Дисертації з теми "Salud general"
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Lores, Seijas Alessandra. "Hospital general universitario." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2015. http://hdl.handle.net/10757/578643.
Повний текст джерелаUmaña, Peña Román Andrés. "El Acuerdo General sobre el Comercio de Servicios (AGCS), características y asociación con salud." Doctoral thesis, Universidad de Alicante, 2016. http://hdl.handle.net/10045/55024.
Повний текст джерелаVictorio, Herrera Anacleto. "Calidad de iluminación en ambientes de trabajo de la Dirección General de Salud Ambiental." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2007. https://hdl.handle.net/20.500.12672/2502.
Повний текст джерела--- In base: people are exposed to the factor risk illumination in the work. In the Peru there are not studies it has more than enough illumination in the work, little it is known with relationship to the prevention of risks, he requires to make investigation studies. Objective: to Evaluate the quality of illumination in the work. Methods: The investigation design is observational, descriptive and traverse; it included 79 samples of offices, located in the Poppies Nº 350 District of Lince, County of Lima. I study realized of January until April of 2006. The quantity of illumination was evaluated with a luxometer.
Tesis
Gonzales, Salazar Maria Claudia. "Síndrome de Burnout y Autoeficacia general en personales de salud en el ámbito deportivo." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2021. http://hdl.handle.net/10757/655731.
Повний текст джерелаThe objective of this research is to analyze the relationship between burnout syndrome and general self-efficacy in a sample of health professionals in the sports field. The method used was a cross-sectional study of the descriptive correlational type. The sample consisted of a total of 50 health professionals such as psychologists, nutritionists, and physical therapists (28 men and 22 women). The Maslach Burnout Inventory and the Baessler and Schwarzer General Self-Efficacy Scale were used. For the descriptive analysis, measures of central tendency were used. Spearman's Rho test was used for the analysis of correlations between self-efficacy and the dimensions of burnout syndrome, and the Mann Whitney and Kruskal-Wallis U were used for inferential analysis. The results indicated a statistically significant negative correlation of self-efficacy with the depersonalization dimension (Rho=-.464); while a positive correlation was maintained with the personal fulfillment dimension (Rho=.384). In addition, it was shown that there were statistically significant differences between the number of working hours and the dimensions of emotional exhaustion and personal fulfillment. Finally, it was evidenced that there are no statistically significant differences between the sex variable and the burnout dimensions.
Tesis
Zevallos, Luna Korali Myriam. "Clínica general con centro geriátrico La Molina." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2013. http://hdl.handle.net/10757/273298.
Повний текст джерелаTesis
Agüero, María Angélica, Cecilia Ruth Torres, and Viviana Elizabeth Torrez. "Automedicación en el personal de salud." Bachelor's thesis, Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería, 2011. http://bdigital.uncu.edu.ar/7815.
Повний текст джерелаFil: Agüero, María Angélica. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
Fil: Torres, Cecilia Ruth. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
Fil: Torrez, Viviana Elizabeth. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería..
Jaramillo, Hernández María Cristina, Ramírez María Luisa Pimentel, and Guzmán Marío Enrique Árceo. "“EL SÍNDROME DE BURNOUT EN EL PERSONAL PROFESIONAL DE LA SALUD DEL HOSPITAL GENERAL DE CADEREYTA, QUERÉTARO DURANTE EL AÑO 2012” SECRETARIA DE SALUD EN EL ESTADO DE QUERÉTARO HOSPITAL GENERAL DE CADEREYTA." Tesis de Licenciatura, Medicina-Quimica, 2013. http://ri.uaemex.mx/handle/123456789/14206.
Повний текст джерелаDuran, Avila Francisco Javier. "“COMPLICACIONES ASOCIADAS A COLECISTECTOMIA ABIERTA. HOSPITAL GENERAL MARIA LOMBARDO DE CASO, DE LOS SERVICIOS DE SALUD DE OAXACA”." Tesis de Licenciatura, Medicina-Quimica, 2013. http://hdl.handle.net/20.500.11799/14263.
Повний текст джерелаLuna, Ruiz-Cabello Aurelio. "La alfabetización en salud de la población española : variables relacionadas según los resultados del proyecto europeo de alfabetización en salud." Doctoral thesis, Universidad de Murcia, 2015. http://hdl.handle.net/10803/309753.
Повний текст джерелаHealth literacy is a relatively new concept that is gaining importance within the field of health. The World Health Organization defined it in 1998 in his Glossary of health promotion as "the cognitive and social skills which determine the motivation and ability of individuals to be able to understand and use information in ways that promote and maintain good health ". Although in its beginnings health literacy was studied primarily in the patient environment, limiting the field of healthcare, today is a crucial concept in public health covering the field of disease prevention and health promotion, referring therefore to the general public and not only a population with a particular disease. The European Consortium of Health Literacy has developed a tool (HLS -EU-Q) to measure and analyze health literacy of the european populatio , being tested in eight european countries. 2. OBJETIVES The aim of this work is to describe the results of the European survey of Health Literacy (HLS-EU) of the Spanish population, and check by statistical analysis, which sociodemographic variables are significantly related to the degree of health literacy, identifying those that describe the profile of the population at risk for inadequate or poor literacy. 3. METODOLOGY We tried to show the complexity of the concept of health literacy by the diversity of frameworks and tools available, and has been submitted to the European project of health literacy as an attempt to give a comprehensive view through a theoretical framework that attempts cover and integrate the different perspectives and the design of a measuring tool consensus among several teams of researchers from different European countries. For data analysis we used SPSS version 15.0 for Windows. Descriptive analysis was performed: quantitative variables were described by mean and standard deviation, and the qualitative variables were described by distribution of absolute and relative frequencies. To verify which variables have a significant relationship with general health literacy, we developed a Health literacy Index from the results of the survey. An analysis of variance of the index with the different variables was performed, considering they obtained significant at p <0.05. With the variables obtained a multiple comparisons were performed to determine which groups of variables have significant differences. 4. RESULTS In the Spanish population the factors that are significantly related to variations in the rate of health literacy are age, to have children, education level, self-perceived social, level of household income, health self-assessment, to have a chronic disease, the number of doctor visits in the last year, and the frecuency of doing physical exercise. Of all the variables, age, education level and health self-assessment , are those with a higher coefficient of determination on the health literacy index. The population at risk of having a low health literacy are people with a low educational level, with a negative assessment of their own health, do not practice exercise and with a weak social support network.
Martínez, Reyes Margarita María. "El derecho a la protección de la salud en el régimen general de garantías explícitas de salud y en la tabla de factores de riesgo." Tesis, Universidad de Chile, 2011. http://www.repositorio.uchile.cl/handle/2250/111012.
Повний текст джерелаLa Salud se enmarca dentro de las necesidades básicas del ser humano, considerándolo tanto en forma personal como en sociedad. La visión que se ha tenido de la salud en los diversos tiempos ha ido evolucionando conforme cambian los ritmos de vida y los roles de los individuos dentro de una sociedad moderna como la de hoy. De ahí la importancia que tiene dentro de la vida del ser humano, y por tanto, de las políticas que se empleen frente a los desafíos del futuro en esta área. En el marco de los Derechos Humanos, el derecho a la salud, viene a formar parte de los derechos de segunda generación, pues en las primeras declaraciones de estos derechos, sólo aparecían aquellos relacionados con las ideas de libertad imperantes en la época de su origen, llamados derechos de primera generación. Los derechos de segunda generación, surgen a fines del siglo XIX producto del proceso de industrialización que vivió el mundo, y su correlativa “cuestión social”, y por el carácter de los bienes jurídicos que protegen se denominan “derechos sociales” y pasan a formar parte del listado contenido en la Declaración Universal de Derechos de 1948, los cuales tienen como base los principios de igualdad y solidaridad.
URBANO, VILLELA PATRICIA GUADALUPE. "ATENCIÓN AL USUARIO EN EL HOSPITAL GENERAL “DR. FERNANDO QUIROZ GUTIÉRREZ." Tesis de Licenciatura, Universidad Autónoma del Estado de México, 2017. http://hdl.handle.net/20.500.11799/80209.
Повний текст джерелаGarcía, Hernández Vicente. "Análisis del criterio de oportunidad en el delito de narcomenudeo de la ley general de salud." Tesis de maestría, Universidad Autónoma del Estado de México, 2013. http://hdl.handle.net/20.500.11799/98974.
Повний текст джерелаHora, Carreño María Elena. "Nivel de conocimientos sobre la tuberculosis multidrogoresistente en población general del “Centro de Salud Mirones Bajo"." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2014. https://hdl.handle.net/20.500.12672/3954.
Повний текст джерелаTesis
Delgado, Gallego María Eugenia. "Evolución del conocimiento del sistema de salud, derechos en salud, de la política de participación y de las experiencias de participación de los usuarios del Sistema General de Seguridad Social en Salud de Colombia: una comparación entre 2000 y 2010." Doctoral thesis, Universitat Autònoma de Barcelona, 2013. http://hdl.handle.net/10803/125907.
Повний текст джерелаBackground During the late 1980s and 1990s, and under the influence of multilateral organizations like the World Bank and the International Monetary Fund, numerous nations undertook reforms based on market models in their social sectors, including healthcare; Colombia was not removed from this. Thus, in 1993 the General System of Social Security in Health (Sistema General de Seguridad Social en Salud – SGSSS). In 1994, a comprehensive policy for social participation in health was also formulated, which established participation in management, planning, and evaluation at various levels: from information to decision making and through different types of health participation: citizen participation (based on a market approach), community participation and participation within healthcare institutions. Users’ awareness of the healthcare system, of their rights to healthcare and awareness of the policy participation, empowers them for effective interaction with health services: for participating in various aspects of the healthcare system; for making informed health decisions; as well as for accessing services and hence, it is one of the fundamental conditions for users to exercise their right to healthcare– among others. Objective To analyze the evolution of awareness of the SGSSS, of rights in health, as well as the awareness and use of the participation mechanisms of health service users in two municipalities in Colombia and associated factors, between 2000 and 2010. Methods A descriptive study was conducted comparing cross-sectional studies based on two surveys of users of the SGSSS in Colombia, the first in 2000, and the second in 2010. The municipalities of Tuluá (urban area) and Palmira (rural area) were taken as study areas. A multistage probability sampling was carried out in both surveys, with a final sample: in the first survey, of 1497 users, and 1405 in the second. Logistic regression models were estimated to compare, on one hand, changes in the levels of awareness of the SGSSS, the standard for participation and rights, taking first the two years together (2000 as a reference and adjusted by the explanatory variables), and then one for each year to determine the factors associated with these levels of knowledge. Moreover, the logistic regression models were estimated to compare changes in the levels of awareness of the participation mechanisms and their use, taking the two years together (2000 as reference and adjusted by explicative variables), and then one for each year to determine the factors associated with the levels of awareness and use of the participation mechanisms. All data were analyzed with the SPSS v17. Results Users’ awareness of the healthcare system, awareness and utilization of the mechanisms in 2000 was limited, and in 2010, it diminished significantly, with the exception of that relating to health insurers and providers. In contrast, results show that more than 90% of users in both surveys perceive themselves as bearers of healthcare rights. In both surveys, living in an urban area, having a higher education, and belonging to a higher socioeconomic status is consistently associated with a higher level of awareness of the SGSSS. Living in rural area, having a higher education, and belonging to a higher socioeconomic status are consistently associated with a higher level of awareness and use of the participation mechanisms. With respect to institutional performance, it is observed that in the year 2000 less than 5% stated having been invited to or notified by any institution or health authority. In the year 2010 this proportion decreased, observing that less than 1.5% said they had been invited or notified. Conclusions The most underprivileged users have lower odds of being knowledgeable of the SGSSS, the social participation norms and participation mechanisms than the others, which represents a barrier for making informed decisions and the enforcement and exercise of their rights to health. In order to reverse this situation, a decisive intervention of health institutions and government is necessary to reduce social inequities.
Catacora, Rojas Isabel, and Altamirano Sonia Pastor. "Estudio del servicio de salud materna en el hospital general del distrito de Jaén, brindado a través del Seguro Integral de Salud : Análisis desde el enfoque intercultural durante los meses de marzo a setiembre de 2012." Master's thesis, Pontificia Universidad Católica del Perú, 2015. http://tesis.pucp.edu.pe/repositorio/handle/123456789/5907.
