Telerehabilitació en pacients amb accidents cerebrovascular: revisió bibliogràfica.

L’ ictus és una alteració brusca de la circulació de la sang al cervell, sent la segona causa de mort al món i la primera en discapacitat. Objectius. Examinar si la telerehabilitació i la realitat virtual poden millorar l'estat físic i psíquic dels pacients amb accident cerebrovascular i avaluar l’impacte en les activitats de la vida diària. Conclusió. Els resultats indiquen que la fisioteràpia convencional i un programa combinat de telerehabilitació o realitat virtual amb fisioteràpia, milloren les capacitats físiques dels pacients, no obstant, el tractament combinat obté millores significativament superiors al tractament convencional. La tecnologia en l’àmbit de la rehabilitació pot ser una alternativa segura per promoure la recuperació motora després d'un accident cerebrovascular.

Effect of cocoa powder in the prevention of cardiovascular disease: biological, consumption and inflammatory biomarkers. A metabolomic approach

Numerous health benefits have been attributed to cocoa and its derived products in the last decade including antioxidant, anti-platelet and positive effects on lipid metabolism and vascular function. Inflammation plays a key role in the initiation and progression of atherosclerosis. However, cocoa feeding trials focused on inflammation are still rare and the results yielded are controversial. Health effects derived from cocoa consumption have been partly attributed to its polyphenol content, in particular of flavanols. Bioavailability is a key issue for cocoa polyphenols in order to be able to exert their biological activities. In the case of flavanols, bioavailability is strongly influenced by several factors, such as their degree of polymerization and the food matrix in which the polyphenols are delivered. Furthermore, gut has become an active site for the metabolism of procyanidins (oligomeric and polymeric flavanols). Estimation of polyphenol consumption or exposure is also a very challenging task in Food and Nutrition Science in order to correlate the intake of phytochemicals with in vivo health effects. In the area of nutrition, modern analytical techniques based on mass spectrometry are leading to considerable advances in targeted metabolite analysis and particularly in Metabolomics or global metabolite analysis. In this chapter we have summarized the most relevant results of our recent research on the bioavailability of cocoa polyphenols in humans and the effect of the matrix in which cocoa polyphenols are delivered considering both targeted analysis and a metabolomic approach. Furthermore, we have also summarized the effect of long-term consumption of cocoa powder in patients at high risk of cardiovascular disease (CVD) on the inflammatory biomarkers of atherosclerosis.

Eficacia de las intervenciones de prevención de caídas en pacientes geriátricos institucionalizados. Revisión sistemática y metaanálisis

Objetivo: Determinar la eficacia de las intervenciones de prevención de caídas en personas mayores institucionalizadas. Material y métodos: La población de estudio consistió en ensayos clínicos controlados y aleatorizados acerca de intervenciones de prevención primaria de caídas, en ancianos institucionalizados en residencias y unidades de larga estancia, publicados en los últimos 15 años en el ámbito mundial. Se realizó un análisis de metaanálisis para determinar la eficacia de las intervenciones de prevención de caídas. Resultados: El equipo investigador revisó un total de 2.382 estudios, de los cuales se seleccionaron 156; finalmente se analizan 7 estudios de forma enmascarada, previo examen de su calidad metodológica mediante Checklist of Consort Statement (2002). Las intervenciones de prevención de caídas en pacientes geriátricos, institucionalizados en residencias geriátricas y unidades de larga estancia reducen de forma global la posibilidad de caerse (odds ratio = 0,63; intervalo de confianza del 95%, 0,53-0,74). Conclusiones: Las intervenciones de prevención de caídas en residencias geriátricas y unidades de larga estancia consiguen disminuir en 1,58 veces la posibilidad de caerse. Se destaca la formación del equipo como uno de los aspectos clave en la prevención, acompañada por un enfoque del problema multifactorial, interdisciplinar e individualizado.

