39 Escritores y medio (Las Tres Edades) (Spanish Edition)

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Esta tendencia se detecta igualmente entre los periodistas. A pesar de que estos hacen un uso amplio de las redes sociales, les conceden una menor credibilidad que a los medios tradicionales Herrero Curiel, Los alumnos no valoran las posibilidades de desarrollo profesional que les ofrecen las redes sociales. A ello se une un incremento del acceso a las cabeceras informativas digitales desde smartphones. Las variables principales de las preguntas han sido las siguientes: En este sentido, se han incorporado preguntas abiertas y cerradas. Los resultados definen tres escenarios dispares donde las preferencias del alumnado son muy diversas.

Pero entre los tres escenarios, se detectan algunos matices: Por otro lado, hay un claro descenso de la credibilidad conferida a otras fuentes dentro de una red social. Este aspecto puede relacionarse con los comentarios que los estudiantes realizan, en las preguntas abiertas, al identificar una fortaleza y una debilidad de las redes sociales.

The link that bind: Uncovering novel motivations for linking on Facebook. Computers in Human Behavior , v. Profile and motivations of Turkish social network sites users. Convergencia Revista de Ciencias Sociales , n.

Our workstations are still based on Windows and the RAIM Alma program does not allow a direct estimation of any kind of perimeter.. For that purpose we introduced the idea of approximating the abdominal circumference by using a formula proposed for the estimation of the perimeter of an ellipse.

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As expected, we found a good correlation between the measurements, and the BlandAltman analysis returned a mean error of just 1. As in the case of the supine abdominal perimeter, the differences appeared with very high values, more than The central and low values of the waist circumference overlapped almost perfectly Figure 2. The sub-analysis of values between 73 and cm showed a mean error of 0.

Our study showed that for abdominal perimeters of less than cm the supine and standing position measurements are equivalent. The estimation of the abdominal perimeter using either a circumferential line or the formula for the perimeter of an ellipse is also equivalent to the real abdominal perimeter measured in standing position.. All authors declare that there is no duality of interest associated with the manuscript.. Please cite this article as: Artigo anterior Artigo seguinte.

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Measurement of waist circumference for retrospective studies — Prospective validation of use of CT images to assess abdominal circumference. Alexandru Ciudin a , b ,?? Mostrar mais Mostrar menos. Introduction To validate the use of supine position and CT images for assessing abdominal circumference AC. Method A prospective study in consecutive patients undergoing scheduled abdominal CT at our center between 17 and 25 September While lying on the CT table. On CT images with a skin contour line, using OsiriX software. Student's t tests and Q-Q and BlandAltman plots were used for statistical analysis.

Results A total of patients were recruited. Resultados Se incluyeron pacientes. Moreover, as the waist circumference changes with time, it cannot be evaluated retrospectively. Method We performed a prospective study with three independent observers in consecutive out-patients who underwent a programmed abdominal CT in our center between the 17th and the 25th of September In supine position on the CT table. On CT images with a free-hand elliptical line following skin contour.

On CT images using an ellipse perimeter formula, imputing anterior-posterior and transverse abdominal diameters. After the patients took 2 or 3 normal breaths the abdominal circumference was measured at the end of a normal expiration. The waist circumference was measured in the vertical plane cranial from the iliac crest, similar to the standing measurement. The study adheres to local regulations and standards and was approved by the Institutional Review Board.

Detailed CT acquisition parameters for a standard non-enhanced abdominal scan. Evaluation of the waist circumference on a CT image, using both a line to approximate the skin contour and calculating the anteriorposterior and transverse abdominal diameters. Results of the comparison of standing abdominal perimeter versus supine, circumferential and ellipse perimeter abdominal perimeter. Q-Q plot of standing versus ellipse formula abdominal perimeters.

BlandAltman plot of the differences between the standing and the ellipse formula abdominal perimeters. Diabet Med, 23 , pp. Body mass index, waist circumference, and health risk: Arch Intern Med, , pp. Body fat distribution and noncommunicable diseases in populations: Eur J Clin Nutr, 64 , pp. Measuring waist circumference in disabled adults. Res Dev Disabil, 31 , pp. The effect of posture on body circumferences in older adults. J Hum Nutr Diet. Waist circumference, waisthip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults.