Повний текст джерелаTesis
Correa, Catalán Sergio Andrés. "Rol del Instituto de Salud Pública como asesor técnico de la Dirección General de Relaciones Económicas Internacionales del Ministerio de Relaciones Exteriores." Tesis, Universidad de Chile, 2014. http://www.repositorio.uchile.cl/handle/2250/129785.
Повний текст джерелаAutor no autoriza el acceso a texto completo de su documento
Los productos farmacéuticos, cosméticos y dispositivos médicos son productos sometidos a control sanitario por la autoridad de salud quien es responsable de la regulación y fiscalización estos, debiendo persistentemente analizar, supervisar y adecuar sus normas y procedimientos con el objetivo de garantizar a la población la provisión de los productos mencionados, velando en esta acción por su calidad, seguridad y eficacia. Por otro lado, en el contexto mundial, los acuerdos comerciales establecidos sólo comprendían, por lo general, disposiciones de política comercial relacionadas al comercio de mercancías, como por ejemplo medidas arancelarias y obstáculos técnicos al comercio. En la evolución de este comercio, la inclusión de nuevos temas a las reglas de comercio internacional, como los aspectos comerciales de los derechos de propiedad intelectual, supusieron la incorporación también de nuevas materias derivadas de la creación intelectual, y es en este sentido, que las patentes aplicadas a los productos farmacéuticos fue la etapa temprana y la base que conectó la esfera sanitaria con la esfera comercial. Los inicios de la participación de Salud, específicamente del Instituto de Salud Pública (ISP) en el Ministerio de Relaciones Exteriores (MRRE) data aproximadamente hace 10 años, transformándose a la fecha en un trabajo regular y sistemático, haciéndose necesario fortalecer, apoyar y formalizar este rol ejercido, teniendo en cuenta que la capacidad y experticia técnica existe. El ISP participa de distintas instancias, las cuales se pueden agrupar de la siguiente manera: como miembro de comisiones interministeriales: Comisión Nacional OTC y Comité Interministerial de Expertos en Propiedad Intelectual CTEPI, asesoría en la administración de acuerdos suscritos por Chile en materia de salud y apoyo en la negociación de nuevos acuerdos comerciales. Lo anterior se da en relación a los temas técnicos específicos que son materia de la institución sanitaria. El trabajo tiene como objetivo describir las funciones del ISP, en su rol como asesor técnico de la Dirección General de Relaciones Económicas Internacionales, dependiente del Ministerio de Relaciones Exteriores, dirigido principalmente a los aspectos de carácter sanitario y de propiedad industrial, en el marco de los acuerdos comerciales establecidos por Chile, con el fin de dar a conocer la función permanente de este y sentar las bases para la formalización de su rol, teniendo en cuenta que es una tarea transversal, que involucra a las áreas técnicas de medicamentos, cosméticos y dispositivos médicos y que se cuenta con el respaldo de estas
Ccuro, Minaya Lucia Rosa, and Espinoza Hector Montoya. "Factores de salud asociados a la calidad de vida en el Cuerpo General de Bomberos Voluntarios del Perú." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2019. http://hdl.handle.net/10757/626468.
Повний текст джерелаQuality of life is perceived as the physical, mental and emotional balance of the person, which can be influenced by different factors such as the presence of pain due to musculoskeletal disorders, obesity, level of physical activity, and smoking habits. In the population of the General Volunteer Fire Department of Peru these factors can be favorable or can decrease the quality of life. Objective: Verify the association between health factors and quality of life in the General Volunteer Fire Department of Peru. Methods: A cross-sectional, observational and analytical study was carried out on the staff of the General Volunteer Fire Department of Peru from Lima-Peru, XXV Departmental Lima-North, XXIV Departmental Command Lima-South, and the IV Departmental Command Lima. The SF-36 version 1 questionnaire was used to measure the quality of life. The standardized Nordic questionnaire was used to measure the presence of pain due to musculoskeletal disorders, the International Physical Activity Questionnaire (IPAQ) to measure the level of physical activity, and abdominal circumference was measured to determine the presence of obesity. A power analysis was performed for the sample studied. The T-Student was used for the analysis of the numerical variables. Anova was used for the analysis of variances and comparing the means of the response variable. Results: 167 people participated, the average age was 37.5 ± 11.3 years, 140 (83.8%) were male. It was found that 31% smoke cigarettes. 141 (83.9%) have abdominal obesity, but more than half had a high level of physical activity (57.7%). Within the 8 dimensions of quality of life on the SF-36, no scores below 70% were observed. 159 (95.2%) reported to have had musculoskeletal pain at some time in their life, while 122 (73.9%) reported having pain during the last year and 99 (61.1%) during the last four weeks. Age was associated with the fatigue dimension (p = 0.014) and emotional well-being (p = 0.002). The sex variable was associated with the dimension limitation due to physical health (p = 0.031); fatigue (p = 0.040); and general health (p = 0.047) and the male group was the one with the highest scores. The service time as a firefighter affected dimensions such as physical functioning (p = 0.013); limitation due to physical health (p = 0.007); social functioning (p = 0.006) and pain (p = 0.012). Having had pain at some time in life was associated with the dimensions of fatigue (p = 0.003), social functioning (p = 0.044), and general health (p = 0.010). While pain reported in the last year was also associated with those same dimensions and with the pain dimension in the SF-36 (p = 0.001). Finally, the pain report in the last month was associated with all the mentioned dimensions and with the physical functioning (p = 0.009). The variables of obesity, smoking and physical activity had no association with any of the 8 dimensions of quality of life. Conclusions: The present study was able to determine the relationship between health factors and with quality of life. An association was found between presence of pain due to musculoskeletal disorders, time as a firefighter, age and sex. No association was found in factors of obesity, smoking and level of physical activity.
Tesis
Juliá-Sanchis, Rocío. "Validez del indicador general de limitación de la actividad (GALI) para medir funcionamiento en la población. Un análisis comparativo con salud percibida, a través de encuestas de salud de España." Doctoral thesis, Universidad de Alicante, 2016. http://hdl.handle.net/10045/68918.
Повний текст джерелаGuerrero, Gironés Julia. "Efecto de la melatonina y de HA/β-TCP/C sobre la pulpa dental de molares de rata". Doctoral thesis, Universidad de Murcia, 2014. http://hdl.handle.net/10803/284960.
Повний текст джерелаMelatonin plays an essential role in the regulation of bone growth. The actions that melatonin exert on odontoblasts may be similar to action on osteoblasts. Hydroxyapatite (HA) and beta-tricalcium phosphate (β-TCP) are bioceramics used as bone substitutes, which together with collagen (C) as support, have satisfactory osteoconductive qualities. The aim of this research was to evaluate pulp response to melatonin and to mixture HA/β-TCP/C used for direct pulp capping and to evaluate the antioxidant effect of melatonin administered orally and its influence on dental pulp. METHODS Direct pulp capping was performed on the upper molars of 28 Sprague-Dawley rats. The study groups were: MTA 30 days; Melatonin 30 days; MTA + Melatonin taken orally 30 days; Melatonin + Melatonin taken orally 30 days; MTA 60 days; Melatonin 60 days;.HA/β-TCP/C 30 days. In the groups MTA + Melatonin taken orally 30 days and Melatonin + Melatonin taken orally 30 days, the animals drank water dosed with melatonin ad libitum (10 mg/100 ml). After 30 or 60 days depend of the group, the animals were sacrificed and 5 ml of blood, the kidneys and liver were extracted in order to evaluate oxidative stress by means of thiobarbituric acid reactive substances testing (TBARS), and fragments of the maxilla containing the study molars were prepared for histological evaluation. The degree of pulp inflammation, the degree of pulp necrosis, the presence of reparative dentin and dentin bridging the pulp chamber, the presence and regularity of the odontoblastic layer and the presence of pulp fibrosis were evaluated from these samples. RESULTS No significant differences were found between the study groups for the histological variables degree of pulp inflammation (p=0,024), degree of pulp necrosis (p=0,61) and presence of pulp fibrosis (p=0,194). There were significant differences for the histological variable presence of reparative dentin and dentin bridging the pulp chamber (p=0,002); group MTA 30 days was associated to presence and group HA/β-TCP/C 30 days was associated to ausence of reparative dentin and dentin bridging. There were significant differences for the variable presence and regularity of the odontoblastic layer between groups (p=0,002); group MTA 30 days was associated to regular odontoblastic layer; group MTA+Melatonin taken orally 30 days was significantly associated to odontoblastic layer regular or irregular; groups Melatonin 60 days and HA/β-TCP/C 30 days were associated to ausence of regular odontoblastic layer. In oxidative stress analysis no significant differences were found between the study groups: blood (p=0.799), kidney (P=0.130) and liver (p=0.724). CONCLUSION The effect of melatonin and HA/β-TCP/C on pulp is similar to that of MTA to the degree of pulp inflammation, the degree of pulp necrosis and the present of pulp fibrosis. Oral administration of melatonin did not modify the local effects of MTA or of melatonin on dental pulp or reduce basal level oxidative stress.
Gómez, Sánchez María Bienvenida. "Evaluación y mejora de la calidad en la alimentación hospitalaria." Doctoral thesis, Universidad de Murcia, 2015. http://hdl.handle.net/10803/334176.
Повний текст джерелаTo assess the quality of the entire process of food in hospitals, from reception of raw materials to food intake of patients. Identifying and designing corrective measures in order to avoid the most frequent errors. Material and method: A study of assessment and improvement of pre/post intervention quality was undertaken with repeated measures for a period of one year. The study was carried out in 4 Stages. At an early stage, a weekly evaluation was done in order to observe if the following criteria was implemented: shipping of primary materials (C1), storage of dairy products in coldrooms (C2), as that of fruits and vegetables (C3), of meat products (C4), of fish (C5), of processed products (C6), of frozen products (C7), and of non-perishable food products (C8). Another task of this stage was that of supervising the quality of non-perishable (C9), fridge perishable (C10) and frozen products (C11). The following aspects were also monitored: dietary compliance (C12), diet schedule (C13), if food trays provided nourishment suitable and according to medical guidance (C14), if food trays were properly fulfilled with all food supplements (C15), meal presentation (C16), and schedule for meals delivery to the patient (C17). Furthermore, patients assessed each food intake on scale of 1 to 10 (C18), the amount of non-ingested food was measured (C19), and, finally, two customer satisfaction survey about the hospital feeding were conducted, one at the beginning (C20) and another at the end of the assessment (C21). Some quality standards were established for all criteria, which for criteria from 1 to 11 is 100%, for criteria from 12 to 17 is 95% and for criteria from 18 to 21 is 70%. All data were expressed as a compliance percentage plus a 95% confidence interval, they were compared with the established standard by using the current Z value and considering meaningful values of p<0,05. In the second stage, based on the information gathered, a quality intervention improve was carried out about healthcare and non-healthcare professionals involved in each of those abovementioned processes. This improvement action consisted of educational interventions and structural-organizational reforms. In the third stage, after applying some improvement measures, a second assessment of all quality criteria analyzed in the first stage was made in order to observe which ones were now refined. Lastly, in the fourth stage, after the testing period had ended, the results were studied and in comparison with activities before the improvement action was developed. Once the step 4 is finished, we should regularly return to the first step in order to study the new improvements to implement. Results: In the second assessment of the criteria in relation to the first one, there was a global improvement of a 34%. Out of the 21 criteria analyzed only one worsened (C15), 2 remained unaltered (C6 and C11) and the remaining 18 improved. When comparing the compliance of the criteria with the established standard for each one, it turn out that only 8 of them reached the standard, having compliances of : C11 (100%), C12 (96,48%±0,71), C13 (99,61%±0,24), C14 (97,18%±0,64), C15 (99,88±0,13), C16 (98,18±0,51), C19 (73,44 ±10,82) y C21 (71,21±10,92). Findings: The assessment of food quality in hospitals has been acceptable without achieving the proposed standards. Therefore, more quality processes must be developed to enable an ongoing improvement.
