Promoting gender equality in responses to climate change: The case of Kenya

The paper discusses how Kenyan policies and organisations address gender equality in climate change-related responses. The political support for gender issues is reflected in presidential directives on various actions for achieving gender equality such as the establishment of gender desk officers and ensuring 30 per cent female representation in government. Despite the well-advanced gender mainstreaming policy in Kenya, few policies focus on climate change and even fewer on its inter-linkages with gender. At the field level, encrusted traditions, inadequately trained staff, limited financial resources, and limited awareness of the inter-linkages between gender and climate change remain major challenges to promoting gender equality in the work of government organisations. The paper thus proposes measures for addressing these challenges and strengthening gender equality in responses to climate change.

Causes, forms and consequences of the professionalization of international sport federa-tions in Switzerland: Conceptual framework and first results

Synopsis: Sport organisations are facing multiple challenges originating from an increasingly complex and dynamic environment in general, and from internal changes in particular. Our study seeks to reveal and analyse the causes for professionalization processes in international sport federations, the forms resulting from it, as well as related consequences. Abstract: AIM OF ABSTRACT/PAPER - RESEARCH QUESTION Sport organisations are facing multiple challenges originating from an increasingly complex and dynamic environment in general, and from internal changes in particular. In this context, professionalization seems to have been adopted by sport organisations as an appropriate strategy to respond to pressures such as becoming more “business-like”. The ongoing study seeks to reveal and analyse the internal and external causes for professionalization processes in international sport federations, the forms resulting from it (e.g. organisational, managerial, economic) as well as related consequences on objectives, values, governance methods, performance management or again rationalisation. THEORETICAL BACKGROUND/LITERATURE REVIEW Studies on sport as specific non-profit sector mainly focus on the prospect of the “professionalization of individuals” (Thibault, Slack & Hinings, 1991), often within sport clubs (Thiel, Meier & Cachay, 2006) and national sport federations (Seippel, 2002) or on organisational change (Griginov & Sandanski, 2008; Slack & Hinings, 1987, 1992; Slack, 1985, 2001), thus leaving broader analysis on governance, management and professionalization in sport organisations an unaccomplished task. In order to further current research on above-mentioned topics, our intention is to analyse causes, forms and consequences of professionalisation processes in international sport federations. The social theory of action (Coleman, 1986; Esser, 1993) has been defined as appropriate theoretical framework, deriving in the following a multi-level framework for the analysis of sport organisations (Nagel, 2007). In light of the multi-level framework, sport federations are conceptualised as corporative actors whose objectives are defined and implemented with regard to the interests of member organisations (Heinemann, 2004) and/or other pressure groups. In order to understand social acting and social structures (Giddens 1984) of sport federations, two levels are in the focus of our analysis: the macro level examining the environment at large (political, social, economic systems etc.) and the meso level (Esser, 1999) examining organisational structures, actions and decisions of the federation’s headquarter as well as member organisations. METHODOLOGY, RESEARCH DESIGN AND DATA ANALYSIS The multi-level framework mentioned seeks to gather and analyse information on causes, forms and consequences of professionalization processes in sport federations. It is applied in a twofold approach: first an exploratory study based on nine semi-structured interviews with experts from umbrella sport organisations (IOC, WADA, ASOIF, AIOWF, etc.) as well as the analysis of related documents, relevant reports (IOC report 2000 on governance reform, Agenda 2020, etc.) and important moments of change in the Olympic Movement (Olympic revenue share, IOC evaluation criteria, etc.); and secondly several case studies. Whereas the exploratory study seeks more the causes for professionalization on an external, internal and headquarter level as depicted in the literature, the case studies rather focus on forms and consequences. Applying our conceptual framework, the analysis of forms is built around three dimensions: 1) Individuals (persons and positions), 2) Processes, structures (formalisation, specialisation), 3) Activities (strategic planning). With regard to consequences, we centre our attention on expectations of and relationships with stakeholders (e.g. cooperation with business partners), structure, culture and processes (e.g. governance models, performance), and expectations of and relationships with member organisations (e.g. centralisation vs. regionalisation). For the case studies, a mixed-method approach is applied to collect relevant data: questionnaires for rather quantitative data, interviews for rather qualitative data, as well as document and observatory analysis. RESULTS, DISCUSSION AND IMPLICATIONS/CONCLUSIONS With regard to causes of professionalization processes, we analyse the content of three different levels: 1. the external level, where the main pressure derives from financial resources (stakeholders, benefactors) and important turning points (scandals, media pressure, IOC requirements for Olympic sports); 2. the internal level, where pressure from member organisations turned out to be less decisive than assumed (little involvement of member organisations in decision-making); 3. the headquarter level, where specific economic models (World Cups, other international circuits, World Championships), and organisational structures (decision-making procedures, values, leadership) trigger or hinder a federation’s professionalization process. Based on our first analysis, an outline for an economic model is suggested, distinguishing four categories of IFs: “money-generating IFs” being rather based on commercialisation and strategic alliances; “classical Olympic IFs” being rather reactive and dependent on Olympic revenue; “classical non-Olympic IFs” being rather independent of the Olympic Movement; and “money-receiving IFs” being dependent on benefactors and having strong traditions and values. The results regarding forms and consequences will be outlined in the presentation. The first results from the two pilot studies will allow us to refine our conceptual framework for subsequent case studies, thus extending our data collection and developing fundamental conclusions. References: Bayle, E., & Robinson, L. (2007). A framework for understanding the performance of national governing bodies of sport. European Sport Management Quarterly, 7, 249–268 Chantelat, P. (2001). La professionnalisation des organisations sportives: Nouveaux débats, nouveaux enjeux [Professionalisation of sport organisations]. Paris: L’Harmattan. Dowling, M., Edwards, J., & Washington, M. (2014). Understanding the concept of professionalization in sport management research. Sport Management Review. Advance online publication. doi: 10.1016/j.smr.2014.02.003 Ferkins, L. & Shilbury, D. (2012). Good Boards Are Strategic: What Does That Mean for Sport Governance? Journal of Sport Management, 26, 67-80. Thibault, L., Slack, T., & Hinings, B. (1991). Professionalism, structures and systems: The impact of professional staff on voluntary sport organizations. International Review for the Sociology of Sport, 26, 83–97.