La imagen corporal en la sociedad del siglo XXI

La imagen corporal (IC) representa la forma en la que un individuo se percibe, imagina, siente y actúa respecto a su propio cuerpo. Es un concepto dinámico que puede modificarse a lo largo de la vida. La percepción de nuestro propio cuerpo está influida por factores socioculturales. Desde el punto de vista histórico, el concepto de belleza se ha modificado sustancialmente. En la prehistoria, la belleza se asociaba a la reproducción de la especie, mientras que en la actualidad, se asocia al éxito personal, profesional y social. El estereotipo de belleza femenino de las sociedades contemporáneas se basa en la extrema delgadez y el masculino en cuerpos musculados. La lucha por alcanzar el canon de belleza impuesto por la sociedad ha contribuido a la aparición de diferentes trastornos de la imagen corporal (TIC). Los medios de comunicación son un factor importante en el desarrollo de determinados procesos patológicos, en la insatisfacción con la propia IC y en la estigmatización del individuo. Se consideran los principales impulsores de los patrones estéticos, siendo las mujeres y los adolescentes los más vulnerables. Las diferentes investigaciones indican que los TIC son frecuentes siendo los trastornos de la conducta alimentaria (TCA) los que suponen un mayor número de ingresos y reingresos entre la población femenina. Aunque los TCA afectan principalmente a la población adolescente, los estudios muestran que puede aparecer en la edad adulta e incluso en la infancia. En el sexo masculino, el trastorno dismórfico corporal (TDC) parece ser el más prevalente. La prevención y el tratamiento de este tipo de trastornos es primordial. En este sentido, enfermería tiene un papel fundamental debido al frecuente contacto que mantiene con el paciente. Debido a la importancia concedida en la sociedad actual a la apariencia física y las posibles repercusiones que ello conlleva, el presente trabajo pretende realizar una revisión de la literatura con el objetivo de analizar el valor y la exigencia que otorga la sociedad a la IC. Palabras clave: imagen corporal, desórdenes mentales, estigma social, medios de comunicación, epidemiología, cuidados de enfermería, proceso de atención de enfermería.

Evaluación y plan de actuación en materia de Prevención de Riesgos Laborales del Hotel Tanit (Benidorm)

El presente documento es un proyecto de intervención en el marco de la prevención de riesgos laborales en un hotel de tres estrellas de la localidad turística de Benidorm. A partir de un análisis exhaustivo de las necesidades de la organización, sus características intrínsecas, su modelo de gestión de la prevención de riesgos laborales, y una evaluación específica de cuatro puestos de trabajo, se pretende comprobar el funcionamiento de la gestión de la prevención, con el objetivo de proponer aquellas actuaciones que puedan mejorarlo. Para llevar a cabo dicha labor, se empleará una metodología analítica extraída de las guías técnicas del Instituto Nacional de Seguridad e Higiene en el trabajo (INSHT en adelante), que contemplan modelos y metodologías de evaluación ampliamente contrastados como el modelo de demanda-control-apoyo social de Robert Karasek, desarrollado por la metodología ISTAS21 de la NTP 604 del INSHT, o la Guía Técnica de pantallas de visualización de datos (PVD) del INSHT desarrolladora del RD 488/1997.El proyecto pretende de esta manera alcanzar unas conclusiones acordes a la fiabilidad de la metodología empleada, y de esta forma proponer actuaciones preventivas correctoras para los factores de riesgo hallados durante la evaluación de los puestos de trabajo, y que se ajusten en todo momento a los requerimientos legales vigentes en materia de prevención de riesgos laborales.Finalmente, el proyecto propondrá a modo de conclusiones la actualización del Plan preventivo con el que cuenta la empresa, en base a los descubrimientos hallados durante la investigación, así como una serie de acciones dirigidas a la satisfactoria integración de la actividad preventiva dentro del modelo de gestión de la empresa.

A topical microemulsion for the prevention of allergic rhinitis symptoms: results of a randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial (Nares study)

Background: Since barrier protection measures to avoid contact with allergens are being increasingly developed, we assessed the clinical efficacy and tolerability of a topical nasal microemulsion made of glycerol esters in patients with allergic rhinitis. Methods: Randomized, controlled, double-blind, parallel group, multicentre, multinational clinical trial in which adult patients with allergic rhinitis or rhinoconjunctivitis due to sensitization to birch, grass or olive tree pollens received treatment with topical microemulsion or placebo during the pollen seasons. Efficacy variables included scores in the mini-RQLQ questionnaire, number and severity of nasal, ocular and lung signs and symptoms, need for symptomatic medications and patients" satisfaction with treatment. Adverse events were also recorded. Results: Demographic characteristics were homogeneous between groups and mini-RQLQ scores did not differ significantly at baseline (visit 1). From symptoms recorded in the diary cards, the ME group showed statistically significant better scores for nasal congestion (0.72 vs. 1.01; p = 0.017) and mean total nasal symptoms (0.7 vs. 0.9; p = 0.045). At visit 2 (pollen season), lower values were observed in the mini-RQLQ in the ME group, although there were no statistically significant differences between groups in both full analysis set (FAS) and patients completing treatment (PPS) populations. The results obtained in the nasal symptoms domain of the mini-RQLQ at visit 2 showed the highest difference (−0.43; 95% CI: -0.88 to 0.02) for the ME group in the FAS population. The topical microemulsion was safe and well tolerated and no major discomforts were observed. Satisfaction rating with the treatment was similar between the groups. Conclusions: The topical application of the microemulsion is a feasible and safe therapy in the prevention of allergic symptoms, particularly nasal congestion.