Lozano, Polo Adelaida. "Estudio sobre el tabaquismo en el alumnado de ciencias sociosanitarias de la Universidad de Murcia : actitudes, consumo de tabaco y exposición al humo ambiental de tabaco." Doctoral thesis, Universidad de Murcia, 2015. http://hdl.handle.net/10803/346058.
Повний текст джерелаTobacco consumption has become one of the main challenges in public health over the last century. It is one of the biggest avoidable and preventable causes of morbidity and mortality, suffer and disability of the society. In Spain, smoking is one of the main three factors that cause more disability adjusted life years (DALYs). Murcia Region shows the highest smoking rate (31,8%) of our country. Medicine, Nursing and Teaching degrees have an important exemplary role in the society. Performing a positive role model on smoking is mediated by attitudes, knowledge, and behaviors related to tobacco consumption and are influenced by existing control policies. To investigate variables associated with smoking consumption and secondhand smoke exposure among future professionals related to health and social sciences may provide an overall idea of the needed training programs to improve their ultimate support to tobacco control, and try to increase the welfare of the students. OBJETIVE: To analyze tobacco consumption and exposure to secondhand smoke, and the attitudes on smoking among health sciences and education students of the University of Murcia, with a gender and equity perspective. MATERIALS & METHOD: This is a cross-sectional study carried out by a self-reported and anonymous questionnaire in 998 Medicine, Nursing, Teaching and Social Work students at the University of Murcia between 2010 and 2011. A questionnaire was developed ad hoc. The scales to evaluate risk perception and the acceptance level of the role model were validated in the current study. Variables related to social characteristics that might influence smoking consumption were analyzed in the statistical analysis. Parametric (mean, standard deviation, percentiles, Chi-square, ANOVA) and non-parametric (U Mann-Whitney and Kruskal-Wallis) tests were employed to analyze related factors. To assess the structural validation of the scales, exploratory factor analysis, confirming it’s appropriated. Cronbach's alpha was used as an estimate of the reliability. The construct and the discriminatory capability of the scales in relationship to smoking consumption were validated. RESULTS: The majority of the students were women (77,7%), with a mean age of 22,4 years old. One out of four a current smoker (24,6%; 95%CI:21,9%-27,3%). Mean cigarette smoking/day was 10.4 [standard deviation (SD): 7,2]. The prevalence of smoking was similar between men and women, and no significant differences were observed by socioeconomic status, residence or employment status of their parents. Tobacco consumption was higher among students older than 25 years old (31,7%; 95%CI: 25%-38,4%) and in Social Work (38,3%; 95%CI: 29,5%-47,1%) and Teaching (26,8%; 95%CI:22,4%-31,2%) degrees. Tobacco consumption was lower in Medicine (18%; 95%CI:14%-22%) and Nursing degrees (24,1%; 95%CI:16,9%-31,3%). The odds of being a smoker was higher in participants older than 25 years old (OR:1,7; 95%CI:1-2,8; p<0.001), if they were living with smokers (OR:2,9; 95%CI:1,9-4,4), especially in women (OR:3,3; 95%CI:2,1-5,3), or if the mother (OR:1,3; 95%CI:0,8-2), the father (OR:1,1; 95%CI:0,7-1,7), any sibling (OR:2; 95%CI:1,2-3,4), the partner (OR:4,8; 95%CI:2,2-10,5), any flatmate (OR:2,6; 95%CI:1,1-6,3), or friends (OR:6,5; 95%CI:1,4-29,9) were smokers. The Risk perception scale showed an acceptable reliability (Cronbach’s alpha=0,71; explained variance=46,5%) with two dimensions (“Health problems related to smoking” and “Believes on the importance to smoking”). The Role model scale includes 3 components (“Informal Function”, “Formal Function” and “Positive Environment”), explaining 48,6% of the variance (Cronbach’s alpha=0,87). Sixty-one percent of the students lived with any smoker and 78,8% were exposed to secondhand smoke (weekdays: 37,5%; weekends: 76,6%), without any difference between smokers and non-smokers or by gender. Older students showed lower exposure. Living with smokers increases secondhand smoke exposure (weekdays: 56%; weekends: 79,7%). Mean exposure to secondhand smoke was 1,07h/24h during weekdays and 3,18 h/24h weekends. A significant reduction is observed in exposure after the implementation of the new Law during the weekdays 47% (OR=0,53; 95%CI:0,38-0,74) and the weekends 83% (OR=0,17; 95%CI:0,09-0,28). CONCLUSIONS: - The smoking prevalence in our study population is lower compared to high-school students and general population of Murcia Region, although higher compared to university students. Health sciences students present lower occurrence of smoking. - Age, degree and living with smokers are important factors for tobacco consumption; however, gender and the socioeconomic status are not. - Secondhand smoke exposure is still elevated; showing an important improvement after the latest Law on tobacco control became effective. - It is necessary to implement actions at the University in order to improve risk perception and the acceptance of the role model of the health and social professionals.
Espi, Forcen Fernando. "Demons, fast and death : mental health in the late middle ages = Demonios, ayuno y muerte : salud mental en la Baja Edad Media." Doctoral thesis, Universidad de Murcia, 2015. http://hdl.handle.net/10803/361102.
Повний текст джерелаResumen en Español Introducción: Con la expansión del Cristianismo en el Imperio Romano, la enfermedad mental, las teorías religiosas predominaron para explicar la enfermedad mental durante la Edad Media. Hipótesis: Es posible estudiar la salud mental en la Baja Edad Media a través del estudio de la posesión demoníaca, el santo ayuno y la ansiedad de la muerte. Métodos: Se han estudiado varios casos descritos en las hagiografías de los Santos, de mujeres que practicaban el ayuno por razones religiosas y los manuales que se empleaban para asistir a los moribundos. Resultados: En el estudio de la posesión demoníaca se intuyen rasgos de trastornos mentales de tipo psicótico, del ánimo, disociativos, cognitivos, de personalidad y neurológicos. Las mujeres que practicaban el ayuno religioso muestran rasgos parecidos a los de la anorexia nerviosa. La ansiedad de la muerte era muy común en la Baja Edad Media y manuales como el Ars Moriendi eran de utilidad para ayudar a los moribundos. Discusión: el riesgo de estudiar el comportamiento medieval desde una perspectiva psiquiátrica conlleva la posibilidad de imponer la nosología actual en el pasado y de que pasen desapercibidas conductas compatibles con la enfermedad mental. Con todo, los avances neurocientíficos sobre la enfermedad mental, y la revisión de literatura existente sugieren la existencia de la enfermedad mental a lo largo de la historia. Conclusiones: Es posible elucidar el estado de la enfermedad mental en la Baja Edad Media a través del estudio de las posesiones demoníacas, del ayuno y de la ansiedad de la muerte. Introduccion: Durante la Edad Media predominaban teorías religionsas o espirituales para explicar el comportamiento errático. Examinando las narrativas literarias de exorcismos se pueden hallar rasgos de tipo ansioso, depresivo, piscótico y de personalidad. Examinando las narrativas de Santos que practicaban el ayuno se hallan rasgos de trastornos de la conducta alimentaria. La muerte prematura en la Edad Media era frecuente debido a epidemias como las peste negra entre otras. La ansiedad de la muerte en la población medieval generan una serie de manuales con el fin de ayudar a los frailes asistir a los moribundos. Las estrategias empleadas en estos manuales tienen paralelos con las técnicas que se usan hoy día para tratar la ansiedad de los pacientes con enfermedades terminales.
Gomez, Martinez Mª Jose. "Proyección de las ciencias y tecnologías de alimentos en el ámbito de la desnutrición." Doctoral thesis, Universidad de Murcia, 2016. http://hdl.handle.net/10803/362921.
Повний текст джерелаSummary The basic aim of this thesis is to highlight the problem of malnutrition suffered by patients in hospitals, which is a problem that affects a greater or lesser degree to many of them, being a significant cause of the increased prevalence and morbidity and mortality. In this situation, even today, the dietitian-nutritionist figure, despite being a university graduate of recognized competence, not in quantitative terms and / or qualitatively sufficiently embedded in the whole-food-nutrition-malnutrition-food diseases the hospital system. This work is also claim some of the work that can develop these professionals with training that enables them to organize and to strengthen cohesion that must exist between these sectors and other professionals in the hospital structure and procedure. The establishment of an action plan for the control and monitoring of the nutritional status of patients, from their arrival at the center and during their stay in it, arises with the implementation of a protocol of nutritional screening for early detection of cases malnutrition and follow the evolution of patients throughout the hospital period. NRS-2002 procedure as a method of nutritional screening, known for its unique characteristics, application and accessible implementation is adopted. Hundred twenty patients undergoing nutritional screening thirty-six patients are classified at risk of malnutrition. In the latter group, affects the dietary and eleven receive special nutritional support measures and the rest are subjected to surveillance and control of intake. A modification of the NRS-2000 method is proposed for patients classified without nutritional risk, which can leave the hospital earlier than seven days, again subject to screening within 72 hours of the first evaluation and complete information on the status of patient. In assessing three hundred and eighty-one patients fall under dietary control situation hundred twenty-nine patients. Twenty-six patients are treated with special nutritional support, representing a third of the figure for the previous experience. In tracking a group of eight patients who are undergoing dialysis three times a week, it is characterized that diets ingest these patients are high protein and/or high fat, and are deficient in carbohydrates. This aggravates the condition of hypercholesterolemia suffering, worsened by rising ingested protein nitrogen, which affects the process of dialysis and kidney failure box. In most patients, male or female, BMI values are higher than 25 kg / m2, overweight index. In contrast, PCR data are less than unity, corresponding to malnourished patients. This contradiction is justified because the numbers just distance themselves from the limits. Out of a total of eighteen patients, nine men and nine women, the latter eat more protein and more fat than the respective recommendations established for this group, but the consumption of carbohydrates is deficient. In male patients the protein intake is slightly elevated and adequate carbohydrates, but the rate of fat intake is lower than recommended. For all patients sodium intakes are within the permitted limits however potassium do not reach the minimum data set. According to the protein catabolic rate fifty percent (5 ♂ ♀ and 4) are malnourished. After one year of follow up, the average rate decreases protein catabolism (mean 0.19, s.d.: 0, 17) and the Pearson correlation assumes no statistically significant differences. However, the reduction that occurs in the data series of the dry weight (-2.52 Kg, s.d.:8.27) is statistically significant (P <0.05). The data variations dry weights and variations of the PCR do not show statistically significant correlations. The results suggest the need for new guidelines for the health of these patients with regard to seeking to improve their nutritional status.
Moreno, Martínez Francisco José. "Diseño y validación de un cuestionario para determinar los hábitos y conocimientos en higiene corporal infantil y su aplicación en escolares y menores en desamparo de la Región de Murcia." Doctoral thesis, Universidad de Murcia, 2016. http://hdl.handle.net/10803/365312.