The Open Door Mission: Measuring and predicting outcomes of one community-based substance abuse treatment program

The objectives of this study were to identify and measure the average outcomes of the Open Door Mission's nine-month community-based substance abuse treatment program, identify predictors of successful outcomes, and make recommendations to the Open Door Mission for improving its treatment program.^ The Mission's program is exclusive to adult men who have limited financial resources: most of which were homeless or dependent on parents or other family members for basic living needs. Many, but not all, of these men are either chemically dependent or have a history of substance abuse.^ This study tracked a cohort of the Mission's graduates throughout this one-year study and identified various indicators of success at short-term intervals, which may be predictive of longer-term outcomes. We tracked various levels of 12-step program involvement, as well as other social and spiritual activities, such as church affiliation and recovery support.^ Twenty-four of the 66 subjects, or 36% met the Mission's requirements for success. Specific to this success criteria; Fifty-four, or 82% reported affiliation with a home church; Twenty-six, or 39% reported full-time employment; Sixty-one, or 92% did not report or were not identified as having any post-treatment arrests or incarceration, and; Forty, or 61% reported continuous abstinence from both drugs and alcohol.^ Five research-based hypotheses were developed and tested. The primary analysis tool was the web-based non-parametric dependency modeling tool, B-Course, which revealed some strong associations with certain variables, and helped the researchers generate and test several data-driven hypotheses. Full-time employment is the greatest predictor of abstinence: 95% of those who reported full time employment also reported continuous post-treatment abstinence, while 50% of those working part-time were abstinent and 29% of those with no employment were abstinent. Working with a 12-step sponsor, attending aftercare, and service with others were identified as predictors of abstinence.^ This study demonstrates that associations with abstinence and the ODM success criteria are not simply based on one social or behavioral factor. Rather, these relationships are interdependent, and show that abstinence is achieved and maintained through a combination of several 12-step recovery activities. This study used a simple assessment methodology, which demonstrated strong associations across variables and outcomes, which have practical applicability to the Open Door Mission for improving its treatment program. By leveraging the predictive capability of the various success determination methodologies discussed and developed throughout this study, we can identify accurate outcomes with both validity and reliability. This assessment instrument can also be used as an intervention that, if operationalized to the Mission’s clients during the primary treatment program, may measurably improve the effectiveness and outcomes of the Open Door Mission.^

