Las competencias profesionales del nutricionista deportivo

[SPA] OBJETIVO: El artículo presenta los resultados obtenidos en la investigación que dio origen a la tesis doctoral defendida por la autora en la Universitat de Lleida (España), cuyo objetivo fue identificar las Competencias Profesionales de los nutricionistas que trabajan en el ámbito de la Nutrición Deportiva. MÉTODOS: Fueron investigados 14 expertos provenientes de Australia (n=1), Brasil (n=7), España (n=3) y Estados Unidos (n=3). La herramienta metodológica utilizada fue la técnica Delphi, compuesta de tres rondas de cuestionarios. En la primera ronda los expertos proporcionaron, a través de sus discursos, la identificación de un listado de Competencias Profesionales, información que en la segunda y tercera ronda pudieron ser evaluadas y posteriormente analizadas a través de cálculos estadísticos descriptivos (media, moda, mediana y desviación Standard). RESULTADOS: De esta manera, se llegó al consenso entre los expertos sobre 147 competencias profesionales identificadas. Las competencias fueron clasificadas en cuatro macro categorías de Competencias Profesionales: Competencias Técnicas (38), Metodológicas (62), Participativas (24) y Personales (23). CONCLUSIÓN: Los resultados demostraron que el estudio sistematizado de las Competencias Profesionales del Nutricionista Deportivo contribuye para el establecimiento de los contenidos que deben componer la disciplina de Nutrición Deportiva a ser incorporada en los itinerarios curriculares de las carreras de Nutrición Humana y Dietética.

Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators.

OBJECTIVE: To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. DESIGN: A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. SETTING: International group of countries participating to OECD projects. PARTICIPANTS: Members of the OECD HCQI expert group. RESULTS: A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. CONCLUSIONS: The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies.

Setting priorities in clinical and health services research: Properties of an adapted and updated method

Objectives: The objectives of this study is to review the set of criteria of the Institute of Medicine (IOM) for priority-setting in research with addition of new criteria if necessary, and to develop and evaluate the reliability and validity of the final priority score. Methods: Based on the evaluation of 199 research topics, forty-five experts identified additional criteria for priority-setting, rated their relevance, and ranked and weighted them in a three-round modified Delphi technique. A final priority score was developed and evaluated. Internal consistency, test–retest and inter-rater reliability were assessed. Correlation with experts’ overall qualitative topic ratings were assessed as an approximation to validity. Results: All seven original IOM criteria were considered relevant and two new criteria were added (“potential for translation into practice”, and “need for knowledge”). Final ranks and relative weights differed from those of the original IOM criteria: “research impact on health outcomes” was considered the most important criterion (4.23), as opposed to “burden of disease” (3.92). Cronbach’s alpha (0.75) and test–retest stability (interclass correlation coefficient = 0.66) for the final set of criteria were acceptable. The area under the receiver operating characteristic curve for overall assessment of priority was 0.66. Conclusions: A reliable instrument for prioritizing topics in clinical and health services research has been developed. Further evaluation of its validity and impact on selecting research topics is required

Finding and Implementing Relevant Resources in Adapted Physical Activity (APA): It's easier said than done...

The purpose of this research was to explore challenges to operationalizing and implementing relevant resources for Adapted Physical Activity (APA) and to develop a framework on how resources should be developed and implemented to foster appropriate APA. An unobtrusive methodology was used to examine existing resources and training/learning opportunities for practitioners teaching APA. Data were collected via unobtrusive methods: documents, records, literature and feedback forms. After the findings were summarized, expert consultations were completed using a modified Delphi- technique to confirm the findings. A constructivist approach and phenomenological orientation was used to analyze the data and develop the “ideal” resource. Results indicate there are limited APA resources and teaching/learning opportunities for practitioners and there is a need for practitioner facilitation through professional development on finding and implementing resources. Future research should develop and evaluate the “ideal” resource and strive to improve the connection and consistency of resources in APA.

