Atenció a l'ictus agut: comparació del sistema català amb el sistema finlandès

L’ictus és un problema de salut pública on les malalties cerebrovasculars representen la tercera causa de mort del nostre país, la primera causa de discapacitat física en adults i la segona de demència. Segons la OMS es preveu que la malaltia cerebrovascular s’ incrementi un 27% en relació a l’envelliment de la població entre els anys 2000 i 2025Objectius: Conèixer i comparar l’atenció i la organització de les persones afectades per ictus a Catalunya i a Finlàndia, específicament a l’Hospital Universitari Doctor Josep Trueta (Girona) i a l’Hospital Universitari de Kuopio (Finlàndia) Metodologia: Estudi observacional quantitatiu i qualitatiu que compara les diferents atencions a la fase pre-hospitalària, hospitalària i sub-aguda a Girona (Catalunya) i a Kuopio (Finlàndia). S’han estudiat variables relacionades amb l’atenció pre-hospitalària, hospitalària i post-hospitalària específicament, s’han estudiat variables relacionades amb cures d’infermeria. S’han realitzat tècniques qualitatives utilitzant la observació directa en els dos centres estudiats, i tècniques quantitatives mitjançant un qüestionari als responsables d’infermeria

Protective effects of social networks on disability among older adults in Spain

The loss of autonomy at advanced ages is not only associated with ageing, but also with the characteristics of the physical and social environment. Recent investigations have shown that social networks, social engagement and participation act like predictors of disability among the elderly. The aim of this study is to determine whether social networks are related to the development and progression of disability in the early years of old age. The source of data is the first wave of the survey "Processes of Vulnerability among Spanish Elderly", carried out in 2005 to a sample of 1 244 individuals. The population object of study is the cohort aged 70 to 74 years in metropolitan areas (Madrid and Barcelona) and not institutionalized. Disability is measured by the development of basic activities of daily life (ADL), and instrumental activities of daily life (IADL). The structural aspects of the social relationships are measured through the diversity of social networks and participation. We used the social network index (SNI). For each point over the SNI, the risk of developing any type of disability decreased by 49% (HR = 0.51, 95%CI = 0.31-0.82). The SNI was a decisive factor in all forecasting models constructed with some hazard ratios (HR) that ranged from 0.29 (95%CI = 0.14-0.59) in the first model to 0.43 (95%CI 0.20-0.90) in the full model. The results of the present study showed a strong association between an active social life, emotional support provided by friends and confidents and disability. These findings suggest a protective effect of social networks on disability. Also, these results indicate that some family and emotional ties have a significant effect on both the prevalence and the incidence of disability.

Impact of multimorbidity on disability and quality of life in the spanish older population

BACKGROUND: Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends. METHODS: Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females. RESULTS: All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: -18.10 (-20.95,-15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability. CONCLUSIONS: Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.

Colombian international trade from a physical perspective: towards an ecologial "Prebisch Thesis"

Prebisch's approach to economic development was based on the notion that there is an international historical division of labour. Peripheral countries are specialized in exporting primary goods while centre countries export industrial goods. The Terms of trade for peripheral countries tend to deteriorate. This approach can be extendend to ecological issues. The international Centre-Periphery division does not only involve the monetary exchange of goods and capital, but also the physical exchange in which Southern countries provide materials and energy so that Northern countries can develop their socioconomic metabolism. This metabolism process is guaranteed through cheap prices for primary goods. This paper aims to apply and extend Prebisch's thought on unequal exchange, both monetary and ecological, in relation to colombian trade in the period 1970-2002, using material flow analysis.

Bases pel desenvolupament i l’aplicació d'un tractament interdisciplinar del dolor crònic pediàtric

Projecte de recerca elaborat a partir d’una estada al Pain Management Unit de la University of Bath-Royal National Hospital for Rheumatic Disease, a Gran Bretanya, entre juliol i setembre del 2006. El dolor crònic en pediatria es defineix com aquell que és persistent o recurrent durant tres o més mesos. Recentment la prevalença a la nostra població entre els escolars de 8 a 16 anys ha estat quantificada en el 37.3%. Davant d’aquestes dades i coneixent la magnitud de l’impacte que el dolor crònic té en aquestes edats, sorgeix la necessitat de desenvolupar programes d’intervenció per donar una resposta a aquesta problemàtica en la nostra població. Les investigacions realitzades assenyalen que els programes multidisciplinars són els que obtenen una major eficàcia. Aquests programes estan adreçats a minimitzar l’impacte dels diferents factors que conformen l’experiència de dolor: físics, emocionals, cognitius, conductuals i socials. A Europa només l’hospital on s’ha realitzat l’estada ofereix un programa d’aquestes característiques. El servei que ofereixen en aquesta Unitat de dolor pediàtric està sent el model de referència pel disseny d’un programa de tractament a la nostra població. Per aquest motiu, s’ha realitzat una estada d’un mes de durada a la PMU, amb l’objectiu d’aprendre els procediments terapèutics per adaptar-los i aplicar-los en el nostre context. Sis adolescents amb problemes de dolor crònic i discapacitat associada, acompanyats de les seves mares han participat en aquest programa de tractament grupal interdisciplinari d’orientació cognitiu-conductual de tres setmanes. Es realitzen aproximadament 110 hores de tractament, distribuïdes en sessions de 50 minuts, d’activitat física i ocupacional, teràpia cognitiu-conductual i educació. Aquesta estada ha permès d’una banda, la formació d’un psicòleg dintre d’un equip de dolor pediàtric interdisciplinar i de l’altra evidenciar l’efectivitat que aquest programa interdisciplinar de rehabilitació cognitiu-conductual té pel maneig del dolor crònic i la discapacitat associada.