Understanding mental illness in Nigeria: Bringing culture and traditional medicine into mental health policy

One of the major challenges in treating mental illness in Nigeria is that the health care facilities and mental health care professionals are not enough in number or well equipped to handle the burden of mental illness. There are several barriers to treatment for individual Nigerians which include the following: such as the lack of understanding of the root causes of mental illness, lack of financial support to get mental treatment, lack of social support (family, friends, neighbors), the fear of stigmatization concerning being labeled as mentally ill or being in association with the mentally ill, and the consultation of traditional native healers who may be unknowingly prolonging illness, rather than addressing and treating them due to lack of formal education and standardization of their treatments. Another barrier is the non-health nature of the mental health services in Nigeria. Traditional healers are essentially the mental health system. The elderly, women, and children are the most vulnerable groups in times of strife and hardships. Their mental well-being must be taken into account as well as their special needs in times of personal or societal crisis. ^ Nigerian mental health policy is geared toward forming a mental health system, but in actuality only a mental illness care system is the observed result of the policy. The government of Nigeria has drafted a mental health policy, yet its actual implementation into the Nigerian health infrastructure and society waits to be materialized. The limited health legislation or policy implementations tend to favor those who have access to these urban areas and the facilities' health services. Nigerians living in rural areas are at a disadvantage; many of them may not even be aware of services available to help them understand and treat mental illness. Perhaps, government driven health interventions geared toward mental illness in rural areas would reach an underserved Nigerians and Africans in general. Issues with political instability and limited infrastructure often hinder crucial financial resources and legislation from reaching the people that are truly in need of governmental leadership in regards to mental health policy.^ Traditional healers are a severely untapped resource in the treatment of mental illness within the Nigerian population. They are abundant within Nigerian communities and are meeting a real need for the mentally ill. However, much can be done to remove the barriers that prevent the integration of traditional healers within the mental health system and improve the quality of care they administer within the population. Mental illness is almost exclusively coped with through traditional medicine practices. Mobilization and education from each strata of Nigerian society and government as well as input from the medical community can improve how traditional medicine is utilized as a treatment for clinical illness and help alleviate the heavy burden of mental illness in Nigeria. Currently, there is no existing policy making structure for a working mental health system in Nigeria, and traditional healers are not taken into account in any formulation of mental health policy. Advocacy for mental illness is severely inadequate due to fear of stigmatization, with no formally recognized national of regional mental health association.^