Since then, the international literature has featured multiple studies generating a wealth of statistics on mortality in PD; in general, these articles point to higher mortality.. Obtaining mortality data for study purposes is possible in Spain by accessing the National Statistics Institute data 61 on deaths broken down by cause of death and coded according to the ICD classification system. In any case, finding this information is only possible if the death certificate states the diagnosis of PD, and this is not the case for a variable percentage of certificates which may be quite high according to different international studies.

Especially noteworthy are the publications on PD mortality in Spain; an example would be the study by Burguera et al. Data on annual deaths and their distribution by sex, age group, and Spanish province were provided by the National Statistics Institute. The overall mortality rate was 2. These observations call for further studies to clarify whether place of residence may have an effect on the development of PD.. The mortality gradient we describe was analysed in great detail by De Pedro-Cuesta et al. The study addressed the geographical distribution of PD mortality in Spain by city between and in order to detect any non-coincidental distribution tendencies and examine their causes.

These data were also obtained from the National Statistics Institute. This distribution can be superimposed on that reported by the earlier study 65 ; furthermore, a previous study 67 of levodopa consumption in Spain between and reported high sales in the north and low consumption in the south. As such, the pattern seems to correspond to selective areas in which PD is underdiagnosed, rather than to aetiological factors having to do with the presence of the disease itself.

The situation calls for measures to improve diagnosis the authors mention a lack of neurologists in smaller Andalusian hospitals. The authors suggest conducting specific aetiological studies in these populations.. Mortality in Parkinson's disease. De Pedro-Cuesta et al. Of this total, 81 patients had PD at baseline, and there were 66 deaths during follow-up. Risk of mortality for patients with PD 2.

Risk of mortality was higher among patients with dementia. For that reason, this study concluded that PD is an independent predictor of mortality in elderly patients, and that risk is especially high among those with dementia. It should be said that PD is mentioned on death certificates in only Another longitudinal study 70 with 20 years of follow-up included patients in the province of Segovia. It found a standardised mortality rate of 1.

In recent years, disability and dependency have become 2 extremely relevant concepts in politics and social health. Spain's National Statistics Institute has completed 3 major surveys on disability and dependency , , 71—73 which present their importance in quantitative terms.

Similarly, a featured article in Gaceta Sanitaria 74 analyses the evolution of our understanding of these concepts. The initial concept of disability was the array of deficiencies and illnesses suffered by an individual and which were addressed with medical treatment, rehabilitation and care; at present, we stress the primordial importance of the resulting disability, understood as a need for personal care..

Data from the last 2 surveys can be accessed from the National Statistics Institute's webpage 72,73 and they include data related to PD. For example, in the group of patients of both sexes aged 65 to 79, we find 38 patients with disability and a diagnosis of PD at this time; in the group of patients of both sexes aged 65 to 69 years, the proportion of patients with disability and diagnosed with PD was 6.

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These authors have shown keen interest in the relationship of these social concepts with health-related quality of life in both patients and carers. One study on the burden of PD-related disease in Spain in the year presents comparisons with data from similar countries in Europe and around the world. Although the authors interpret this data cautiously, they stress the need for a better understanding of the burden of PD in Spain. They feel that disability in this context may arise due to multiple factors; although PD is a motor disorder, depression, dementia, and psychosis are manifestations of advanced stages of the disease that increase burden..

Additional publications 76—79 have also addressed carer burden in PD and its impact on quality of life. A study 76 analysed the impact of PD on those caring for patients and aimed to identify the main factors associated with carer stress. Another cross-sectional multicentre study 77 evaluated 80 patients and their carers and delivered the following findings: In summary, the psychological well-being of carers, clinical aspects of the disease, the patient's mental state, and the quality of life related to patient and carer health are predictors of the burden of the disease..

The ELEP group 78 has also presented an article on these topics in which it studied patients and their carers to reach the following conclusions: Lastly, the carer's emotional state is the factor with the greatest influence on the carer's burden and self-perceived state of health; as such, ameliorating this aspect may lessen the burden and prevent a decrease in health-related quality of life.

This will have positive repercussions on both care for the patient and use of healthcare resources.. They also highlight the importance of applying effective interventions to promote carer well-being, which will result in the patient being able to remain at home and still receive appropriate care.. Different studies have illustrated the social health repercussions of PD, both in terms of the medical expenses it generates and in terms of decreased productivity and lower quality of life related to the disease.