Discrete time Non-homogeneous Semi-Markov Processes applied to Models for Disability Insurance

In this paper, we present a stochastic model for disability insurance contracts. The model is based on a discrete time non-homogeneous semi-Markov process (DTNHSMP) to which the backward recurrence time process is introduced. This permits a more exhaustive study of disability evolution and a more efficient approach to the duration problem. The use of semi-Markov reward processes facilitates the possibility of deriving equations of the prospective and retrospective mathematical reserves. The model is applied to a sample of contracts drawn at random from a mutual insurance company.

Availability analysis of GMPLS connections based on physical network topology

This paper presents a study of connection availability in GMPLS over optical transport networks (OTN) taking into account different network topologies. Two basic path protection schemes are considered and compared with the no protection case. The selected topologies are heterogeneous in geographic coverage, network diameter, link lengths, and average node degree. Connection availability is also computed considering the reliability data of physical components and a well-known network availability model. Results show several correspondences between suitable path protection algorithms and several network topology characteristics

Studies about the atomic capabilities concept for linear control systems in physical multi-agent environments

This paper shows the impact of the atomic capabilities concept to include control-oriented knowledge of linear control systems in the decisions making structure of physical agents. These agents operate in a real environment managing physical objects (e.g. their physical bodies) in coordinated tasks. This approach is presented using an introspective reasoning approach and control theory based on the specific tasks of passing a ball and executing the offside manoeuvre between physical agents in the robotic soccer testbed. Experimental results and conclusions are presented, emphasising the advantages of our approach that improve the multi-agent performance in cooperative systems

Health-related quality of life assessment in people with multiple sclerosis and their family caregivers. A multicenter study in Catalonia (Southern Europe)

Objectives: To measure the health-related quality of life (HRQoL) of multiple sclerosis (MS) patients and their caregivers, and to assess which factors can best describe HRQoL. Methods: A cross-sectional multicenter study of nine hospitals enrolled MS patients and their caregivers who attended outpatient clinics consecutively. The instruments used were the SF-36 for patients and the SF-12 and GHQ-12 for caregivers. Classification and regression tree analysis was used to analyze the explanatory factors of HRQoL. Results: A total of 705 patients (mean age 40.4 years, median Expanded Disability Status Scale 2.5, 77.8% with relapsing-remitting MS) and 551 caregivers (mean age 45.4 years) participated in the study. MS patients had significantly lower HRQoL than in the general population (physical SF-36: 39.9; 95% confidence interval [CI]: 39.1–40.6; mental SF-36: 44.4; 95% CI: 43.5–45.3). Caregivers also presented lower HRQoL than general population, especially in its mental domain (mental SF-12: 46.4; 95% CI: 45.5–47.3). Moreover, according to GHQ-12, 27% of caregivers presented probable psychological distress. Disability and co-morbidity in patients, and co-morbidity and employment status in caregivers, were the most important explanatory factors of their HRQoL. Conclusions: Not only the HRQoL of patients with MS, but also that of their caregivers, is indeed notably affected. Caregivers’ HRQoL is close to population of chronic illness even that the patients sample has a mild clinical severity and that caregiving role is a usual task in the study context

One- and two-center physical space partitioning of the energy in the density functional theory

A conceptually new approach is introduced for the decomposition of the molecular energy calculated at the density functional theory level of theory into sum of one- and two-atomic energy components, and is realized in the "fuzzy atoms" framework. (Fuzzy atoms mean that the three-dimensional physical space is divided into atomic regions having no sharp boundaries but exhibiting a continuous transition from one to another.) The new scheme uses the new concept of "bond order density" to calculate the diatomic exchange energy components and gives them unexpectedly close to the values calculated by the exact (Hartree-Fock) exchange for the same Kohn-Sham orbitals

Coupling digital and physical worlds in an AR magic show performance: lessons learned

“Magic for a Pixeloscope” is a one hour show conceived to berepresented in a theater scenario that merges mixed and augmented reality (MR/AR) and full-body interaction with classical magic to create new tricks. The show was conceived by an interdisciplinary team composed by a magician, twointeraction designers, a theater director and a stage designer. Themagician uses custom based hardware and software to createnew illusions which are a starting point to explore new languagefor magical expression. In this paper we introduce a conceptualframework used to inform the design of different tricks; weexplore the design and production of some tricks included in theshow and we describe the feedback received on the world premiere and some of the conclusions obtained.