“Realidad o Utopía" : : ley de ordenamiento territorial

La lógica del mercado y al cambio de modelo de desarrollo en América Latina, en el intento de poder competir a nivel mundial, ha agudizado las disparidades y el deterioro ambiental. La presión que ejercen las grandes empresas y ciertos grupos con poder, el enquistamiento de una estructura administrativa que puja por mantener esquemas tradicionales ya perimidos y la falta de planificación impiden atender uno de los problemas claves que plantea la economía en el territorio, el de la concentración y los desequilibrios territoriales. Surge entonces el Ordenamiento Territorial como alternativa válida para atenuar estos procesos y dar respuesta a la sociedad. El caso que se presenta pone en el tapete muchos de estos temas que hoy preocupan y puede servir como experiencia transferible y aplicable a otras realidades que buscan consolidar un desarrollo local sustentable. El ante-proyecto de Ley de Ordenamiento Territorial y Usos del Suelo para la provincia de Mendoza, República Argentina, es un instrumento elaborado en el año 2006 por el sector académico-científico que desde una visión interdisciplinaria incorpora fundamentos técnicos y aportes de los actores sociales involucrados. La metodología aplicada permite consensuar por la sociedad en su conjunto los principios que sustentan la Ley, determinar la aplicación de ciertos instrumentos para efectivizar acciones en el territorio y definir una forma innovadora de hacer política, gestionar y planificar el uso del suelo. La propuesta considera al Ordenamiento Territorial como una política de Estado que debe propiciar condiciones de gobernabilidad. Sus principios y normas priorizan la equidad y el bienestar general por encima de los intereses particulares así como también el respeto de los valores y costumbres de la sociedad. Surge de un proceso participativo y sus principios y fines responden a los problemas actuales. Incorpora una serie de instrumentos debidamente jerarquizados conforme a las competencias jurisdiccionales y existencia de distintas escalas geográficas, como también, instrumentos jurídicos y prácticas administrativas innovadoras que permiten la resolución de conflictos territoriales. Identifica además recursos financieros para implementarla y prioriza el fortalecimiento de los mecanismos de control para un funcionamiento más ágil y eficaz de la gestión pública. Sin embargo existen riesgos vinculados a la voluntad política y el poder económico que pueden impedir que esta utopía se transforme en realidad. Solo la participación social es la que puede lograr vencer los intereses en juego y conseguir la aprobación de la Ley. Si esto se consigue se habrá dado un paso muy importante a ser imitado, sin lugar a dudas, en otros lugares de Argentina y América Latina.

Las prácticas de la actividad física en Veracruz

La práctica de la actividad física, según K. Zimman, se define como la forma sistemática y regular y como elemento significativo en la prevención, desarrollo y rehabilitación en la salud del ser humano. Este trabajo forma parte de un proyecto de investigación de corte cuantitativo, en la ciudad de Veracruz y Boca del Río, y tiene por objeto de estudio las actividades físicas en espacios públicos y privados. Además busca apoyar acciones del estado, del sector empresarial y educativo con el objetivo de ejecutar un programa integral de actividades físicas que cuente con mayor índice de instalaciones propias, recursos económicos, humanos y materiales, para promover mayor participación de la ciudadanía en actividades físicas

Reformas laborales y movilización sindical en los años noventa en Argentina : El caso del sindicato automotriz

Este artículo trata de las relaciones entre las reformas neoliberales y la movilización sindical en los años noventa en la Argentina. ¿Hasta qué punto los sindicatos y los trabajadores aprobaron el neoliberalismo y las reformas económicas? ¿Cómo afectaron estos cambios sus capacidades organizativas? Nuestra hipótesis es que a pesar de los costos que trajeron sobre los asalariados, los sindicatos mantuvieron su organización no solo mediante negociaciones por recursos financieros sino también a través de la capacidad de movilización en las grandes fábricas. Estas negociaciones sucedieron luego de oponerse contra los efectos de tales políticas en la primera parte de la década, aunque no contra su política global. Realizamos un estudio de caso basado en el sector automotriz con enfoque en algunas fábricas terminales. Asimismo intentamos hacer una contribución crítica respecto de la bibliografía especializada en las relaciones laborales en la Argentina en la era neoliberal

Las prácticas de la actividad física en Veracruz

La práctica de la actividad física, según K. Zimman, se define como la forma sistemática y regular y como elemento significativo en la prevención, desarrollo y rehabilitación en la salud del ser humano. Este trabajo forma parte de un proyecto de investigación de corte cuantitativo, en la ciudad de Veracruz y Boca del Río, y tiene por objeto de estudio las actividades físicas en espacios públicos y privados. Además busca apoyar acciones del estado, del sector empresarial y educativo con el objetivo de ejecutar un programa integral de actividades físicas que cuente con mayor índice de instalaciones propias, recursos económicos, humanos y materiales, para promover mayor participación de la ciudadanía en actividades físicas

Reformas laborales y movilización sindical en los años noventa en Argentina : El caso del sindicato automotriz