Повний текст джерелаGeneral aim (1) To evaluate the knowledge and personal hygiene habits of schoolchildren and children in residential foster care aged between 7 and 12 years. Specific aims (1) To design and validate an instrument to comprehensively assess the knowledge and personal hygiene habits in children aged between 7 and 12 years. (2) To describe the knowledge and personal hygiene habits in schoolchildren aged between 7 and 12 years and children in residential foster care in the Region of Murcia. (3) To evaluate the relationship between knowledge and personal hygiene habits of schoolchildren and sociodemographic factors age and sex. (4) To evaluate the relationship between knowledge and personal hygiene habits of schoolchildren and the location of the school. (5) To compare the knowledge and personal hygiene habits among children in residential foster care and schoolchildren by socioeconomic level of the families. Methodology: First phase: cross-sectional study for the validation of an experiment carried out during the years 2013 and 2014. A literature review; content validation for 7 experts; pilot survey; item response analysis, and evaluation by test-retest reliability were carried out. Participants were students from 2nd to 6th grade of Primary School in an area close to the city of Murcia suburban area, aged between 7 and 12 / as well as their parents and / or mothers. Also it is got with the participation of children from a medium/long stay center for young from the Region of Murcia (CARM). Second phase: The study was conducted during 2014 and 2015 through quantitative design. An observational and descriptive study was carried out to evaluate the habits and personal hygiene knowledge in schoolchildren aged between 7 and 12 years compere with children in children´s home in the Region of Murcia. The study was conducted with the participation of schoolchildren in three schools in rural, urban and suburban location and their parents or legal guardians, and with the collaboration of abandoned minors recently joined a protection center of the CARM. Data collection in school and under protection centers was conducted through a questionnaire HICORIN®. Socioeconomic data were obtained from school survey of parents / mothers through the questionnaire HICORIN-Socioeconomic, and centers under protection through data recorded in the software GISME and / or records of minors. Analysis of the data was performed using the statistical package SPSS version 21 for Windows. Results: First phase: 20 items including items with instruments on child personal hygiene were obtained. 34 items were selected and drafted 48 new. Validation of experts reduced HICORIN® to 63 items and included seven dimensions of child personal hygiene (body skin, hair, hands, oral, feet, ears, and personal hygiene). After running a pilot survey some terms were adapted to improve the children´s understanding. Only two items have rates exceeding 10% of non-response. The test-retest showed 84.1% of the items reliability between very good and moderate. Second phase: From the sample of students selected for the study (n=758) participated finally 59.89% (n=454), with 49.8% boys and 49.3% girls. 61.2% of the children came from families with high studies. For those under protection centers was surveyed to 51 children, being 47.1% boys and 52.9% girls. 90.2% came from families with no education or primary education. In bivariate analysis 80 significant associations were obtained between age, sex and location of the center and variables related to body hygiene HICORIN® and independent variables. The comparison between schoolchildren and children from juvenile protection centers gets 50 significant associations. Conclusions HICORIN® is a reliable and valid instrument that fully values the habits and personal hygiene knowledge in children of 7-12 years. It could be applied to social care and education sectors and for children of all socioeconomic levels. Schoolchildren with higher incomes in the usual home and living in urban or suburban areas have better health habits, being the schoolchildren in rural areas have considerably habits far away from the current recommendations on personal hygiene. It is evident that the acquisition of knowledge and autonomy in personal hygiene are higher with age, there are few significant differences between sexes associated to the habits and personal hygiene knowledge in childhood. Children living in children´s home have less knowledge and personal hygiene habits considerably far from current recommendations those schoolchildren. Also, suffer a major social rejection by other minor motivated by poor personal hygiene, while this hardly happens in schoolchildren. The family is the principal agent in education in personal hygiene of children, being more influential in school than under protection centers.
Rodríguez, Manzano Jesús. "Detección y caracterización de virus patógenos emergentes de interés general en seguridad alimentaria / Detection and characterization of emerging viral pathogens of general interest in food safety." Doctoral thesis, Universitat de Barcelona, 2012. http://hdl.handle.net/10803/83324.
Повний текст джерелаThe main objectives of this thesis are the study of emerging viral pathogens of interest in food safety, by assessing their prevalence and environmental dissemination, and the characterization of the microbiological risk associated with the presence of pathogenic viruses in sewage reuse and consumption of bivalve molluscs. Thus, we studied the presence of hepatitis E virus (HEV), hepatitis A (HAV), norovirus (NoV), new polyomaviruses (KIPyV, WUPyV and MCPyV) and human adenovirus (HAdV) as an indicator of fecal contamination. The samples analyzed were raw sewage, reclaimed water (secondary and tertiary), river water and bivalve molluscs. Furthermore, it has sought to improve the methodology for concentration of viral particles from sewage, as well as provide information about the viral removal efficiency through sewage depuration treatments and shellfish production companies. Finally, a mathematical model has been established for a quantitative microbial risk assessment. Thus, the conclusions of these studies are described below. The HEV prevalence observed in sewage demonstrate that HEV is circulating among the Spanish population and that sewage is a source of infection. Moreover, the sporadic presence of HEV genotype 1 confirms the wide distribution of different genotypes. Regarding the pattern of HAV excretion, no significant differences emerged when comparing sewage from two adjacent areas with different vaccination programs and equivalent levels of sanitation; hence, it is presumed that the drastic reduction observed during lately is mainly due to improvements in healthcare. New polyomaviruses have been detected in sewage and river water, indicating their potential involvement in the fecal-oral route through contaminated water and representing the first description of cancer-associated virus in sewage and river. On the other hand, sewage treatment plants significantly reduce the presence of high-resistance fecal contamination indicators and three new methods to concentrate virus particles from sewage have been developed. Also, it has reaffirmed the presence of NoV GGII and HAV in samples that meet the European regulations through the detection of bivalve molluscs collected at market and samples linked to a hepatitis A outbreak, respectively. The efficiency of three treatments for bivalve molluscs depuration was found limited at reducing the presence of HAdV. In addition, a significant correlation between the identification of positive bivalve shellfish samples for HAdV and NoV GGII has been described, showing high sensitivity and specificity. Finally, using dose-response models we have mathematically modeled the risk of NoV infection and disease associated with raw oyster consumption.
González, María Isabel <1955>. "Cáncer y tratamiento oncológico: Representaciones sociales de la población general, el paciente oncológico y miembros del equipo de salud." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2013. http://amsdottorato.unibo.it/5769/.
Повний текст джерелаThe present study consists of three qualitative studies whose purpose was to know the representations constructed by the general population, by oncological patients and health professionals, regarding cancer, chemotherapy and bone marrow transplant. This study also carried out an analysis of similarities and differences between them. It was done in Bogotá (Colombia) with 55 people: 20 patients with cancer in process for bone marrow transplant, 20 people without cancer diagnosis and 15 people who work with patients with cancer. An in-depth interview was performed with each of the participants, as well as free, classical and by substitution associations of the words “cancer”, “chemotherapy” and “bone marrow transplant”. The data obtained was analyzed in light of the Theory of Social Representations (TSR). The analysis of the information followed the research technique of qualitative analysis of content in order to find symbolic significances and to construct, to denominate and to define categories. For the three groups, cancer is a terrible disease that could lead to death. Health personnel and the general population believe that the disease creates terror, anxiety and fear. Patients are aware of the seriousness and the consequent fear triggered by a disease that changes everything, produces suffering, pain, obliges them to depend of someone else and that could lead to death. Health professionals consider that patients can live cancer as a punishment and the general population believes that it can be the consequence of unhealthy life habits. For all, chemotherapy is a treatment for the disease that, one the one hand, produces difficult and visible collateral effects and creates negative feelings of fear and anxiety and, on the other hand, constitutes an option and a possibility for healing. The bone marrow transplant represents, for all of them, an opportunity to live.
Peydró, Navarro Cristina. "Calidad de vida, trabajo y salud en los profesionales sanitarios: un estudio en el Hospital General Universitario de Alicante." Doctoral thesis, Universidad de Alicante, 2015. http://hdl.handle.net/10045/53705.
Повний текст джерелаOrozco, Solis Sully, la Torre Yupanqui Roxana Paola De, and Camargo Mercedes Rosa Vega. "Evaluación y análisis de la calidad del servicio de medicina general basado en la metodología SERVQUAL, aplicado a los pacientes de consulta externa en el centro materno infantil Juan Pablo II." Bachelor's thesis, Pontificia Universidad Católica del Perú, 2018. http://tesis.pucp.edu.pe/repositorio/handle/123456789/13266.
Повний текст джерелаTesis
Amigo, Fernández Francisca Pía, Chevesich Francisca de la Maza, and Camhi Carolina Sofía Flisfisch. "La tutela del Derecho Constitucional a la protección de la salud a partir de la dictación de la Ley Nº 19.966 que establece un régimen general de garantías en salud (Plan Auge)." Tesis, Universidad de Chile, 2006. http://www.repositorio.uchile.cl/handle/2250/107754.
Повний текст джерелаel objetivo de nuestro trabajo es analizar si la tutela del derecho a la protección de la salud consagrado en el artículo 19 Nº 9 de la Constitución Política de la República se encuentra debidamente garantizada a partir de la dictación de la Ley Nº 19.966 que establece un Régimen General de Garantías en Salud. El desarrollo de nuestro análisis se centrará en el cumplimiento del principio de la reserva legal en la dictación de la referida Ley, debido a que por el carácter social del derecho a la protección de la salud esta garantía cobra especial relevancia en la tutela de éste
Roa, Tejeda Adriana Patricia, Tejeda Adriana Patricia Roa, and Zelanda María de Lourdes Gómez. "Prevalencia del Síndrome de Burnout en el personal de Salud del Área de Urgencias en el Hospital General de Chalco." Tesis de Licenciatura, Medicina-Quimica, 2013. http://ri.uaemex.mx/handle/20.500.11799/13814.
Повний текст джерелаSánchez, Romera Juan Francisco. "Registro de gemelos : utilidades, organización y supuestos clave. Registro de gemelos de Murcia." Doctoral thesis, Universidad de Murcia, 2013. http://hdl.handle.net/10803/120511.
Повний текст джерелаThis doctoral dissertation deals with twin registries and the "Murcia Twin Registry" (MTR) in particular, as a fundamental research resource for in depth understanding of the relative contribution of genetic and environmental factors to behavior. Genetically informative designs, specifically twin studies, are an important resource for the analysis of the causes of human phenotypic variation. These designs are the methodology of choice in order to separate genetic from environmental causes in family resemblance. Currently, such studies are widely implemented and entail a high degree of specialization, in accordance with its enormous research potential. Their development is based on the existence of multiple births records. Nowadays, twin registries are distributed worldwide, and their implantation represent a methodological response to specific twin studies initiated by the scientific community. Zygosity determination, assessment of the equal environment assumption (EEA), and verification of the representativeness of the sample, are core issues of the twin studies methodology. These three elements are the key to ensure the usefulness of the comparisons, and the validity of the results obtained. It therefore seems clear that testing these three questions is an essential principle in establishing the scientific utility of any twin registry. This dissertation has three main objectives: to validate the zygosity questionnaire used so far in the MTR, by means of comparing the classification by this instrument and the zygosity results obtained by genetic markers; to analyze the accuracy of the equal environments assumption among participants of the MTR, comparing the data about periods of shared residence between MZ and DZ twins; and to investigate to what extent the sample of subjects participating in the MTR is representative of the reference population, according to geographical context, sex and age group. The design for the overall development of the MTR is a population-based cohort, consisting of individuals born from multiple births and living in the Region of Murcia. These subjects are included in a twin registry with voluntary participation. This particular work uses the full sample of MTR participants, as well as some selected sub-samples, depending on the specific objectives of each of the investigations that compose it. In the same way, the procedures used vary and adapt to the specific objectives of analysis. The main conclusion of this dissertation is that the general objective of validating the MTR as a research resource has been reasonably achieved. Some of the main findings that contribute to that objective can be highlighted. The validity of the Spanish adaptation of the zygosity questionnaire has been proved. There is a major discrepancy between the subjective zygosity classification of the twins, and the classification by questionnaire and analysis of genetic markers, showing a striking overestimation of dizygosity. The proportion of twins living in the same or different municipality throughout their lives is not influenced by the type of zygosity, fulfilling in general, and a priori, the equal environment assumption. What is more, zygosity is not related to the proportion of pairs who have lived in the same town during the first 16 years of life. Finally, the representativeness of the sample of the MTR in relation to the reference populations of Murcia and Spain has been estimated and the results support the generalizability of the data to the general population.
Ferrari, Carlevari Mauro. "Diseño de un modelo de Benchmarking para evaluar competitividad en el mercado de cirugías del sector privado de salud." Tesis, Universidad de Chile, 2017. http://repositorio.uchile.cl/handle/2250/145981.