La formation continue à distance des enseignants du secondaire au Bénin : réalités et perspectives

Cette recherche porte sur la pertinence et la faisabilité d’un programme de formation continue à distance des enseignants qualifiés de l’enseignement secondaire général public du Bénin. Elle a deux objectifs spécifiques : l’identification et l’analyse des besoins de formation continue des enseignants du secondaire du Bénin et l’étude des modalités administratives, pédagogiques et techniques de mise en place d’un tel programme dans le contexte béninois. Les recherches sont effectuées sur la base de la mise en œuvre de la technique du groupe nominal (TGN) qui a permis de générer un premier questionnaire soumis à un échantillon de 278 enseignants représentatifs des 1 488 enseignants qualifiés de l’enseignement secondaire général public du Bénin et trois autres questionnaires, basés sur la technique Delphi, adressés à 13 experts du système éducatif béninois. Il apparaît qu’un futur programme de formation continue à distance des enseignants du secondaire devrait comporter, principalement, les trois thèmes ci-après, classés par ordre de priorité : «Technologies de l’information et de la communication »; «Méthodes pédagogiques» et « Matière de spécialité ». L’utilisation de la technique Delphi a permis d’établir une liste de 23 items correspondant aux modalités administratives, pédagogiques et techniques pour la mise en œuvre de la formation. L’analyse des résultats de la technique Delphi et celle des réponses au questionnaire adressé aux enseignants ont permis d’opérer un choix de médias à utiliser et/ou à intégrer pour transmettre le savoir et soutenir l’apprentissage. Il ressort des résultats de la recherche que les enseignants béninois du secondaire ont d’importants besoins de formation continue et que la conception et la mise en œuvre d’un programme de formation à distance axée sur l’utilisation des TIC sont pertinentes et faisables au Bénin. Un modèle organisationnel de formation continue à distance a été proposé.

Indicadores da individualização de cuidados para o curso de licenciatura em enfermagem

RESUMO: A individualização dos cuidados de enfermagem tem sido associada a uma evolução clínica mais favorável, representando um importante parâmetro de avaliação e de desenvolvimento dos serviços de saúde. A tónica atribuída a esta problemática não só é evidenciada por diversos autores, como se enquadra nas metas de modernização do Sistema Nacional de Saúde e é destaque em vários códigos normativos da profissão nacionais e internacionais, como uma obrigação moral e deontológica. Assim, pretende-se mediante os ganhos em saúde sensíveis às intervenções de enfermagem, identificar quais indicadores do cuidado individualizado, para se efectivar a sua incorporação na formação inicial em enfermagem. Para tal efeito, construiu-se uma bateria de indicadores mediante análise de duas revisões sistemáticas da literatura, que teve por base o Modelo da Eficácia do Papel de Enfermagem, desenvolvido por Irvine et al. (1998). Para à adaptação à realidade portuguesa recorreu-se à técnica de Delphi, com duas rondas, que incluiu respectivamente, 12 e 10 peritos de enfermagem. Na análise de dados utilizou-se o nível de concordância superior ou igual a 90%, na última ronda. Na segunda fase do estudo, aplicou-se um inquérito por questionário (α de Cronbach = 0,919) para testar a sua aplicabilidade dos indicadores, a 156 enfermeiros, do mesmo hospital da área da grande Lisboa, no Serviço de Medicina e Cirurgia. Recorreu-se ao SPSS, versão 19 e realizou-se análise univariada e estatística analítica. Na bateria final de indicadores foram incorporados aqueles com ponderação positiva (≥51%). Os dados qualitativos obtidos foram submetidos a análise de conteúdo. Dos 58 indicadores iniciais, consolidaram-se 8 categorias: cuidado à pessoa em fim de vida e família, toque terapêutico, educação para a auto-gestão da saúde, cuidados de proximidade, gestão de casos, empoderamento/ literacia para a saúde, linha telefónica de apoio permanente/ tele-assistência e apoio psico-emocional, com valorização de 28 indicadores. O tempo de experiência profissional, tipo de serviço e tempo de permanência no mesmo serviço influenciou a percepção dos enfermeiros, confirmando os pressupostos de Irvine et al. (1998) e Benner (2001). A correlação total dos indicadores, no questionário, variou entre 0,248 e 0,650, para p<0,01. O facto de todas as correlações serem positivas significa que provavelmente estão associados à problemática da individualização, pelo que se sugere a sua transposição para o ensino de enfermagem. ABSTRACT: The individualization of nursing care has been associated with a more favorable clinical evolution, an important parameter for the evaluation and development of health services. The emphasis given to this problem is not only evidenced by several authors, as fits the goals of modernizing the National Health System and is featured in several normative codes of the profession nationally and internationally, as a moral and ethical obligation. Thus, it is intended by the gains in health sensitive to nursing interventions, identify indicators of individualized care and give effect to its incorporation into the initial training in nursing. For this purpose, we constructed a series of indicators by analyzing two systematic reviews of literature, which was based on the The Nursing Role Effectiveness Model developed by Irvine et al. (1998). For the adaptation to the Portuguese appealed to the Delphi technique with two rounds, which included, respectively, 10 and 12 nursing experts. In data analysis we used the level of agreement greater than or equal to 90% in the last round. In the second phase of the study, we applied a questionnaire (Cronbach's α = 0.919) to test the applicability of the indicators, the 156 nurses in the same hospital in the Greater Lisbon area, the Department of Medicine and Surgery. Done using the SPSS, version 19 and conducted a univariate analysis and analytical statistics. In the final heat of indicators were incorporated into those with positive weight (≥ 51%). Qualitative data were subjected to content analysis. Of the initial 58 indicators, eight were consolidated categories: care to the person and family life, therapeutic touch education for self-management of health care outreach, case management, empowerment / literacy to health, a telephone line permanent support / tele-assistance and psycho-emotional, with an appreciation of 28 indicators. The length of professional experience, type of service and length of stay in the same service influenced the perception of nurses, confirming the assumptions of Irvine et al. (1998) and Benner (2001). The total correlation of the indicators in the questionnaire ranged between 0.248 and 0.650, p <0.01. The fact that all correlations are positive means that are probably associated with the problem of individuation, which is suggested by its implementation in nursing education.