Este artículo trata de las relaciones entre las reformas neoliberales y la movilización sindical en los años noventa en la Argentina. ¿Hasta qué punto los sindicatos y los trabajadores aprobaron el neoliberalismo y las reformas económicas? ¿Cómo afectaron estos cambios sus capacidades organizativas? Nuestra hipótesis es que a pesar de los costos que trajeron sobre los asalariados, los sindicatos mantuvieron su organización no solo mediante negociaciones por recursos financieros sino también a través de la capacidad de movilización en las grandes fábricas. Estas negociaciones sucedieron luego de oponerse contra los efectos de tales políticas en la primera parte de la década, aunque no contra su política global. Realizamos un estudio de caso basado en el sector automotriz con enfoque en algunas fábricas terminales. Asimismo intentamos hacer una contribución crítica respecto de la bibliografía especializada en las relaciones laborales en la Argentina en la era neoliberal

Las prácticas de la actividad física en Veracruz

La práctica de la actividad física, según K. Zimman, se define como la forma sistemática y regular y como elemento significativo en la prevención, desarrollo y rehabilitación en la salud del ser humano. Este trabajo forma parte de un proyecto de investigación de corte cuantitativo, en la ciudad de Veracruz y Boca del Río, y tiene por objeto de estudio las actividades físicas en espacios públicos y privados. Además busca apoyar acciones del estado, del sector empresarial y educativo con el objetivo de ejecutar un programa integral de actividades físicas que cuente con mayor índice de instalaciones propias, recursos económicos, humanos y materiales, para promover mayor participación de la ciudadanía en actividades físicas

Reformas laborales y movilización sindical en los años noventa en Argentina : El caso del sindicato automotriz

Este artículo trata de las relaciones entre las reformas neoliberales y la movilización sindical en los años noventa en la Argentina. ¿Hasta qué punto los sindicatos y los trabajadores aprobaron el neoliberalismo y las reformas económicas? ¿Cómo afectaron estos cambios sus capacidades organizativas? Nuestra hipótesis es que a pesar de los costos que trajeron sobre los asalariados, los sindicatos mantuvieron su organización no solo mediante negociaciones por recursos financieros sino también a través de la capacidad de movilización en las grandes fábricas. Estas negociaciones sucedieron luego de oponerse contra los efectos de tales políticas en la primera parte de la década, aunque no contra su política global. Realizamos un estudio de caso basado en el sector automotriz con enfoque en algunas fábricas terminales. Asimismo intentamos hacer una contribución crítica respecto de la bibliografía especializada en las relaciones laborales en la Argentina en la era neoliberal

Diverging Development Paths of the Electronics Industry in Korea and Taiwan

This paper examines the process and mechanism of economic development in the Republic of Korea and Taiwan through a comparative analysis of the electronics industry in each country. The paper will show that in its initial stage of development, the electronics industry in both economies had the same type of dual structure: a domestic demand sector based on the protected domestic market, and an export sector intended to capitalize on low-wage labor for the international market. However, this dual structure in the two economies faded away after the mid-1970s as their respective indigenous export-oriented enterprises began to develop. But the primary industrial players in each economy were very different. In Korea they were comprehensive electronics manufacturers affiliated with chaebols, and in Taiwan they were small and medium-size enterprises. Differences in the two economies' development mechanisms have brought about this divergence in development paths. In Korea this mechanism has been characterized by the government's positive role and the chaebol's readiness to react to the government's leadership. In Taiwan the development mechanism has been based on the private sector independent from the government. As an extension of such diverged development paths, ICs and personal computers showed spectacular growth in Korea and Taiwan after the 1980s. The development of ICs in Korea was primarily the result of a decisive role played by the chaebol's sizable financial resources, while the competitiveness in personal computers largely reflected the agility and flexibility of Taiwanese small and medium-size enterprises.