Повний текст джерелаEl sistema de salud privada se encuentra constantemente en el ojo de las autoridades sanitarias, debido a la complejidad del sistema de financiamiento que se basa en las cotizaciones de salud provenientes del bolsillo de los cotizantes. Alzas desmedidas y alta dispersión de precios caracterizan a un mercado sostenido por un segmento reducido de la población, de ingresos sobre la media. La asimetría de información es el principal factor. En el marco de un proyecto de consultoría, desarrollado por Genesis Partners y financiado por la Red de Salud UC-Christus -quienes buscan nuevas estrategias para potenciar los servicios de atención hospitalaria- este trabajo de tesis busca contribuir en la búsqueda de un nuevo estándar en la industria para comparar niveles de precios y determinar la competitividad de los principales prestadores privados en Chile. En el proceso de diseño de un estudio de benchmarking de procedimientos hospitalarios, se ahonda en los factores que hoy ponen en riesgo la continuidad del sistema de salud privada con evidencia estadística sostenida por grandes volúmenes de información transaccional entre prestadores privados e Isapres. A través de estos datos, es posible reconstruir gran parte de la facturación de la Red de Salud UC-Christus y de toda su competencia relevante, desagregada a nivel de cuentas individuales de procedimientos hospitalarios -principalmente cirugías- y utilizarlas para caracterizar el mercado y establecer métricas e indicadores de competencia. Se desarrolla una metodología de comparación de cirugías relevantes en el mercado, haciéndose cargo de la variabilidad que estas presentan en su composición a nivel de prestaciones individuales. Los resultados confirman la existencia de alta variabilidad en los procedimientos dentro de cada prestador, y entre prestadores. De este proyecto nace un benchmark que permite identificar fortalezas, debilidades, oportunidades y amenazas en el mercado de las cirugías, se espera que este sea un insumo para la fijación de metas, diseño de estrategias comerciales y apoyo en negociaciones entre prestadores y aseguradoras.
Sarabia, Cos Laura. "Estudio sobre la calidad seminal en jóvenes universitarios de la Región de Murcia." Doctoral thesis, Universidad de Murcia, 2015. http://hdl.handle.net/10803/326745.
Повний текст джерелаDiversos estudios muestran una disminución en la concentración espermática en las últimas décadas, aunque en este hecho se han observado diferencias geográficas importantes. El descenso de la concentración espermática se ha atribuido a exposiciones a tóxicos y contaminantes ambientales, estilos de vida o ciertos factores nutricionales pero que, en gran medida, son aún desconocidos, permanecen inexplorados o no han sido suficientemente estudiados. Entre 2010 y 2011 se llevó a cabo un estudio transversal en jóvenes universitarios de la Región de Murcia (n=215) con el propósito de estudiar su calidad seminal. Los participantes proporcionaron una muestra seminal, se les realizó un examen andrológico y cumplimentaron cuestionarios epidemiológicos sobre hábitos de vida, incluido un cuestionario de frecuencia alimentaria. El análisis de los parámetros seminales se realizó siguiendo las recomendaciones de la OMS (2010) y también se analizó la fragmentación del ADN espermático mediante el método de dispersión de la cromatina espermática (SCD). A partir de los datos de este estudio, en la presente tesis doctoral se profundiza en el estudio de la calidad seminal en jóvenes varones, abordando el problema desde distintos aspectos. En el primer trabajo se estudió la asociación entre la ingesta dietaria de nutrientes antioxidantes y la calidad seminal en dichos varones. Los resultados indicaron una asociación positiva entre el consumo de distintos nutrientes antioxidantes (criptoxantina, vitamina C, licopeno y b-caroteno) y el recuento total de espermatozoides móviles. El volumen seminal también aumentó con una mayor ingesta de vitamina C, licopeno y b-caroteno. En conclusión, nuestro estudio sugirió que algunos parámetros espermáticos podrían ser sensibles a la ingesta de nutrientes antioxidantes, y que la recomendación actual de ingesta de vitamina C podría ser insuficiente para alcanzar el máximo beneficio en términos de calidad seminal. En el segundo trabajo, el objetivo fue examinar si la calidad seminal había variado durante la última década entre los jóvenes del sureste español. Para llevar a cabo este trabajo se utilizaron los datos obtenidos en un estudio anterior realizado en Almería entre 2001 y 2002. Los datos del estudio de Almería se incluyeron en un análisis de tendencias junto con los datos relativos a los jóvenes estudiantes murcianos. Se utilizó modelos de regresión lineal múltiple para analizar en la población combinada un efecto de cohorte de nacimiento durante el período de estudio 2001-2011. Nuestros resultados indicaron que el recuento total y la concentración espermática podrían haber disminuido en los jóvenes del Sureste español durante la última década, mostrando una tendencia temporal adversa en dichos parámetros. En el sur de España recientemente ha tenido lugar un aumento de la industrialización, y con ello, un aumento del riesgo de posibles exposiciones potencialmente adversas que podrían afectar a distintos parámetros reproductivos masculinos. En el tercer trabajo se estudió la fragmentación del ADN espermático en los jóvenes varones. Dicha fragmentación podría estar relacionada con procesos de estrés oxidativos y comprometer la calidad seminal. Por una parte, se describieron y analizaron los índices de fragmentación del ADN espermático (SDF) de las muestras tras la eyaculación, lo que se denominó como SDF basal. Y por otro lado, se estudió la dinámica de la fragmentación del ADN espermático, es decir, el incremento de la fragmentación del ADN con el tiempo tras la eyaculación. Para estudiar la dinámica se incubaron las muestras a 37ºC durante 2.5, 17 y 24 horas y se calculó la tasa de fragmentación del ADN espermático (rate SDF; rSDF). Los resultados obtenidos indicaron unos valores medios de SDF basal relativamente altos comparados con otros estudios publicados. La rSDF fue mayor durante las primeras horas tras la eyaculación. Por otra parte, las muestras con SDF basal superior a 30% presentaron una rSDF mayor durante las primeras horas de incubación comparadas con las muestras con niveles basales inferiores a 15%.
In the last decades several studies have shown a decrease in human sperm concentrations. In spite of this fact, there have been significant geographical differences. The decline in sperm count has been attributed to exposure to environmental toxins and pollutants, lifestyle or certain nutritional factors which are still largely unknown, unexplored or have been understudied. Between 2010 and 2011 we conducted a cross-sectional study among university students in the Region of Murcia (n = 215) in order to study their sperm quality. Participants provided a semen sample, underwent an andrological examination, and filled out epidemiological questionnaires on lifestyle and a food frequency questionnaire. The seminal analysis was performed following the WHO guidelines (2010) and sperm DNA fragmentation was also analyzed by the sperm chromatin dispersion method (SCD). From all this data, the current thesis explores the semen quality in young males, approaching the problem from different perspectives. In the first study, the association between dietary intake of antioxidant nutrients and semen quality was studied. The results indicated a positive association between the consumption of various antioxidant nutrients (cryptoxanthin, vitamin C, lycopene and b-carotene) and total motile sperm count. The seminal volume also increased with a higher intake of vitamin C, lycopene and b-carotene. In conclusion, our study suggested that some sperm parameters could be sensitive to the intake of antioxidant nutrients, and that the current recommended intake of vitamin C may be insufficient to achieve the maximum benefit in terms of semen quality. In the second study, the aim was to examine whether semen quality has changed among Spanish young men in the last decade. To carry out this study we used data obtained in a previous study in Almeria between 2001 and 2002. This data was added to our current population in order to analyze the sperm quality trend in Southern Spain. Multiple linear regression models were used to analyze the combined effect of population birth cohort during the study´s period 2001-2011. Our results indicated that the total count and sperm concentration may have decline in young Spanish men over the last decade, showing an adverse temporal trend in these parameters. Southern Spain has recently gone through a growing innovation and industrialization in many areas, and with this, an increased risk of potential adverse exposures, which might affect reproductive parameters in men. In the third study, the sperm DNA fragmentation was studied in young men. Such fragmentation could be related to oxidative stress and compromise semen quality. On the one hand, sperm DNA fragmentation (SDF) of the samples after ejaculation was analyzed, which was named as basal SDF. On the other hand, the dynamics of sperm DNA fragmentation, that is the increase of DNA fragmentation after ejaculation time was studied. To study the dynamics, samples were incubated at 37°C for 2.5, 17 and 24 hours and the rate of sperm DNA fragmentation (SDF rate; rSDF) was calculated. The results showed average values of basal SDF relatively high compared with other published studies. The rSDF was higher during the first hours after ejaculation. Besides, the samples with basal SDF higher to 30% showed an elevated rSDF during the first hours of incubation compared with the samples with basal levels lower than 15 %.
Aparicio, Cinthia Paola, Pablo Emanuel Caramia, and Roberto Carlos Ferreyra. "Reingreso de pacientes a la guardia general del Hospital del Carmen para la reinstalación de sonda nasogástrica." Bachelor's thesis, Universidad Nacional de Cuyo. Facultad de Ciencias Médicas. Escuela de Enfermería, 2018. http://bdigital.uncu.edu.ar/12783.
Повний текст джерелаFil: Aparicio, Cinthia Paola.
Fil: Caramia, Pablo Emanuel.
Fil: Ferreyra, Roberto Carlos.
Orozco, Montes Javier. "Utilidad de la lidocaína intravenosa para reducir la tos tras la extubación en pacientes fumadores intervenidos de cirugía electiva bajo anestesia general." Doctoral thesis, Universidad de Murcia, 2015. http://hdl.handle.net/10803/334164.
Повний текст джерелаThe aim of the present study was to assess whether intravenous lidocaine at a dose of 1 mg/kg (ideal weight-adjusted) decreases the risk of cough and its severity after extubation. We also evaluated the effect on respiratory complications, as well as a potential impact with regards to the attenuation of hemodynamic changes and SatO2 that occur after removal of the endotracheal tube, the improvement of the subjective quality of extubation, the reduction of postoperative pharyngeal discomfort and its safety. Material and methods Observational, cohort study carried out from May to September 2015 at Hospital General Universitario Santa Lucia in Cartagena. We consecutively recruited 106 patients who were active smokers (≥ 10 cigarettes/day), aged 18 to 69 years, ASA I-II, scheduled for elective surgery under general anesthesia with tracheal intubation. Exclusion criteria were: allergy or contraindication to lidocaine, interruption of smoking, recent infections of respiratory tract, anticipated difficult airway, gastroesophageal reflux, hypersalivation, difficult swallowing, epilepsy, current or previous airway surgery, pregnancy or breastfeeding, and refusal to participate in the study. At the end of the surgery, prior to the administration of neuromuscular blockade reversor, the anesthesiologist administered intravenous lidocaine 1 mg/kg by weight ideal (lidocaine group) or saline (reference group). A blind observer recorded the presence of cough and its severity after extubation. Respiratory complications, the subjective quality of extubation, vital signs, cough during transportation and resuscitation, and pharyngeal discomfort were also recorded. Results The administration of IV lidocaine was associated with a lower probability of cough after extubation in active smokers (OR -odds ratio- = 0.33; 95% CI 0.13-0.87, p = 0.024). In addition, lidocaine was associated with a reduction of the incidence of moderate to severe cough (OR= 0,28, 95% CI 0,09 – 0,84, p = 0.024). Patients in the lidocaine group had less cough during the transfer to resuscitation (p < 0.001), improved subjective quality of extubation (p = 0.003) and better SatO2 income in resuscitation, without presenting any complication due to its administration. No significant differences are found in the perioperative hemodynamic variations nor in postoperative pharyngeal discomfort. Conclusions Intravenous lidocaine administered prior to extubation has proven to be useful with regards to the appearance and severity of cough after extubation.
Aguilar, Riveros Jacqueline Beatriz. "Experiencia de enfermedad y su asociación con calidad de vida a salud general y oral en mujeres chilenas con Síndrome de Sjögren." Tesis, Universidad de Chile, 2019. http://repositorio.uchile.cl/handle/2250/170963.
Повний текст джерелаIntroducción: El Síndrome de Sjögren (SS) es una enfermedad autoinmune crónica caracterizada por una disminución o pérdida en la producción de secreciones glandulares, que se manifiesta principalmente con síntomas de sequedad ocular y oral, junto con fatiga y dolor musculoesquelético. El SS afecta la cotidianidad y reduce de forma significativa el estado de salud, provocando un cambio importante en el quehacer de las personas, alterando la calidad de vida en múltiples ámbitos. Para comprender mejor la implicancia del SS, resulta necesario analizar la perspectiva del paciente según sus propias experiencias de enfermedad (EE) y la alteración en su calidad de vida, por lo que esta investigación tiene como objetivo determinar el grado de concordancia entre las EE y la asociación entre calidad de vida en relación a salud general y oral en mujeres chilenas con síndrome de Sjögren. Materiales y métodos: Participaron 31 mujeres voluntarias con diagnóstico confirmado de SS entre los rangos de 18 y 70 años, las cuales debieron evaluar 70 experiencias de enfermedad en relación al síndrome, en base a una escala Likert según su grado de acuerdo y desacuerdo. Además, respondieron dos cuestionarios el EQ-5D-5L y OHIP-14Sp. En estos tres instrumentos se utilizaron tablas de frecuencia de datos, análisis estadístico de tendencia central en base a la media y desviación estándar. Para el grado de concordancia de las EE se utilizó la prueba Wilcoxon y para la asociación entre las variables se usó el coeficiente de correlación de Spearman. Resultados: En el 62,9% del total de las afirmaciones, existió concordancia entre las voluntarias. En el EQ-5D-5L las dimensiones con mayores problemas fueron las de “Dolor/Malestar” y “Actividades habituales”, mientras que en el OHIP-14Sp fueron las de “Dolor físico” y “Malestar psicológico”. No se determinó una correlación significativa entre la salud actual y la calidad de vida en relación a salud oral. Conclusiones: Existe una alta concordancia de las experiencias de enfermedad entre las mujeres con SS. Además, la calidad de vida en relación a salud general y oral, sí se ven afectadas, aunque no se observó una asociación entre salud actual y calidad de vida oral.