The republican case for workplace democracy

The republican case for workplace democracy (WD) is presented and defended from two alternative means of ensuring freedom from arbitrary interference in the firmnamely, (a) the right to freely exit the firm and (b) workplace regulation. This paper shows, respectively, that costless exit is neither possible nor desirable in either perfect or imperfect labor markets, and that managerial discretion is both desirable and inevitable due to the incompleteness of employment contracts and labor legislation. The paper then shows that WD is necessary, from a republican standpoint, if workers" interests are to be adequately tracked in the exercise of managerial authority. Three important objections are finally addressed (i) that WD is redundant, (ii) that it is unnecessary provided that litigation and unionism can produce similar outcomes, and (iii) that it falls short of ensuring republican freedom compared to self-employment.

Dynamic patterns of flow in the workplace: characterizing within-individual variability using a complexity science approach

As a result of the growing interest in studying employee well-being as a complex process that portrays high levels of within-individual variability and evolves over time, this present study considers the experience of flow in the workplace from a nonlinear dynamical systems approach. Our goal is to offer new ways to move the study of employee well-being beyond linear approaches. With nonlinear dynamical systems theory as the backdrop, we conducted a longitudinal study using the experience sampling method and qualitative semi-structured interviews for data collection; 6981 registers of data were collected from a sample of 60 employees. The obtained time series were analyzed using various techniques derived from the nonlinear dynamical systems theory (i.e., recurrence analysis and surrogate data) and multiple correspondence analyses. The results revealed the following: 1) flow in the workplace presents a high degree of within-individual variability; this variability is characterized as chaotic for most of the cases (75%); 2) high levels of flow are associated with chaos; and 3) different dimensions of the flow experience (e.g., merging of action and awareness) as well as individual (e.g., age) and job characteristics (e.g., job tenure) are associated with the emergence of different dynamic patterns (chaotic, linear and random).

Induced maritime accidents

Humanity system of life is highly supported by maritime transport when circa 8 thousand million people require about 8.800 million tons of merchandises by sea, going in some 105.000 merchant ships of over 100 GT, sailing every thinkable dangerous waters 365 days year 24 hours day. All that Enormous activity plus others different factors produce accidents, as is shown in an ascendant 1.7 rate related to ships lost with big number in life, cargoes losses, and pollution. That is why this study pretend to detect causes factors of maritime accidents, to try to reduce them, and with that targetin mind it was tested the new theory of Induced Maritime Accidents, crossing itsproposals with relevant sinister of different times and circumstances, as Andrea Doria, Torrey Canyon, Costa Concordia, among others. Those cases were re evaluated to establish the key points of such theory, as they are the Production Pressure, the Risk Homeostasis, technological advances and the rupture of safety margin. Cases studies gave as result the existence of referred key points, in a manner combined that the chain of events derived to the fatality, and more than that highlights the possibility that been suppressed to acceptable limits the production pressure or the risk homeostasis, a permissible safety margin were been maintained, avoiding catastrophe.

TCDI vs TCD for stroke risk prevention in children with sickle cell anemia: a cross-sectional study

Children with sickle cell anemia (SCA) are at increased risk of stroke. Elevated blood-flow velocities in the middle cerebral artery detected by Transcranial Doppler (TCD) are a good predictor of stroke risk in these children. Velocities obtained by TCD are measured by using a specific parameter, the time-averaged mean of the maximum velocity (TAMM). Children with TAMM velocities ≥200 cm/sec are at high risk of stroke, and transfusions as primary prevention might be done. Transcranial Doppler-imaging (TCDI) is now widely available and it allows the visualization of intracranial vessels.Few studies have compared the TAMM in TCD and TCDI, and no studies have established a cutoff point for TAMM in TCDI equivalent to the STOP criteria of “normal”, “conditional” and “abnormal”, which could predict a high risk of stroke in children with SCAObjectives: To compare the TAMM velocity obtained by TCDI with the TAMM velocity obtained with TCD in the middle cerebral artery, and to determine a cutoff point for TAMM in TCDI that could predict a high risk of stroke in children with SCAMethods: This study is a cross-sectional study of a diagnostic test. 78 children with sickle cell anemia between 2 to 16 years will be evaluated with both TCD and TCDI in order to determinate the TAMM with the two devices. Velocities obtained with both Doppler techniques will be compared using an intraclass correlation coefficient