Fiabilidad de los sistemas fotovoltaicos autónomos

Los sistemas fotovoltaicos autónomos, es decir, sistemas que carecen de conexión a la red eléctrica, presentan una gran utilidad para poder llevar a cabo la electrificación de lugares remotos donde no hay medios de acceder a la energía eléctrica. El continuo avance en el número de sistemas instalados por todo el mundo y su continua difusión técnica no significa que la implantación de estas instalaciones no presente ninguna problemática. A excepción del panel fotovoltaico que presenta una elevada fiabilidad, el resto de elementos que forman el sistema presentan numerosos problemas y dependencias, por tanto el estudio de las fiabilidades de estos elementos es obligado. En este proyecto se pretende analizar y estudiar detalladamente la fiabilidad de los sistemas fotovoltaicos aislados. Primeramente, el presente documento ofrece una introducción sobre la situación mundial de las energías renovables, así como una explicación detallada de la energía fotovoltaica. Esto incluye una explicación técnica de los diferentes elementos que forman el sistema energético (módulo fotovoltaico, batería, regulador de carga, inversor, cargas, cableado y conectores). Por otro lado, se hará un estudio teórico del concepto de fiabilidad, con sus definiciones y parámetros más importantes. Llegados a este punto, el proyecto aplica la teoría de fiabilidad comentada a los sistemas fotovoltaicos autónomos, profundizando en la fiabilidad de cada elemento del sistema así como evaluando el conjunto. Por último, se muestran datos reales de fiabilidad de programas de electrificación, demostrando la variedad de resultados sujetos a los distintos emplazamientos de las instalaciones y por tanto distintas condiciones de trabajo. Se destaca de esta forma la importancia de la fiabilidad de los sistemas fotovoltaicos autónomos, pues normalmente este tipo de instalaciones se localizan en emplazamientos remotos, sin personal cualificado de mantenimiento cercano ni grandes recursos logísticos y económicos. También se resalta en el trabajo la dependencia de la radiación solar y el perfil de consumo a la hora de dimensionar el sistema. Abstract Stand-alone photovoltaic systems which are not connected to the utility grid. These systems are very useful to carry out the electrification of remote locations where is no easy to access to electricity. The number increased of systems installed worldwide and their continued dissemination technique does not mean that these systems doesn´t fails. With the exception of the photovoltaic panel with a high reliability, the remaining elements of the system can to have some problems and therefore the study of the reliabilities of these elements is required. This project tries to analyze and study the detaila of the reliability of standalone PV systems. On the one hand, this paper provides an overview of the global situation of renewable energy, as well as a detailed explanation of photovoltaics. This includes a technical detail of the different elements of the energy system (PV module, battery, charge controller, inverter, loads, wiring and connectors). In addition, there will be a theoricall study of the concept of reliability, with the most important definitions and key parameters. On the other hand, the project applies the reliability concepts discussed to the stand-alone photovoltaic systems, analyzing the reliability of each element of the system and analyzing the entire system. Finally, this document shows the most important data about reliability of some electrification programs, checking the variety of results subject to different places and different conditions. As a conclussion, the importance of reliability of stand-alone photovoltaic systems because usually these are located in remote locations, without qualified maintenance and financial resources.These systems operate under dependence of solar radiation and the consumption profile.

Políticas de esfuerzo combinado económico-laboral en la retención y atracción del conocimiento científico: un estudio del caso español

El objetivo de este trabajo es la aportación de un caso que evidencie la importancia de realizar esfuerzos tanto en el terreno económico como en el laboral para conseguir una adecuada retención y atracción del conocimiento científico. Para ello, se analizan los datos de un estudio que destaca estas cuestiones para un país como España, que necesita urgentemente mejorar su balance de movilidad investigadora. Los resultados confirman la importancia de la aplicación de estas medidas y las debilidades que presenta en este tipo de políticas el sistema nacional de investigación, desarrollo e innovación (I+D+i). Abstract: The goal of this paper is to disclose a case study which highlights the impor tance of realising effor ts at an economic and labour scale in order to reach an adequate retention and attraction of scientific knowledge. Although science has evolved during different periods through the flow of mankind and ideas, studies about international mobility of scientists are recent in time. It started mid XXth century with the brain drain phenomenon. To alleviate the loss of scientists, countries have disclosed different politics. Some countries like Singapore, Southern Korea, India and China have been successful in bringing scientists back home. Those countries have made huge effor ts in human resources investments and scientific infrastructures, so as to enforce their national R&D&I systems. Despite such experiences and despite the increasement in terms of evidences related with international scientific mobility, few studies and figures have been disclosed. The goal of this current work is to disclose data, which backs up the liability of such kind of politics that combine effor ts in economic and labour terms. For that reason, data has been analyzed from a study which highlights these key aspects for a country like Spain and which recently established a wide range of politics in order to attract scientists. Despite the increasement of financial resources, such politics have turned out unable to reach a proper balance in terms of mobility research. Such data as well as it analysis comes from the development of an annual survey to Spanish scientists during the period 2008- 2011. Based on sample data and analysis an expectations index for the coming year has been constructed. This compares the level of confidence which related the support and prestige of their national R&D&I systems in which they operate. Two groups where surveyed: young researchers which currently work in Spain and as a group are more likely to go working abroad and Spanish scientists who are currently working abroad. Samples were obtained for young researchers were the following: 2008 (217), 2009 (270), 2010 (390) and 2011 (610). In the case of Spanish scientists abroad, the following data were obtained: 2008 (218), 2009 (250), 2010 (241) and 2011 (167). Both groups assume simple random sampling, with a level of confidence of 95%. The results obtained confirm the importance of this combined effor t of labor and economic policies which presents weaknesses of Spanish national R&D&I systems and its application, so that Spain becomes a pole of excellence in terms of attraction and retention of scientific knowledge.