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Campos, Torres Sara Rosa. "Reglamento de la Ley General de Inspección del Trabajo: Régimen de Infracciones y Sanciones en Materia de Seguridad y Salud en el trabajo." Derecho & Sociedad, 2017. http://repositorio.pucp.edu.pe/index/handle/123456789/119164.
Повний текст джерелаRuiz, Cano Domingo. "Mejora de la composición y calidad nutritiva del pastel de carne de Murcia y su repercusión sobre la salud." Doctoral thesis, Universidad de Murcia, 2016. http://hdl.handle.net/10803/374250.
Повний текст джерелаLos alimentos artesanales son ampliamente reconocidos como una parte importante del patrimonio nutricional, gastronómico y cultural de los diferentes países. Sin embargo, muchos de estos productos artesanales, tales como los productos procesados de carne picada, a veces son percibidos como nutricionalmente desequilibrados, debido a su alto valor calórico y contenido de grasa. En la actualidad, el Pastel de carne de Murcia es un alimento típico de la gastronomía de la Región de Murcia, que se elabora diariamente en obradores artesanales, localizados en los propios establecimientos, donde se vende directamente al consumidor. En general, se tratan de pequeños negocios familiares o con un escaso número de trabajadores, que elaboran sus productos con materias primas naturales, mediante procesos manuales o con ayuda de pequeños utensilios y equipos. Según la información aportada por la Asociación de Empresarios de Pastelerías de Murcia (AREPA), del total de pastelerías asociadas a la misma (30), el 90% de éstas elaboran y venden diariamente el Pastel de carne de Murcia. Lógicamente, dependiendo del tamaño, de la localización y del prestigio de estas pastelerías, el número de unidades de Pastel de carne de Murcia vendidas a la semana varía ampliamente entre establecimientos (250-5.000 unidades/semana). Estas cifras pueden dar una idea de la importancia del consumo de Pastel de carne de Murcia en la Región de Murcia, que es más frecuente en días festivos y en diferentes celebraciones, y que se extiende entre los diferentes grupos de población, desde niños a personas mayores. Si bien, el Pastel de carne de Murcia es un alimento ampliamente conocido y muy valorado de la gastronomía murciana, actualmente no existen en la bibliografía científica, según nuestro conocimiento, estudios sobre el valor nutricional y energético de este producto. Debido a su contenido en proteínas de alta calidad (11%), este alimento podría sustituir a otros platos de carne, y ser incorporado en una dieta equilibrada. Sin embargo, su valor energético total, el contenido de energía de la grasa y el contenido de grasa saturada representan límites muy importantes para su consumo en una dieta equilibrada. La reformulación de los alimentos artesanales a través de la selección adecuada de uno o varios de sus ingredientes, con el objetivo de mejorar sus propiedades saludables, podría ser una estrategia efectiva para evitar la desaparición de algunos de estos productos tradicionales, que se han consumido durante siglos en diferentes partes del mundo. Otro aspecto de gran interés en la actualidad es el desarrollo de alimentos con propiedades funcionales, que le confieren al producto un valor añadido. Es por ello, que en el presente proyecto se ha incluido un estudio con el fin de seleccionar un ingrediente funcional, rico en fructooligosacáridos (inulina), que sea de utilidad para la elaboración de alimentos funcionales, a partir de un subproducto de alcachofa. El estudio demuestra que es posible mejorar las características nutritivas y saludables de los alimentos artesanales, mediante una mejor selección de alguno o algunos de sus ingredientes, tales como la carne de ternera picada y la manteca de cerdo, sin que dicha modificación suponga una reducción significativa de sus propiedades sensoriales originales. Por otro lado, el ingrediente funcional añadido en una concentración del 5%, sustituyendo a la harina de trigo en la base del pastel, representa una mejora factible en las características funcionales del alimento estudiado. Estas mejoras pueden contribuir, sin duda, a mantener este tipo de alimentos tradicionales y a evitar la pérdida en la cultura, identidad y herencia gastronómica de España en general y de la Región de Murcia en particular.
Artisan foods are widely recognised as an important part of the nutritional, gastronomic and cultural heritage of different countries. However, many of these artisan products are perceived as nutritionally unbalanced due to their high caloric value and fat content. Nowadays, the meat pie of Murcia is a typical food of the Murcia’s Regional gastronomy, which is elaborated daily in artisan workshops, where they are directly sold to the consumer. They are generally small family companies with few employees that elaborate their products with natural raw materials through hand processing or with the help of small tools and equipment. According to the information provided by the Murcia’s bakers association (AREPA) from the number of affiliated members, a 90% of artisan meat pies are made and sold daily. The number of pieces of Murcia’s meat pie sold weekly varies widely among establishments, depending on their size, location and reputation (250-5.000 units/week). Those numbers can give an idea of the importance of the consumption of the Murcia’s meat pie in the region, being more frequent during celebrations. Moreover it is consumed by any population group, from children to the elderly. Although the meat pie of Murcia is a food very well known and appreciated in the Murcia’s gastronomy, currently the scientific literature lacks studies on the nutritional and energy values of this product. Due to its content in high quality proteins (11%), this food could replace other meat dishes and can be incorporated into a balanced diet. However, its total energy value, energy from fat, and saturated fat content represent very important limits for their consumption in a balanced diet. The reformulation of artisan foods though the adequate selection of one or more of their ingredients with the aim of improving their healthy properties, is a possible effective strategy to avoid the disappearance of some of these traditional products, that have been consumed for centuries all over the world. Another aspect of interest currently is the development of foods with functional properties which confer an added value to the products. That is the reason for including in this Project a study with the aim of selecting a functional ingredient, rich in fructooligosaccharides (inulin) that could be useful for the elaboration of functional foods from a by-product of artichoke. This study demonstrates that it is possible to improve the nutritional and healthy characteristics of artisan foods, through a better selection of some of the ingredients such as the minced beef meat and the pork fat without a significative reduction on its original sensory properties. On the other hand, the functional ingredient added in a concentration of 5% (wheat flour basis) to the bottom part of the meat pie, represents a feasible improvement of the functional characteristics of this food under research. Those improvements could contribute undoubtedly to avoid a loss of the cultural identity to preserve this type of traditional foods avoiding the loss of cultural identity and gastronomic heritage in Spain and particularly in the Region of Murcia.
Escobar, Gómez-Villalba Fernando. "Efecto de un programa escolar de intervención nutricional y conductual sobre los niveles de vitamina D y síndrome metabólico del adolescente." Doctoral thesis, TDR (Tesis Doctorales en Red), 2015. http://hdl.handle.net/10803/334412.
Повний текст джерелаIntroduction: Child and adolescent obesity is a serious public health concern, involving severe comorbidities if the obesity endures into adulthood. The increase in child and adolescent obesity responds, among other factors, to environmental factors that emphasize poor dietary habits and an increasingly sedentary lifestyle. Moreover, obesity is considered a risk factor for developing vitamin D deficiency, interacting with insulin resistance and inflammation. Our working hypothesis draws from the increase in the prevalence of excess weight and obesity in children and adolescents and the high prevalence of vitamin D deficiency in this population and the need for intervention measures. We will assess the effect of an educational program for nutritional and behavioural intervention (PNBI) on weight and levels of vitamin D in adolescents from Granada. Objectives: To study the prevalence of overweight and obesity, dietary habits, vitamin D levels and parameters of the metabolic syndrome (MS) in a representative sample of adolescents from Granada. To develop an Educational Program for Nutritional and Behavioural Intervention (PNBI) and study the above parameters before and after developing the PNBI. Subjects and Methods: We selected a total of 2246 students from E.S.O. (Compulsory Secondary Education) (1102 males), aged between 12 and 16 years, belonging to schools in the city of Granada and nearby towns. A total of 263 students were randomly selected to participate in the PNBI during the school year. The PNBI was based on the teaching of nutritional recommendations for age and dietary changes as well as lifestyle adjustments by fortnightly lessons of 45 minutes. In addition, each day, they received a Mediterranean breakfast at school that assured they receive 200 IU of vitamin D. At the beginning and end of the school year (May and September respectively), the body mass index (BMI) and the waistline perimeter was determined. They were also surveyed about their dietary habits by using a frequency test about the consumption of valid foods and about exercise habits. In addition, body composition was studied by impedance measures, by measuring blood pressure, and serum determinations of glucose, vitamin D, cholesterol (LDL and HDL), and triglycerides. Results: We found a prevalence of overweight of 22.8% in men and 15.8% in women and 6.7% of obesity in men and 3.1% for women. After the intervention, the prevalence of overweight decreased among both male and female students (21.3% vs. 31.5%, p <0.001 in males; 14.0% vs. 21.7%, p <0.001 for women). The prevalence of obesity decreased in both male (5.5% vs. 7.9%, p <0.001) and females (3.9% vs. 4.7%, p <0.001). After the intervention, both sexes significantly decreased total energy volume and total fat intake (p <0.001). A significant increase in lean mass was observed in males and females and the percentage of students with MS criteria was significantly lower after the PNBI (32% vs. 19.7%, p <0.001). Prior to the intervention, 18.7% of adolescents had vitamin D deficiency, and 38.3% had insufficiency. After the intervention, the prevalence of vitamin D deficiency is reduced to 0.46% (p <0.0001) and vitamin D insufficiency to 19.1% (p <0.0001). The effect of the intervention program on the values of vitamin D depends on the BMI (p <0.006), fat mass (p <0.05), linoleic acid consumption (p <0.03) and plasma cholesterol. Conclusions: Spain currently has a high prevalence of excess weight and obesity that places it as one the top countries in the European Union with this problem. The Educational Program for Nutritional and Behavioural Intervention significantly decreases the prevalence of overweight and obesity in adolescents of both sexes, changing dietary habits and lifestyle, changing body composition and decreasing the prevalence of MS. The prevalence of insufficiency and vitamin D deficiency found in healthy adolescents is high. After the PNBI, vitamin D deficiency is corrected and insufficient vitamin D is significantly reduced. The effect of PNBI on serum levels of 25 (OH) D is related to weight and body fat. Increased waist circumference is a risk factor for developing the adolescent insufficiency or deficiency of vitamin D.
Chumpitaz, Chávez Yessica Lizeth. "Nivel de funcionalidad en actividades básicas e instrumentales de la vida diaria del adulto mayor del club “Conjunto residencial de San Juan de Miraflores Lima, Perú - 2013”." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2014. https://hdl.handle.net/20.500.12672/10258.
Повний текст джерелаTesis
Pertegal, Ruiz Miriam. "Estudio del papel del polimorfismo Val108/158 Met del gen humano de la catecol-O-metiltransferasa y su producto, el 2-metoxiestradiol, en el origen y fisiopatología de la preeclampsia." Doctoral thesis, Universidad de Murcia, 2015. http://hdl.handle.net/10803/301279.