Seleção de categorias da Classificação Internacional de Funcionalidade, Incapacidade e Saúde para avaliação do paciente com acidente vascular cerebral em reabilitação

Stroke represents the first cause of disabilities among adults. Although different professions work together in treatment of stroke patients, all they use different terminologies for the description of the patients problems and it can constitute an impediment in the communication between the staff members. Thus, the multidisciplinary and interdisciplinary work would be facilitated if using a reference common tool, as the new International Classification of Functioning, Disability and Health (ICF). However, the ICF is very extensive and complex and due to its complexity, it has been evidenced the necessity to select its categories to become it more practical. The aim of the study was to investigate which categories of the ICF are more suitable to evaluate and to describe the stroke patient in the view of teachers and municipal public health professionals. It was a descriptive research, which involved 5 professors and 11 professionals of Physiotherapy that have worked at the health public area in Natal / RN. It was used the Delphi Technique in 3 rounds and the Likert Scale to select the categories among the ICF components. As result, from the 362 IFC categories, 94 were selected. The selected categories correspond to rehabilitative characteristics of Stroke patients in the universe of the Physiotherapy performance. The methodology applied was suitable to the studied object emphasizing the necessity of future studies for validation of the chosen categories

Validação de protocolo de assistência para pessoas com úlcera venosa na atenção primária