Transition probabilities and duration analysis among disability states: Some evidence from Spanish data

In this paper we study the disability transition probabilities (as well as the mortalityprobabilities) due to concurrent factors to age such as income, gender and education. Althoughit is well known that ageing and socioeconomic status influence the probability ofcausing functional disorders, surprisingly little attention has been paid to the combined effectof those factors along the individuals' life and how this affects the transition from one degreeof disability to another. The assumption that tomorrow's disability state is only a functionof the today's state is very strong, since disability is a complex variable that depends onseveral other elements than time. This paper contributes into the field in two ways: (1) byattending the distinction between the initial disability level and the process that leads tohis course (2) by addressing whether and how education, age and income differentially affectthe disability transitions. Using a Markov chain discrete model and a survival analysis, weestimate the probability by year and individual characteristics that changes the state of disabilityand the duration that it takes its progression in each case. We find that people withan initial state of disability have a higher propensity to change and take less time to transitfrom different stages. Men do that more frequently than women. Education and incomehave negative effects on transition. Moreover, we consider the disability benefits associatedto those changes along different stages of disability and therefore we offer some clues onthe potential savings of preventive actions that may delay or avoid those transitions. Onpure cost considerations, preventive programs for improvement show higher benefits thanthose for preventing deterioration, and in general terms, those focussing individuals below65 should go first. Finally the trend of disability in Spain seems not to change among yearsand regional differences are not found.

Award errors and permanent disability benefits in Spain

There is a controversial debate about the effects of permanent disability benefits on labormarket behavior. In this paper we estimate equations for deserving and receiving disabilitybenefits to evaluate the award error as the difference in the probability of receiving anddeserving using survey data from Spain. Our results indicate that individuals aged between55 and 59, self-employers or working in an agricultural sector have a probability of receiving a benefit without deserving it significantly higher than the rest of individuals. We also find evidence of gender discrimination since male have a significantly higher probability of receiving a benefit without deserving it. This seems to confirm that disability benefits are being used as an instrument for exiting the labor market for some individuals approaching the early retirement or those who do not have right to retire early. Taking into account that awarding process depends on Social Security Provincial Department, this means that some departments are applying loosely the disability requirements for granting disability benefits.

Disability, capacity for work and the business cycle: An international perspective

An important policy issue in recent years concerns the number of people claimingdisability benefits for reasons of incapacity for work. We distinguish between workdisability , which may have its roots in economic and social circumstances, and healthdisability which arises from clear diagnosed medical conditions. Although there is a linkbetween work and health disability, economic conditions, and in particular the businesscycle and variations in the risk of unemployment over time and across localities, mayplay an important part in explaining both the stock of disability benefit claimants andinflows to and outflow from that stock. We employ a variety of cross?country andcountry?specific household panel data sets, as well as administrative data, to testwhether disability benefit claims rise when unemployment is higher, and also toinvestigate the impact of unemployment rates on flows on and off the benefit rolls. Wefind strong evidence that local variations in unemployment have an importantexplanatory role for disability benefit receipt, with higher total enrolments, loweroutflows from rolls and, often, higher inflows into disability rolls in regions and periodsof above?average unemployment. Although general subjective measures of selfreporteddisability and longstanding illness are also positively associated withunemployment rates, inclusion of self?reported health measures does not eliminate thestatistical relationship between unemployment rates and disability benefit receipt;indeed including general measures of health often strengthens that underlyingrelationship. Intriguingly, we also find some evidence from the United Kingdom and theUnited States that the prevalence of self?reported objective specific indicators ofdisability are often pro?cyclical that is, the incidence of specific forms of disability arepro?cyclical whereas claims for disability benefits given specific health conditions arecounter?cyclical. Overall, the analysis suggests that, for a range of countries and datasets, levels of claims for disability benefits are not simply related to changes in theincidence of health disability in the population and are strongly influenced by prevailingeconomic conditions. We discuss the policy implications of these various findings.

Learning and adaptation in physical heterogeneous teams of robots

In this paper we present a novel approach to assigning roles to robots in a team of physical heterogeneous robots. Its members compete for these roles and get rewards for them. The rewards are used to determine each agent’s preferences and which agents are better adapted to the environment. These aspects are included in the decision making process. Agent interactions are modelled using the concept of an ecosystem in which each robot is a species, resulting in emergent behaviour of the whole set of agents. One of the most important features of this approach is its high adaptability. Unlike some other learning techniques, this approach does not need to start a whole exploitation process when the environment changes. All this is exemplified by means of experiments run on a simulator. In addition, the algorithm developed was applied as applied to several teams of robots in order to analyse the impact of heterogeneity in these systems