Propuesta de algoritmos de predicción de glucosa en pacientes diabéticos

La diabetes mellitus es el conjunto de alteraciones provocadas por un defecto en la cantidad de insulina secretada o por un aprovechamiento deficiente de la misma. Es causa directa de complicaciones a corto, medio y largo plazo que disminuyen la calidad y las expectativas de vida de las personas con diabetes. La diabetes mellitus es en la actualidad uno de los problemas más importantes de salud. Ha triplicado su prevalencia en los últimos 20 anos y para el año 2025 se espera que existan casi 300 millones de personas con diabetes. Este aumento de la prevalencia junto con la morbi-mortalidad asociada a sus complicaciones micro y macro-vasculares convierten la diabetes en una carga para los sistemas sanitarios, sus recursos económicos y sus profesionales, haciendo de la enfermedad un problema individual y de salud pública de enormes proporciones. De momento no existe cura a esta enfermedad, de modo que el objetivo terapéutico del tratamiento de la diabetes se centra en la normalización de la glucemia intentando minimizar los eventos de hiper e hipoglucemia y evitando la aparición o al menos retrasando la evolución de las complicaciones vasculares, que constituyen la principal causa de morbi-mortalidad de las personas con diabetes. Un adecuado control diabetológico implica un tratamiento individualizado que considere multitud de factores para cada paciente (edad, actividad física, hábitos alimentarios, presencia de complicaciones asociadas o no a la diabetes, factores culturales, etc.). Sin embargo, a corto plazo, las dos variables más influyentes que el paciente ha de manejar para intervenir sobre su nivel glucémico son la insulina administrada y la dieta. Ambas presentan un retardo entre el momento de su aplicación y el comienzo de su acción, asociado a la absorción de los mismos. Por este motivo la capacidad de predecir la evolución del perfil glucémico en un futuro cercano, ayudara al paciente a tomar las decisiones adecuadas para mantener un buen control de su enfermedad y evitar situaciones de riesgo. Este es el objetivo de la predicción en diabetes: adelantar la evolución del perfil glucémico en un futuro cercano para ayudar al paciente a adaptar su estilo de vida y sus acciones correctoras, con el propósito de que sus niveles de glucemia se aproximen a los de una persona sana, evitando así los síntomas y complicaciones de un mal control. La aparición reciente de los sistemas de monitorización continua de glucosa ha proporcionado nuevas alternativas. La disponibilidad de un registro exhaustivo de las variaciones del perfil glucémico, con un periodo de muestreo de entre uno y cinco minutos, ha favorecido el planteamiento de nuevos modelos que tratan de predecir la glucemia utilizando tan solo las medidas anteriores de glucemia o al menos reduciendo significativamente la información de entrada a los algoritmos. El hecho de requerir menor intervención por parte del paciente, abre nuevas posibilidades de aplicación de los predictores de glucemia, haciéndose viable su uso en tiempo real, como sistemas de ayuda a la decisión, como detectores de situaciones de riesgo o integrados en algoritmos automáticos de control. En esta tesis doctoral se proponen diferentes algoritmos de predicción de glucemia para pacientes con diabetes, basados en la información registrada por un sistema de monitorización continua de glucosa así como incorporando la información de la insulina administrada y la ingesta de carbohidratos. Los algoritmos propuestos han sido evaluados en simulación y utilizando datos de pacientes registrados en diferentes estudios clínicos. Para ello se ha desarrollado una amplia metodología, que trata de caracterizar las prestaciones de los modelos de predicción desde todos los puntos de vista: precisión, retardo, ruido y capacidad de detección de situaciones de riesgo. Se han desarrollado las herramientas de simulación necesarias y se han analizado y preparado las bases de datos de pacientes. También se ha probado uno de los algoritmos propuestos para comprobar la validez de la predicción en tiempo real en un escenario clínico. Se han desarrollado las herramientas que han permitido llevar a cabo el protocolo experimental definido, en el que el paciente