People with venous ulcers constitute as an important public health problem, its treatment is onerous and require assistance provided by trained professionals, systematized through protocols, however what lies in the assistance is that the management of this group of people differs from that preconized in the scientific literature, interfering with wound healing and quality of life of affected. In this sense, the construction of a assistance protocol specific to people with venous ulcers (VU) can help professionals of the Family Health Strategy both in patient assessment as and in establishment of quality assistance. Thus, this study aimed to analyse the validity of a multiprofessional assistance protocol for people with venous ulcers in primary care by health professionals using Delphi technique. This is a quantitative study, the methodological type conducted in two steps: first step related to integrative literature review to subsidize the development of the protocol, then these aspects were organized and proposed to the judges of the study through the Delphi technique. The study was initiated after approval by the Research Ethics Committee. The first step was performed between August and September 2012, in the virtual library of health, in the page of the Coordination of Improvement of Higher Education Personnel, of Municipal Health Secretariat and international guidelines of associations and in the subsequent step carried out between September 2012 to January 2013, was performed search by Lattes platform of the National Council of Technological and Scientific Development, in order to identify health professionals in Brazil who act as judges of the instrument and then, via online, the form was submitted to them.The sample for the second step was 51 judges in the first round and 35 for the second round Delphi. The analysis was done by adopting Kappa index ≥ 0.81 and Content Validity Index (CVI)> 0.80. In the first submission for the judges, items that did not reach Kappa and CVI established were: request / realization / test results, demographic data, medical history, risk factors, verification of pain / vital signs / pulse / infection signs / lesion location/ edema and pain treatment. After removal of items which have not obtained Kappa or CVI index established, it was found achieving optimal levels of these index for the categories. In the next step was the ressubmissão of protocol to judges through the Delphi technique in it was found that, of the 15 categories of the protocol, 12 presented higher scores in Delphi 2 phase and the other three categories remained the same Kappa and IVC of the previous phase. As for the average of evaluation requirements of the protocol was found that the scores assigned by the judges were higher in the second phase in nine of the 10 items, remaining the same in only one of the items indicating validity of the instrument before the consensus of the judges. Thus, we accepted the alternative hypothesis in this study, as they were obtained in the second Delphi phase the validity index greater than or equal to the Delphi 1 phase. The formulation of this assistance protocol valid and reproducible will enable a reorganization and redesign of assistance, with standardization of actions and continuity of care for persons with venous ulcers in primary health care

Preliminary core sets of measures for disease activity and damage assessment in juvenile systemic lupus erythematosus and juvenile dermatomyositis

Objective. To identify preliminary core sets of outcome variables for disease activity and damage assessment in juvenile systemic lupus erythematosus (JSLE) and juvenile dermatomyositis (JDM). Methods. Two questionnaire surveys were mailed to 267 physicians from 46 different countries asking each member to select and rank the response variables used when assessing clinical response in patients with JSLE or JDM. Next, 40 paediatric rheumatologists from 34 countries met and, using the nominal group technique, selected the domains to be included in the disease activity and damage core sets for JSLE and JDM. Results. A total of 41 response variables for JSLE and 37 response variables for JDM were selected and ranked through the questionnaire surveys. In the consensus conference, domains selected for both JSLE and JDM activity or damage core sets included the physician and parent/patient subjective assessments and a global score tool. Domains specific for JSLE activity were the immunological tests and the kidney function parameters. Concerning JDM, functional ability and muscle strength assessments were indicated for both activity and damage core sets, whereas serum muscle enzymes were included only in the activity core set. A specific paediatric domain called 'growth and development' was introduced in the disease damage core set for both diseases and the evaluation of health-related quality of life was advised in order to capture the influence of the disease on the patient lifestyle. Conclusions. We developed preliminary core sets of measures for disease activity and damage assessment in JSLE and JDM. The prospective validation of the core sets is in progress.

Sistema de classificação de pacientes cirúrgicos em hospitais especializado: construção e validação de um instrumento

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Avaliação de serviços de atenção básica: atualização e validação do instrumento QualiAB

Pós-graduação em Saúde Coletiva - FMB

A coleta seletiva como instrumento propulsor da gestão do consórcio de resíduos sólidos na região metropolitana do Cariri-Ceará

Pós-graduação em Geografia - IGCE

International palliative care experts' view on phenomena indicating the last hours and days of life

BACKGROUND Providing the highest quality care for dying patients should be a core clinical proficiency and an integral part of comprehensive management, as fundamental as diagnosis and treatment. The aim of this study was to provide expert consensus on phenomena for identification and prediction of the last hours or days of a patient's life. This study is part of the OPCARE9 project, funded by the European Commission's Seventh Framework Programme. METHOD The phenomena associated with approaching death were generated using Delphi technique. The Delphi process was set up in three cycles to collate a set of useful and relevant phenomena that identify and predict the last hours and days of life. Each cycle included: (1) development of the questionnaire, (2) distribution of the Delphi questionnaire and (3) review and synthesis of findings. RESULTS The first Delphi cycle of 252 participants (health care professionals, volunteers, public) generated 194 different phenomena, perceptions and observations. In the second cycle, these phenomena were checked for their specific ability to diagnose the last hours/days of life. Fifty-eight phenomena achieved more than 80% expert consensus and were grouped into nine categories. In the third cycle, these 58 phenomena were ranked by a group of palliative care experts (78 professionals, including physicians, nurses, psycho-social-spiritual support; response rate 72%, see Table 1) in terms of clinical relevance to the prediction that a person will die within the next few hours/days. Twenty-one phenomena were determined to have "high relevance" by more than 50% of the experts. Based on these findings, the changes in the following categories (each consisting of up to three phenomena) were considered highly relevant to clinicians in identifying and predicting a patient's last hours/days of life: "breathing", "general deterioration", "consciousness/cognition", "skin", "intake of fluid, food, others", "emotional state" and "non-observations/expressed opinions/other". CONCLUSION Experts from different professional backgrounds identified a set of categories describing a structure within which clinical phenomena can be clinically assessed, in order to more accurately predict whether someone will die within the next days or hours. However, these phenomena need further specification for clinical use.