The costs generated by PD were estimated by including both direct and indirect costs. Direct costs were those generated directly by primary care, other levels of medical care, and treatments. Indirect costs were those generated by the decrease in productivity due to the patient's early retirement or decreased participation in the workforce on the part of the carer.

We also find intangible costs that gauge the patient's degree of suffering due to the decrease in quality of life..

In addition to evaluating the motor symptoms that characterise PD, it is important to assess non-motor symptoms, especially psychiatric symptoms, which contribute greatly to the decision to institutionalise patients. Multiple studies evaluate the direct and indirect costs of PD associated with both motor and non-motor symptoms. Furthermore, monetary expenses rise as the disease progresses, such that a higher score on the UPDRS signifies higher direct costs generated by the disease. In the Spanish population, the economic impact of PD was measured in a cross-sectional multicentre study in a cohort of 82 patients in Using this approach, it analysed the association between clinical variants and their direct and indirect costs.

The indirect costs, whether medical or non-medical, included specialist and primary care visits, diagnostic tests, prescribed orthotics, transport, homecare services, home adaptations, etc. Indirect costs generated by the disease were linked to a decrease in workplace productivity as well as to early retirement.

As has been shown on multiple occasions, drug costs place the highest burden on the healthcare system. The lower costs linked to surgical treatment was the result of the reduced drug consumption in patients treated with DBS rather than the other techniques requiring continuous administration of dopaminergic drugs. Data support using advanced PD therapies rather than conventional drug treatment in patients referred to more specialised hospitals.

Generally speaking, evidence shows that costs incurred by patients undergoing DBS may be as much as The appearance of motor complications worsens quality of life in addition to increasing costs. As the second most common neurodegenerative disease, PD incurs major healthcare expenses in our population. The severity of this disease, and the extent of the disability caused by motor and non-motor symptoms, contribute greatly to increases in both direct and indirect costs. Evaluating use of advanced treatments for these cases of PD is therefore of the utmost importance.

Projections for the future, taking into account the tendency of life expectancy to increase, indicate that there will be rising demand for social and healthcare resources having to do with PD. Developing and optimising not only treatments but also health protocols able to reduce the social and economic impact of PD on the population is therefore a crucial undertaking..

Since no data on this type of neurological care are available in Spain, the present report includes a study whose main objective is to define the public and private resources offered to patients with PD in our country.. We received answers from a total of 40 neurologists from 40 different hospitals throughout Spain. Respondents included neurologists from all of Spain's autonomous communities.

Although data do not reflect the entire panorama of PD care in Spain, since we do not have data from every health district, it does map out an approximate idea of how neurological care is provided to PD patients at this time.. Secondly, we consulted data from the Imserso publication 89 on the situation, needs, and priorities of patients with PD.. According to the analysis of data provided by the surveys, all of Spain's autonomous communities have at least one specialised PD unit. Health districts with fewer than inhabitants also have specialist clinics.

The Region of Madrid has specialised units in all of its major hospitals, with specialist consults in smaller hospitals. Catalonia is another example of an autonomous community with specialised units in all major hospitals, most of which are in Barcelona. The types of patients cared for by these units will vary from place to place. Half of the units provide care to all patients diagnosed with PD who are referred to the neurology department.

The patient referred by a general practitioner as a suspected PD case will be seen by a general neurologist. This doctor in turn will assign the case to the specialised unit, and all follow-up work will be performed by that unit. This is the dominant model in Madrid and Barcelona. Other units, such as those in Seville and in most hospitals in the Valencian Community and Castile-Leon, only follow up on complicated patients, young patients, or those undergoing advanced therapy with perfusion or deep stimulation techniques..

PD units include one to 5 neurologists, who are not solely dedicated to that unit in most cases.

They will also be active in other areas of neurology. Patients in the early stages of PD are examined in the specialised unit once or twice yearly, whereas patients in later stages are seen every 3 months on average. However, respondents from most hospitals stated that the patients had a direct line of contact in case they needed to move up their appointment.. We note that only 10 of the 40 units on which we have data are supported by a specialised nursing consult. This consult is usually offered once a week. Another 10 hospitals have general nursing staff assisting neurologists specialised in PD in their consults.

Telephone consults are not a common practice.. What we have discovered is that although PD units should be multidisciplinary, the vast majority of them consist solely of neurologists.