Повний текст джерелаThe objectives of this thesis were on one hand to assess the association between fetal and maternal catechol-O-methyltransferase (COMT) Val108/158Met functional polymorphism and the risk of developing preeclampsia (PE), examining the influence of this polymorphism in expression and activity of placental COMT enzyme and in maternal plasma levels of its product, 2-methoxyestradiol (2ME), in both control and preeclamptic pregnant women. On the other hand, we analyze whether 2ME levels are associated with different clinical severity index and biomarkers of PE. We conducted an observational, analytical and prospective case-control study in 126 pregnant women (53 preeclamptic and 73 normal pregnancies) recruited at the Hospital Clínico Universitario Virgen de la Arrixaca in Murcia from January 2010 to January 2012. Blood samples of pregnant women were taken before delivery and, immediately after, cord blood (fetal) and placental tissue fragments were taken. Blood samples were used for genotyping studies, and to measure maternal levels of 2ME, and different biomarkers related to PE (homocysteine, sFlt1, PlGF). Moreover, we made the analysis of expression and enzymatic activity in vitro of COMT in placental tissue. Finally, we obtained clinical and laboratory data from the clinical history of patients. The main results of this work show that the genotype met-met was twice as frequent in fetal blood from patients with PE as in controls. The adjusted odds ratio (ORajt) for the risk of PE in these women was 3.22 [95% confidence interval (CI): 1.01 -10.28]. Analyses of maternal COMT polymorphism did no reveal a significant increased risk of PE, and either added nothing COMT haplotypes analysis. When analyzing the enzyme activity in vitro, it was determined by fetal Val108/158Met polymorphism, being lower for met-met genotype than for val-met and val-val both the total population and preeclamptic. The COMT activity in vitro did not differ between control and preeclamptic pregnant women within each genotype. The expression of soluble COMT was lower for the met-met genotype in both subpopulations and this expression was inversely correlated with in vitro activity values, then such activity may be determined by the amount of protein. Placental expression of soluble COMT not differ between controls and preeclamptic within each genotype In respect to in vivo activity, we found no association between the polymorphism studied and levels of 2ME in maternal plasma, however those values were significantly decreased in women with PE compared to control (1818.41±189.25 pg/ml versus 2906.43±200.69 pg/ml). In addition, there were a higher plasma homocysteine levels in preeclamptic women conditioning them at increased risk of PE, and correlated inversely with the values of 2ME in total population, which could contribute to the lower COMT activity in vivo observed in PE. On the other hand, plasmatic 2ME values were significantly correlated with different clinical and laboratory parameters of severity of the syndrome such as higher peak systolic blood pressure, the need for more aggressive antihypertensive therapeutic, lower birth weight or early onset of PE. Finally, maternal 2ME levels were also correlated (in patients with PE and in total population) with known angiogenic imbalance factors present in PE as sFlt1 or PlGF, suggesting that 2ME could be a key factor in maintaining the balance angiogenic necessary for the proper development of gestation.
Omonte, Gutiérrez Johan Rolando. "Características clínicas y epidemiológicas de los pacientes sometidos a tratamiento odontológico integral bajo anestesia general en el Instituto Nacional de Salud del Niño, 2010." Bachelor's thesis, Universidad Nacional Mayor de San Marcos, 2011. https://hdl.handle.net/20.500.12672/2826.
Повний текст джерелаTesis
Mogollón, Pérez Amparo Susana. "Acceso de la población desplazada por conflicto armado a los servicios de salud en las empresas sociales del estado de primer nivel de la ciudad de Bogotá, Colombia." Doctoral thesis, Universitat Autònoma de Barcelona, 2004. http://hdl.handle.net/10803/4604.
Повний текст джерелаMetodología Se realizó un estudio cualitativo descriptivo de tipo exploratorio. Se aplicaron tres técnicas: análisis documental, entrevista individual semiestructurada y estudio de caso. La composición final de la muestra fue de 28 documentos: 17 políticas públicas relativas al manejo del desplazamiento forzado en Colombia, 11 promulgadas por el Sistema General de Seguridad Social en Salud (SGSSS) y 81 informantes procedentes de 3 ESE: gestores (10); profesionales de la salud (25), personal administrativo (18) y usuarios desplazados (28). El estudio de caso correspondió a una mujer desplazada, usuaria de una ESE. Se utilizó la técnica de análisis narrativo del contenido, con una generación mixta de categorías y segmentación por tipo de informantes y categorías. El área de estudio lo constituyeron cuatro localidades de Bogotá. El trabajo de campo se efectuó durante los meses de abril a diciembre de 2003.
Resultados: Son principios orientadores de la política: la definición del desplazamiento forzado como un evento catastrófico, el reconocimiento de la atención en salud como un derecho fundamental, la atención preferencial para la población vulnerable y la gestión interinstitucional. Como objetivos surgen: afiliar a la población desplazada al SGSSS, brindar atención integral en salud y divulgar las políticas existentes. Estos objetivos, junto con los principios se constituyen en facilitadores del acceso potencial a los servicios de salud. No obstante, los procesos establecidos para identificar a los beneficiarios, la falta de claridad en la financiación, la restricción en los servicios garantizados y los cambios continuados en las disposiciones emergen como los factores que desde el contenido de la política y desde la percepción de los distintos actores, restringen el acceso potencial a las ESE. Todos los actores identificaron fallas tanto en la divulgación de la política, como en su implementación a nivel de las diversas instancias. En cuanto a las dificultades procedentes de las instituciones, los gestores y el personal administrativo, indican los límites en la financiación y la facturación de los servicios, en tanto que, el personal de salud y la población desplazada centran su análisis en los problemas para la prestación efectiva del servicio y el acceso geográfico. Los distintos actores coinciden en que el bajo nivel de ingresos del desplazado, unido al bajo nivel de información, a las múltiples necesidades de atención en salud y a la escasez de redes de apoyo social, son los factores relativos a la población desplazada que inciden en su acceso a las ESE.
Conclusiones: Durante el periodo 1997-2003, Colombia realizó un avance significativo en la formulación de la política de atención en salud para la población desplazada, buscando que sus principios y sus alcances, estuvieran acordes con los lineamientos del SGSSS. No obstante, las dificultades para la afiliación y el posterior acceso a las ESE, se constituyen en la principal ruptura que presenta la política. El desconocimiento de los cambios y los alcances de la política de atención en algunos prestadores de servicios y en la gran mayoría de los desplazados, reflejan las fallas del gobierno nacional y las instituciones de salud en su divulgación. La búsqueda del equilibrio financiero de las ESE, se constituye en una de las principales barreras que desde las instituciones limitan la atención integral. Las precarias condiciones económicas son el principal factor que desde los usuarios restringe el acceso potencial y real a las ESE, situación que se complejiza en quienes no han logrado su afiliación al SGSSS.
Objective: To analyse conditions of access to public first level healthcare services (Empresas Sociales del Estado; (ESE) in Bogota, of an internally displaced population due to armed conflict, in order to establish potential areas of improvement
Methods. An exploratory, descriptive, and qualitative study was carried out by means of documental analysis, individual semi-structured interviews, and a case study. The final sample was: 28 documents, of which 17 were public policies relating to management of forced displacement in Colombia and 11 policies directly issued by the General Social Security System in Health (SGSSS); 81 informants of 3 different ESE (10 managers; 25 health professionals; 18 administrative staff and 28 internally displaced users); and, a case study of a displaced woman user of an ESE. A narrative content analysis was conducted with a mixed generation of categories and segmentation by types of informants and categories. Four localities of Bogotá made up the area of study. Field work was carried out from April to December 2003.
Results: Definition of forced displacement as a catastrophic event, acknowledgement of health care as a fundamental right, preferential care to vulnerable population and inter-institutional management, are the basic policy principles. The following main objectives emerged: to affiliate internally displaced population to the SGSSS; to provide integral health care to the displaced population; and to disseminate existing policies. Those objectives together with the above mentioned principles can be considered as enabling factors for potential access to healthcare of the displaced population. However, established processes for beneficiaries identification, lack of clarity in financing, restrictions in guaranteed services and continuous changes in dispositions emerged as factors that, from the policy and actors viewpoint, limit potential access to ESE. All actors identified problems in policy dissemination and implementation at the various levels of the system. As barriers to access coming from the health institutions, managers and administrative personnel indicated limits in financing and in actual payment collection, whereas health personnel and service users focused their analysis in the problems for effective care provision and geographical barriers. All actors agreed in considering low income together with lack of information, multiple health needs, and scarce social networks as factors relating the displaced population that affect their access to ESE.
Conclusions: During the period of 1997 to 2003 Colombia experienced significant progress in policy formulation for health care to internally displaced populations, striving for principles and contents in line with those of the SGSSS. However, difficulties in affiliation and subsequent access to ESE constitute the main policy rupture. The lack of knowledge on health care policy changes and contents of part of health personnel and the majority of displaced users indicate Government and health institutions failure in disseminating it. The search for an ESE's economic balance becomes one of the main institutional barriers for integrated health care. Poor economic condition is the main user factor that limits potential and actual access to ESE, condition that becomes more complex among those not affiliated to SGSSS.
Gómez, Martínez María Dolores. "Actitudes ante el documento de instrucciones previas, deseos al final de la vida y preferencias de tratamiento de soporte vital en población general." Doctoral thesis, Universidad de Murcia, 2016. http://hdl.handle.net/10803/362373.
Повний текст джерелаIntroduction Advance Directives mean a reaffirmation of citizens’ autonomy in times of disability for taking decisions. Spain, in spite of the great legislative development in this subject, shows a limited knowledge and use of Advance Directives among the population. Objective To evaluate knowledge, completion rates and attitude towards Advance Directives for users of the Murcia Health Service, as well as to analyse their wishes of care at the end of life and preferences for life support treatment. We also perform research into the predisposition of citizens towards organ donation for transplantation and associated factors. Material and methods Descriptive cross-sectional study developed in Primary Care Centres from Health Areas I, III, IV and VII from the Murcia Health Service, from September 2012 to June 2013. An ad hoc designed survey was used as a tool for gathering data. That survey, filled in by the participants, contained sociodemographic variables from users, variables related with their health and life experiences, as well as the level of knowledge, completion rates and attitude towards Advance Directives, and their wishes of care at the end of their lives. Preferences for life support treatment were gathered by a Life Support Preferences Questionnaire (LSPQ). The studied population was made up of users of the Murcia Health Service that went to Primary Care Centres. 1200 surveys were delivered, of which1051 were completed. Results The mean age of participants was 39.65 years (SD: 14,46; Range: 18-87), 60,1% were women. 56,3% had a university education, 92,6% were Spanish and 72,2% declared themselves as Catholic. 52,6% expressed having a good or very good state of health, and 27,4% had suffered the loss of a relative in the last year. 65,7% did not know Advance Directives, and just 3,3% had completed it. 24,8% would do it in the three next months. After logistic regression analysis, low education level, lack of chronic disease and lack of labour activity were the primary factors relating to the lack of awareness of the document. 47,8% had at some point thought about how they would like to be treated at the end of their lives; 88,2% would talk about this with their families; 42,6% had discussed it at some point. 50% would like their doctor to ask them about this. 74,2% would prefer to die in their home and 45,6% would like to be buried. 71,8% would donate their organs for transplantation, and the factors that seemed to be related to an unfavourable attitude towards donation were low level education, being a foreigner, being male and having a bad state of health. Participants showed a positive attitude towards life support treatments, apart from the case of a very bad prognosis, factors related to the rejection of treatment were found to be age, religious beliefs and life experiences. Conclusions There is a lack of knowledge and use of Advance Directives among the population, making clear the need to start training projects for professionals as well as promotion projects among the citizens. Communication about citizens’ wishes at the end of their lives does not reach desired levels in medical consultations or families, so it must be improved in order to get a proper Advanced Care Planning. Although the population predisposition for organ donation for transplantation reaches considerable levels, institutions must continue encouraging donation. Multiple factors and circumstances have influenced in preferences for life support treatment, therefore health professionals must explore the wishes of patients and keep in mind their individual characteristics.
García, García Juan. "Perfil epidemiológico de las gestantes inmigrantes y autóctonas. Hospital General Universitario de Albacete, 2009." Doctoral thesis, Universidad de Alicante, 2011. http://hdl.handle.net/10045/20501.
Повний текст джерелаSalazar, Tello Roxana Rocío. "Nivel de conocimiento sobre derechos en salud y su relación con el cumplimiento en la atención desde la perspectiva de los padres de pacientes hospitalizados en el Servicio de Cirugía General del Instituto Nacional de Salud del Niño- Breña 2017." Master's thesis, Universidad Nacional Mayor de San Marcos, 2019. https://hdl.handle.net/20.500.12672/10531.