Lernzielkatalog für die studentische Lehre im Fachbereich „Geriatrie“ an Fakultäten für Humanmedizin.

Zusammenfassung Die Betreuung geriatrischer Patientinnen und Patienten setzt, nebst einer entsprechenden Haltung, fundierte Kenntnisse in Diagnostik und Behandlung praktisch aller medizinischen Fachgebiete voraus. Daher ist es wichtig, dass die Kompetenz von Studierenden der Humanmedizin im Bereich Geriatrie entsprechend gefördert wird. Bis heute hat jedoch die studentische Ausbildung im Fach Geriatrie an vielen europäischen Universitäten einen unklaren oder untergeordneten Stellenwert. Als ersten Schritt zur Förderung der Lehre in der Geriatrie hat die Europäische Facharztvereinigung Geriatrie (UEMS-GMS) in einem Delphi-Prozess einen Lernzielkatalog entwickelt. Dieser Katalog enthält die Mindestanforderungen mit spezifischen Lernzielen (Wissen, Fertigkeiten und Haltungen), welche die Studierenden der Humanmedizin bezüglich Geriatrie bis zum Abschluss des Medizinstudiums erwerben sollen. Zur Förderung der Implementierung dieses neuen, kompetenzbasierten Lernzielkatalogs an den deutschsprachigen Universitäten wurde eine an den Sprachgebrauch des „DACH-Raums“ (Deutschland, Österreich und Schweiz) angepasste deutsche Version erstellt. Im vorliegenden Beitrag wird diese Übersetzung vorgestellt. Die Fachgesellschaften für Geriatrie aus Deutschland, Österreich und der Schweiz empfehlen den medizinischen Fakultäten der jeweiligen Länder, diesen Katalog umzusetzen.

Diseño y aplicación de una metodología prospectiva para la determinación de los condicionantes futuros del crecimiento de los grandes buques portacontenedores