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Neurologists work with neurosurgeons and neurophysiologists in those units performing DBS.. There are no specific rehabilitation programmes in any of these units, or in any rehabilitation departments in public hospitals. This coincides with the Spanish National Health System's list of common services approved by Royal Decree in ; according to this document, rehabilitation, including physical, occupational, and speech therapy, is currently considered only for those patients with a reversible functional loss.

This being the case, most patients with PD do not have continued access to these therapies in hospitals forming part of the Spanish National Health System. Rather, this role is filled by patient associations, which will be described in a later section.. According to the data obtained, advanced therapies are covered sufficiently in most of Spain's autonomous communities.

All 40 hospitals from which we received a response indicated that they can perform apomorphine and duodopa pump therapy. While DBS is performed in 15 of the 40 hospitals, it is available for patients in all autonomous communities. Nevertheless, waiting periods are long at 6 months to a year at most hospitals.. Our data are limited, but they do show that once patients have been referred to extremely specialised units, which is an option in most provinces, their neurological care is well covered.

Units with neurologists able to dedicate at least part of their time to specialised care are available in all provinces in Spain. Intervals between follow-up visits are reasonable, and patients experiencing emergencies can contact their doctors directly. However, there are drawbacks including a marked lack of the other treatments that are fundamental to the complex task of managing PD: The waiting lists for surgical treatment are also very long.. According to data from Imserso, 90 the main problem seems to stem from the preceding level, primary care. Long periods of time may pass before some patients are suspected of having Parkinson's disease and referred to a neurologist.

One possible explanation is that this disease has numerous manifestations and may therefore be difficult for a general practitioner to recognise. Furthermore, PD has a low prevalence in the primary care setting compared to other diseases, so general practitioners may be less familiar with its signs.. As mentioned before, the Spanish public health system does not contemplate part of the integral treatment that patients with PD need, and which includes physical, speech, and occupational therapy, and psychological support. This gap is currently filled by patient associations. Part of the problem arises from their neurologists not providing this information.

Patients are more commonly informed of these options in specialised units, where neurologists have a deeper understanding of integral treatment of the disease and tend to work with associations in their area.. However, these treatments are essential at all stages of the disease. As we have seen, patients in the early stages of Parkinson's disease are not seen in specialised units. Rather, they are assessed by general neurologists who do not provide information about patient associations and other treatment options available because they are not aware of them.

Doctors at the primary care level are also unlikely to know of any patient associations.. Associations also provide material to patients and their family members that healthcare professionals may not explain fully. Among other activities, associations organise training courses, sessions, and workshops on the disease which are aimed at both patients and their carers. This being the case, good care will require raising awareness of the role played by associations and better coordination between them and healthcare professionals at all levels..

In addition to its effects on patients, PD has an impact on those living with them. Patients with PD present an array of motor symptoms that will give rise to various difficulties and disabilities over the course of the disease. As the disease progresses, the patient will experience decreased autonomy, obliging the family to gradually take responsibility for his or her daily activities. This will involve a loss of free time, working time, or leisure activities on the part of the patient's main carer. However, patients will present other types of symptoms that are equally important and which limit quality of life and social relationships: All of these manifestations mean that family relationships will be affected at all stages of the disease..

The extent to which all of these considerations will affect the family is fundamentally determined by the patient's age. Older patients tend to be more accepting of their condition, whereas the workplace and economic problems that PD poses for younger patients make their experience more traumatic. Behaviour disorders in younger patients, especially compulsive behaviours, are common and they can result in serious difficulties in the home, including divorce and family rupture..

The consequences of these disruptions are extremely negative for families in some cases. Carers may experience depression, apathy, exhaustion, and social isolation. They will require substantial psychological support, in addition to social assistance and information. These aspects of the disease are normally covered by associations..

This report allows us to conclude that PD incidence and prevalence in Spain are similar to rates in the rest of Europe. Given the current population estimates, we calculate that there are at least patients with PD in Spain. The disease has a major impact on the patient's quality of life and mortality rates are nearly twice that in non-patients.

Healthcare professionals and government bodies are making a concerted effort to provide patients with quality care. Nevertheless, much remains to be done to ensure high-quality, effective multidisciplinary care for all patients with PD in Spain.. The authors have no conflicts of interest to declare..

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