Повний текст джерелаTesis
Egea, Cánovas Elisa. "Estudio de prevalencia, factores de riesgo del Síndrome de Burnout y encuesta de satisfacción laboral en personal sanitario de un área de salud de la región de Murcia." Doctoral thesis, Universidad de Murcia, 2015. http://hdl.handle.net/10803/310222.
Повний текст джерелаIn the current financial crisis, the health personnel is under pressure from superiors, users and oneself. Job insecurity, demanding workloads and the lack of resources and staff, are responsible for the so increasingly burnout syndrome. The aim of the thesis is to analyze if the dimensions of the Burnout Syndrome (Emotional Exhaustion, depersonalization and professional accomplishment) is statistically significantly associated with major demographic and personal variables of health workers in our health area. To do so, we propose to establish the prevalence, describe the sociodemographic characteristics of respondent professionals, identify potential risk factors, thus facilitating early detection and prevention and assessing the degree of job satisfaction among healthcare staff participating in the study. METHODOLOGY: The study was carried out in the Health Area VI of the Regional Health Service in Murcia. Between February 1 and April 30, 2014, questionnaires were distributed among staff. Burnout syndrome was studied by the Spanish version of the Maslach Burnout Inventory and it was also ran a survey of job satisfaction. Both the questionnaire and the job satisfaction survey were anonymous and delivered personally or by coworkers, being then collected in a mailbox anonymously. Statistical analysis was performed using SPSS v.15 software. and Epidat 4.1. The satisfaction survey was evaluated using a Likert scale with scores of 1-4. CONCLUSIONS: 1.- We have observed a statistically significant relationship between the dimensions of burnout syndrome and certain socio-demographic characteristics of health personnel. 2.- The prevalence of burnout syndrome in health workers Health Area VI of the Region of Murcia is high in depersonalization and intermediate in personal accomplishment and emotional exhaustion. 3.- There are sociodemographic factors associated with the development of burnout syndrome. 4.- Detecting the existence of these factors could contribute to early diagnosis and / or prevention of this syndrome. 5.- The job satisfaction survey shows that the overall satisfaction is good, especially concerning peer relationships.
Waschgler, Kathrin. "Estrés laboral : hostilidad percibida en el personal sanitario y variables psicosociales relacionadas." Doctoral thesis, Universidad de Murcia, 2015. http://hdl.handle.net/10803/313228.
Повний текст джерелаEl objetivo del presente estudio es el desarrollo y la evaluación psicométrica de dos instrumentos específicos que permiten la evaluación del fenómeno de la hostilidad (workplace bullying y violencia) percibida en personal sanitario, utilizando para ello una metodología cualitativa y cuantitativa rigurosa. En primer lugar se estudia el workplace bullying y la violencia en personal sanitario desde una perspectiva cualitativa, elaborando y validando semánticamente un banco de items pertenecientes a los tres focos de hostilidad: superiores, compañeros y usuarios, como primera fase del desarrollo de dos instrumentos de evaluación específicos. La segunda fase cuantitativa del estudio, trata del desarrollo y de la evaluación psicométrica del instrumento HABS-U (Hospital Aggressive Behaviour Scale- Users) el cuál permite evaluar las conductas violentas hacia el personal sanitario por parte de los usuarios, como son los pacientes y familiares. Formando parte de la fase cuantitativa del estudio, diferenciando entre los actores de este fenómeno, este compendio finaliza con el desarrollo y la evaluacion psicométrica de una escala de evaluación del workplace bullying por parte de los compañeros y superiores (HABS-CS, Hospital Aggressive Behaviour Scale - version Co-workers-Superiors). Es de destacar el elevado tamaño muestral de 1,484 sanitarios de todos los hospitales públicos de la Region de Murcia y la elevada tasa de respuesta (81,36%). Los instrumentos resultantes de 10 y 17 ítems, muestran adecuadas propiedades psicométricas pudiendo ser útiles en el ámbito de la prevención de riesgos psicosociales para indicar el tipo de intervención necesaria y también para valorar posteriormente la eficacia de programas de intervención. Aunque con este estudio se culmina en cierta medida el trabajo de investigación desarrollado, quedan abiertas varias perspectivas para el desarrollo de futuras líneas de investigación en este ámbito.
Work and stress: Workplace bullying and violence in nursing and the relationship with psychosocial factors Abstract Healthcare staff is one of the professional groups that suffers the highest exposure to sources of occupational stress such as workplace bullying from co-workers and superiors and violence from service- users. Aim: In order to contribute to the assessment of aggressive behaviours in the healthcare sector and to obtain brief and manageable instruments for the assessment of this psychosocial risk, we developed the Hospital Aggressive Behaviour Scale - version Co-workers-Superiors (HABS-CS) and the Hospital Aggressive Behaviour Scale – Users (HABS-U). Methods: Using qualitative and quantitative methodology, an instrument was applied to a sample of 1,489 nurses from 11 public hospitals of a south-eastern region of Spain (Murcia). Results: Exploratory factor analysis yielded a 10-item instrument (HABS-U) about service user violence distributed in two factors (non-physical violence and physical violence), which was validated by means of confirmatory factor analysis. Regarding the Hospital Aggressive Behaviour Scale - version Co-workers-Superiors (HABS-CS), the analyses concluded with the selection of 17 items. The internal 5-factor structure is the result of exploratory and confirmatory factor analysis conducted in two samples. The resulting questionnaires and the factors identified present adequate psychometric properties: high internal consistency and adequate external validity, analyzed by means of significant correlations between the HABS-CS, the HABS-U and psychosocial factors. Conclusion: The systematic use of both scales within the prevention of occupational hazards can be useful for the early detection of workplace bullying and violence from the organizational viewpoint, identifying the services at risk, and at the individual level, detecting conflicts among co-workers and superiors, where possible victims of workplace bullying could be identified. Another possible application of the instrument is its use as an indicator of the risk of psychological alterations due to exposure to violent behaviours at the workplace.
Clavel, Rojo Araceli. "Conocimiento del paciente acerca de la medicación prescrita : influencia de las fuentes de información y legibilidad de los prospectos." Doctoral thesis, Universidad de Murcia, 2013. http://hdl.handle.net/10803/119646.
Повний текст джерелаThe aim of this PhD research is to assess the factors which influence the patient knowledge of prescribed medication, analyzing sociodemographic and pharmacological variables of the patient, as well as different information sources ( in and outside the care environment) available to patients. It is therefore proposed the assessment of use, legibility and comprehension of the information package leaflet. A survey designed to that effect was used and it included sociodemographic variables of the patient, information of type of medication and length of the treatment, legibility of the information package leaflet (calculated by means of the Flesch-Szigriszt coefficient and Inflesz Scale degree), as well as patient prescribed medication knowledge. A prospectively observational, cross-sectional descriptive study was outlined. The data collection period was January- December 2011. The study population comprises patients and caregivers that went to the pharmacy with medical prescriptions issued by professionals of the Spanish Health Care System. The sample size, 450 users, was calculated for 4% accuracy and a 95% confidence level. The representative sampling of 81,1% patients and 18,9% caregivers, shows an average age of 54,21 years old (SD: 16,86; Range: 15-88), being 66% women. The 8,4% without studies, the 35,6% with primary education, 32% secondary studies and 24% with higher education. A 27,3% was multimedicated. The 51,1% of the respondent did not know the medication prescribed to him, and 25,3% had an unsatisfactory knowledge, 23,3% had a sufficient knowledge and 0,2% (just one patient) had a optimum knowledge. Following the assessment of knowledge by dimensions the Process of Using was the best well known by the patient (64,4%), followed by the Conservation (48%) and the Therapeutic Target. None of the patients answered all questions referred to Security correctly. Examined the regression analysis employed, the factors significantly associated to patient prescribed medication knowledge founded were: patient’s level of studies and reading of the package leaflet. 69,8% of the patients who repeated the medication treatment confirmed to have looked for information out of the care environment, being the information package leaflet, with 89,1%, the most referred source. Regarding package leaflet legibility, Flesch-Szigriszt coefficient was at 57,38 (standard deviation of 4,93%), corresponding to a normal legibility level according to the Inflesz Scale. Nevertheless, 27,5% of the package leaflet was in a level of little difficult legibility , and 1% of very difficult legibility level . On a global level, it can be concluded that 3 of 4 patients have insufficient knowledge about the prescribed medication. Reading the package leaflet (principal source of information referred by the patient, out of the care environment) decrease 1,5 times the risk to unknown the medication prescribed. Regarding level of studies, individuals without studies have 3,5 higher risk to unknown the medication prescribed if compared with individuals with university studies. Security scope is the least well–known by the patient, and therefore should be emphasized with an optimal and effective writing of the package leaflet as it refers to special precautions, adverse effects, contraindications and interactions. The figure of the Community Pharmacist, as the latest health professional before the patient takes the medication prescribed, should take a more active role as a source of information for the patient.
Nieto, Guindo Pablo. "Caracterización nutricional y de calidad de vida en pacientes de esclerosis múltiple." Doctoral thesis, Universidad de Murcia, 2014. http://hdl.handle.net/10803/284959.
Повний текст джерелаCharacterize nutritional condition and quality of life in patients with multiple sclerosis (ME), and their connection with the degree of physical capacity. Material and methods: It was carried out a study of descriptive and transversal type, on which 31 patients diagnosed of Multiple Sclerosis were included. Such patients belonged to the Integral Centre of Neurological Diseases of Albacete city or to the Multiple Sclerosis Association of Almería. For the nutritional characterization it was employed: a) Analytic data (classic biochemistry, lipid profile and hepatic profile; b) Anthropometric measures; c) Questionnaire of consumption frequency; d) 24 hour reminder; e) Nutrition questionnaire “Nutrition Screening Initiative Check List”. For the quality of life characterization it was employed: a) EuroQol-5D questionnaire; b) MSQOl-54 questionnaire; c) Barthel index ; d) Katz index ; e) Tinetti test to assess mobility and walk. Results: 14 patients showed a degree of slight physic disability and 17 patients a degree of moderate-severe disability. Patients with ME showed some values in the analytics (general biochemistry, lipid profile and hepatic profile) within the peak interval, without significant differences between the two study groups. Anthropometric data were similar in both groups. Paying attention to the degree of disability, there were not observed differences either in the nutritional assessment, carried out through Questionnaire of consumption frequency and 24 hour reminder. With regard to macronutrients, it was stressed a high contribution of lipids, mainly saturated fat acids, and a high content in proteins. Besides, it was a poor diet in carbohydrates and a bit low in fibre. With regard to micronutrients, content in zinc, iodine, folate and retinol was also found below the daily requirements. Through Nutrition Screening Initiative Check List Questionnaire it was checked that patients with a degree of moderate-severe disability showed a higher malnutrition risk than patients with a degree of slight physic disability, without that this difference were statistically significant. Patients with a degree of moderate-severe disability showed a lower assessment of quality of life than patients with a degree of slight disability. The dimensions on which there were observed statistically significant differences, were mobility (p=0.028), physic health (p=0.04), energy (p=0.019), health perception (p=0.026), quality of life as a whole (p=0.029) and physic dimension (p=0.026). Mental dimension was not seen so affected by the disability degree. Patients with a degree of moderate-severe disability showed a higher level of dependence than patients with a degree of slight disability, for executing daily life basic activities. With regard to Barthel index, the items more affected were: bathing, mobility, going up/down the stairs, and bladder control. With regard to Katz index, dependence level was higher in patients with a degree of moderate-severe disability, although without reaching the statistic significance. Patients with a degree of slight disability did not showed fall risk, however patients with a degree of moderate-severe disability had a high risk of falls. Conclusions: Nutritional characterization of ME patients is similar to both study groups. There exist imbalances in diet by an insufficient contribution of carbohydrates, zinc, iodine, folate and retinol. On the contrary, there exists a high consumption of proteins and fats. It is recommended to increase fruit consumption, vegetables, wholemeal cereals and to reduce butter consumption, pastries, sausages and other foods rich in saturated fats. Patients with a degree of moderate-severe disability show a worse mark on quality of life, a less capacity to carry out daily life basic activities and a higher risk of falls.