Durante las últimas décadas se observa una tendencia sostenida al crecimiento en las dimensiones de los grandes buques portacontenedores, que produce, que las infraestructuras portuarias y otras destinadas al tráfico de contenedores deban adaptarse para poder brindar los servicios correspondientes y mantenerse competitivas con otras para no perder el mercado. Esta situación implica importantes inversiones y modificaciones en los sistemas de transporte de contenedores por el gran volumen de carga que se debe mover en un corto periodo de tiempo, lo que genera la necesidad de tomar previsiones relacionadas con la probable evolución a futuro de las dimensiones que alcanzarán los grandes buques portacontenedores. En relación a los aspectos citados surge la inquietud de determinar los condicionantes futuros del crecimiento de los grandes buques portacontenedores, con una visión totalizadora de todos los factores que incidirán en los próximos años, ya sea como un freno o un impulso a la tendencia que se verifica en el pasado y en el presente. En consideración a que el tema a tratar y resolver se encuentra en el futuro, con un horizonte de predicción de veinte años, se diseña y se aplica una metodología prospectiva, que permite alcanzar conclusiones con mayor grado de objetividad sobre probables escenarios futuros. La metodología prospectiva diseñada, conjuga distintas herramientas metodológicas, cualitativas, semi-cuantitativas y cuantitativas que se validan entre sí. Sobre la base del pasado y el presente, las herramientas cuantitativas permiten encontrar relaciones entre variables y hacer proyecciones, sin embargo, estas metodologías pierden validez más allá de los tres a cuatro años, por los vertiginosos y dinámicos cambios que se producen actualmente, en las áreas política, social y económica. Las metodologías semi-cuantitativas y cualitativas, empleadas en forma conjunta e integradas, permiten el análisis de circunstancias del pasado y del presente, obteniendo resultados cuantitativos que se pueden proyectar hacia un futuro cercano, los que integrados en estudios cualitativos proporcionan resultados a largo plazo, facilitando considerar variables cualitativas como la creciente preocupación por la preservación del medio ambiente y la piratería. La presente tesis, tiene como objetivo principal “identificar los condicionantes futuros del crecimiento de los grandes buques portacontenedores y determinar sus escenarios”. Para lo cual, la misma se estructura en fases consecutivas y que se retroalimentan continuamente. Las tres primeras fases son un enfoque sobre el pasado y el presente, que establece el problema a resolver. Se estudian los antecedentes y el estado del conocimiento en relación a los factores y circunstancias que motivaron y facilitaron la tendencia al crecimiento de los grandes buques. También se estudia el estado del conocimiento de las metodologías para predecir el futuro y se diseña de una metodología prospectiva. La cuarta fase, denominada Resultados, se desarrolla en distintas etapas, fundamentadas en las fases anteriores, con el fin de resolver el problema dando respuestas a las preguntas que se formularon para alcanzar el objetivo fijado. En el proceso de esta fase, con el objeto de predecir probables futuros, se aplica la metodología prospectiva diseñada, que contempla el análisis del pasado y el presente, que determina los factores cuya influencia provocó el crecimiento en dimensiones de los grandes buques hasta la actualidad, y que constituye la base para emplear los métodos prospectivos que permiten determinar qué factores condicionarán en el futuro la evolución de los grandes buques. El probable escenario futuro formado por los factores determinados por el criterio experto, es validado mediante un modelo cuantitativo dinámico, que además de obtener el probable escenario futuro basado en las tendencias de comportamiento hasta el presente de los factores determinantes considerados, permite estudiar distintos probables escenarios futuros en función de considerar un cambio en la tendencia futura de los factores determinantes. El análisis del pasado indica que la tendencia al crecimiento de los grandes buques portacontenedores hasta el presente, se ha motivado por un crecimiento económico mundial que se tradujo en un aumento del comercio internacional, particularmente entre los países de Asia, con Europa y Estados Unidos. Esta tendencia se ha visto favorecida por el factor globalización y la acelerada evolución tecnológica que ha permitido superar los obstáculos que se presentaron. Es de destacar que aún en periodos de crisis económicas, con pronósticos de contracciones en el comercio, en los últimos años continuó la tendencia al crecimiento en dimensiones, en busca de una economía de escala para el transporte marítimo de contenedores, en las rutas transoceánicas. La investigación de la evolución de los grandes buques portacontenedores en el futuro, se efectúa mediante el empleo de una metodología prospectiva en la que el criterio experto se valida con un método cuantitativo dinámico, y además se fundamenta en una solida base pre-prospectiva. La metodología diseñada permite evaluar con un alto grado de objetividad cuales serán los condicionantes que incidirán en el crecimiento en tamaño de los grandes buques portacontenedores en el escenario con mayor probabilidad de acontecer en los próximos veinte años (2032), y también en otros escenarios que podrían presentarse en el caso de que los factores modifiquen su tendencia o bien se produzcan hechos aleatorios. El resultado se sintetiza en que la tendencia al crecimiento de los grandes buques portacontenedores en los próximos 20 años se verá condicionada por factores en relación a los conceptos de oferta (los que facilitan u obstaculizan la tendencia), demanda (los que motivan o impulsan la tendencia) y factores externos (los que desestabilizan el equilibrio entre oferta y demanda). La tendencia al crecimiento de los grandes buques portacontenedores se verá obstaculizada / limitada principalmente por factores relacionados a las infraestructuras, resultando los pasos y/o canales vinculados a las rutas marítimas, los limitantes futuros al crecimiento en dimensiones de los grandes buques portacontenedores; y la interacción buque / infraestructura (grúas) un factor que tenderá a obstaculizar esta tendencia de los grandes portacontenedores. El