consulta la predicción bajo demanda y tiene el control sobre las variables metabólicas. Este experimento ha permitido valorar el impacto sobre el control glucémico del uso de la predicción de glucosa. ABSTRACT Diabetes mellitus is the set of alterations caused by a defect in the amount of secreted insulin or a suboptimal use of insulin. It causes complications in the short, medium and long term that affect the quality of life and reduce the life expectancy of people with diabetes. Diabetes mellitus is currently one of the most important health problems. Prevalence has tripled in the past 20 years and estimations point out that it will affect almost 300 million people by 2025. Due to this increased prevalence, as well as to morbidity and mortality associated with micro- and macrovascular complications, diabetes has become a burden on health systems, their financial resources and their professionals, thus making the disease a major individual and a public health problem. There is currently no cure for this disease, so that the therapeutic goal of diabetes treatment focuses on normalizing blood glucose events. The aim is to minimize hyper- and hypoglycemia and to avoid, or at least to delay, the appearance and development of vascular complications, which are the main cause of morbidity and mortality among people with diabetes. A suitable, individualized and controlled treatment for diabetes involves many factors that need to be considered for each patient: age, physical activity, eating habits, presence of complications related or unrelated to diabetes, cultural factors, etc. However, in the short term, the two most influential variables that the patient has available in order to manage his/her glycemic levels are administered insulin doses and diet. Both suffer from a delay between their time of application and the onset of the action associated with their absorption. Therefore, the ability to predict the evolution of the glycemic profile in the near future could help the patient to make appropriate decisions on how to maintain good control of his/her disease and to avoid risky situations. Hence, the main goal of glucose prediction in diabetes consists of advancing the evolution of glycemic profiles in the near future. This would assist the patient in adapting his/her lifestyle and in taking corrective actions in a way that blood glucose levels approach those of a healthy person, consequently avoiding the symptoms and complications of a poor glucose control. The recent emergence of continuous glucose monitoring systems has provided new alternatives in this field. The availability of continuous records of changes in glycemic profiles (with a sampling period of one or five minutes) has enabled the design of new models which seek to predict blood glucose by using automatically read glucose measurements only (or at least, reducing significantly the data input manually to the algorithms). By requiring less intervention by the patient, new possibilities are open for the application of glucose predictors, making its use feasible in real-time applications, such as: decision support systems, hypo- and hyperglycemia detectors, integration into automated control algorithms, etc. In this thesis, different glucose prediction algorithms are proposed for patients with diabetes. These are based on information recorded by a continuous glucose monitoring system and incorporate information of the administered insulin and carbohydrate intakes. The proposed algorithms have been evaluated in-silico and using patients’ data recorded in different clinical trials. A complete methodology has been developed to characterize the performance of predictive models from all points of view: accuracy, delay, noise and ability to detect hypo- and hyperglycemia. In addition, simulation tools and patient databases have been deployed. One of the proposed algorithms has additionally been evaluated in terms of real-time prediction performance in a clinical scenario in which the patient checked his/her glucose predictions on demand and he/she had control on his/her metabolic variables. This has allowed assessing the impact of using glucose prediction on glycemic control. The tools to carry out the defined experimental protocols were also developed in this thesis.