enseñanza del diseño; la primera se enfoca en temáticas que se desprenden del diseño en la educación para la sustentabilidad; en la segunda, se identifican las tendencias del diseño como un modo de verlo y sentirlo: va desde el diseño emocional hacia uno de conservación, reúso y reparación de objetos para reducir el consumo de recursos materiales