desarrollo económico mundial que estimula el comercio internacional y los factores precio del petróleo y condicionantes medioambientales impulsarán la tendencia al crecimiento de los grandes buques portacontenedores. Recent years have seen a sustained tendency towards the growth in the dimensions of large container ships. This has meant that port and other infrastructure used for container traffic has had to be adapted in order to provide the required services and to maintain a competitive position, so as not to lose market share. This situation implies the need for major investments in modifications to the container transport system, on account of the large volume of traffic to be handled in a short period of time. This in turn has generated a need to make provision for the probable future evolution of the ultimate dimensions that will be reached by large container ships. Such considerations give rise to the question of what are the future determinants for the growth of large container ships, requiring an overall vision of all the factors that will apply in future years, whether as a brake on or an incentive to the growth tendency which has been seen in the past and present In view of the fact that the theme to be dealt with and resolved relates to the future, with a forecasting horizon of some 20 years, a foresight methodology has been designed and applied so as to enable conclusions about probable future scenarios to be reached with a greater degree of objectivity. The designed methodology contains different methodological tools, both qualitative, semi-quantitative and quantitative, which are internally consistent. On the basis of past and present observations, the quantitative elements enable relationships to be established and forecasts to be made. Nevertheless such an approach loses validity more than three or four years into the future, on account of the very rapid and dynamic changes which may be seen at present in political, social and economic spheres. The semi-quantitative and qualitative methodologies are used coherently together and allow the analysis of past and present conditions, thus obtaining quantitative results which for short-term projections, which when integrated with the qualitative studies provide results for the long-term, facilitating the consideration of qualitative variables such as the increasing importance of environmental protection and the impact of piracy. The principal objective of the present thesis is "to identify the future conditions affecting the growth of large container ships and to determine possible scenarios". The thesis is structured in consecutive and related phases. The first three phases focus on the past and present in order to determine the problem to be resolved. The background is studied in order to establish the state of knowledge about the factors and circumstances which have motivated and facilitated the growth tendency for large container ships and the methodologies that have been used. In this way a specific foresight methodology is designed. The fourth phase, Results, is developed in distinct stages based on the previous phases, so as to resolve the problem posed and responding to the questions that arise. In this way the determined objective is reached. The fourth phase sees the application of the methodology that has been designed in order to predict posible futures. This includes analysis of the past and present factors which have caused the growth in the dimensions of large container ships up to the present. These provide the basis on which to apply the foresight methods which enable the future factors which will condition the development of such large container ships. The probable future scenarios are made up of the factors identified by expert judgement (using the Delphi technique) and validated by means of a dynamic quantitative model. This model both identifies the probable future scenarios based on past and present factors and enables the different future scenarios to be analysed as a function of future changes in the conditioning factors. Analysis of the past shows that the growth tendency up to the present for large container ships has been motivated by the growth of the world economy and the consequent increased international trade, especially between the countries of Asia with Europe and the United States. This tendency has been favoured by the trend towards globalization and by the rapid technical evolution in ship design, which has allowed the obstacles encountered to be overcome. It should be noted that even in periods of economic crisis, with an expectation for reduced trade, as experienced in recent years, the tendency towards increased ship dimensions has continued in search of economies of scale for the maritime transport of containers on transoceanic routes. The present investigation of the future evolution of large container ships has been done using a foresight methodology in which the expert judgement is validated by a dynamic quantitative methodology, founded on a firm pre-foresight analysis. The methodology that has been designed permits the evaluation, with a high degree of objectivity, of the future factors that will affect the growth of large container ships for the most probable scenario expected in the next 20 years (up to 2032). The evaluation applies also to other scenarios which may arise, in the event that their component factors are modified or indeed in the light of random events. In summary, the conclusión is that the tendency for growth in large container ships in the future 20 years will be determined by: factors related to supply, which slow or halt the tendency; factors related to demand, which encourage the tendency and finally, external factors which interrupt the equilibrium between supply and demand. The tendency for increasing growth in large container ships will be limited or even halted by factors related to infrastructure, including the natural and man-made straits and canals used by maritime transport. In addition the infrastructure required to serve such vessels both in port (including cranes and other equipment) and related transport, will tend to slow the growth tendency. The factors which will continue to encourage the tendency towards the growth of large container ships include world economic development, which stimulates international trade, and an increasing emphasis on environmental aspects.