11 research outputs found
Changes in health related quality of life 3 months after an acute coronary syndrome
No full textAbstract Background The aim of the study was to identify the changes in Health Related Quality of Life (HRQL) 3 months after discharge from hospital, in patients who have had an acute coronary episode, and to determine the clinical and sociodemographic variables that explain those changes. Methods HRQL was assessed in 132 patients while they were admitted to the hospital and at 3 months after discharge, using the SF-36 health questionnaire. To identify the variables associated with the change, multiple linear regression models were constructed for two summary dimensions of the SF-36 (PCS and MCS) taking the change in the score of the dimension as dependent variable. Results There were no significant differences between the patients who completed the monitoring (n = 76) and those who were dropped out. After three months, a significant decrease was observed in the dimensions of physical functioning, general health, vitality, and Physical Summary Component (PCS). The variables revascularisation, age, and the interaction between previous history of coronary heart disease (CHD) and the presence of one or more risk factors explained 16.6% of the decrease in the PCS. The decrease in the PCS was 6.4 points less in the patients who had undergone revascularisation, 0.2 points less for each year of age, and 4.7 points less in the patients who had antecedents of the illness as well as one or more risk factors. Conclusion The dimensions most affected at three months after an acute coronary episode were those related to the physical component. Undergoing revascularisation improved the PCS in patients, but in the younger patients and those without personal antecedents or risk factors, the PCS was affected more, perhaps due to greater expectations for recovery in these patients.</p
A review of chronic pain impact on patients, their social environment and the health care system
No full textMaría Dueñas,1 Begoña Ojeda,2 Alejandro Salazar,2 Juan Antonio Mico,3 Inmaculada Failde,2 1Nursing Faculty “Salus Infirmorum”, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 2Preventive Medicine and Public Health Area, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 3Department of Neuroscience, Pharmacology, and Psychiatry, CIBER of Mental Health, CIBERSAM, Institute of Health Carlos III, University of Cádiz, Cádiz, Spain Abstract: Chronic pain (CP) seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives. Keywords: pain, everyday problems, social relationships, family environment, health service
Prevalence of Therapeutic use of Opioids in Chronic non-Cancer Pain Patients and Associated Factors: A Systematic Review and Meta-Analysis
No full textObjectives: To determine the prevalence and factors associated with the use of opioids among patients with chronic non-cancer pain (CNCP).
Methods: A systematic review and meta-analysis. Comprehensive literature searches in Medline-PubMed, Embase and SCOPUS databases. Original studies published between 2009 and 2019 with a cross-sectional design were included. The quality of the studies was assessed with Critical Appraisal Checklist for Studies Reporting Prevalence Data from the Joanna Briggs Institute. Protocol registered in the International Prospective Register of Systematic Reviews with reference number: CRD42019137990.
Results: Out of the 1,310 potential studies found, 25 studies fulfilled the inclusion criteria. Most of the studies were of high quality. High levels of heterogeneity were found in the studies included. In the general population, the prevalence of long-term opioid use was 2.3% (95% CI: 1.5-3.6%), the prevalence of short-term opioid use was 8.1% (95% CI: 5.6-11.6%), and among people with chronic low back pain it was 5.8% (95% CI: 0.5-45.5%). The prevalence of opioid use among patients from the health records or medical surveys was 41% (95% CI: 23.3-61.3%). Finally, in patients with musculoskeletal pain, the prevalence was 20.5% (95% CI: 12.9-30.9%) and in patients with fibromyalgia, 24.5% (95% CI: 22.9-26.2%). A higher prevalence of opioid use was observed among men, younger people, patients receiving prescriptions of different types of drugs, smokers and patients without insurance or with noncommercial insurance. In addition, non-white and Asian patients were less likely to receive opioids than non-Hispanic white patients.
Conclusions: The prevalence of opioid use among patients with CNCP was higher in subjects with short or occasional use compared to those with long-term use. Men, younger people, more chronic pain conditions, and patients without insurance or with noncommercial insurance were most related to opioid use. However, non-white and Asian patients, and those treated by a physician trained in complementary medicine were less likely to use opioids
Prevalence of central and peripheral neuropathic pain in patients attending pain clinics in Spain: factors related to intensity of pain and quality of life
No full textInmaculada Failde,1,2 María Dueñas,2,3 Maria Victoria Ribera,4 Rafael Gálvez,5 Juan A Mico,2,6,7 Alejandro Salazar,2,3 Helena de Sola,1,2 Concepción Pérez8 1Department of Biomedicine, Biotechnology and Public Health, Faculty of Medicine, University of Cádiz, Cádiz, Spain; 2Institute of Research and Innovation in Biomedical Sciences of the Province of Cadiz, Spain; 3Department of Statistics and Operational Research, Faculty of Sciences, University of Cádiz, Cádiz, Spain; 4Pain Clinic, Hospital Vall d’Hebrón, Barcelona, Spain; 5Pain Clinic, Hospital Virgen de las Nieves, Granada, Spain; 6Department of Neuroscience, Pharmacology and Psychiatry, Faculty of Medicine, University of Cádiz, Cádiz, Spain; 7CIBER of Mental Health, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain; 8Pain Unit, Hospital de la Princesa, Madrid, Spain Background: The objective of the study was to estimate the prevalence of pure central neuropathic pain (CNP) and peripheral neuropathic pain (PNP) among patients attending pain clinics in Spain. The study also aimed to analyze factors associated with pain intensity and quality of life (QoL). Methods: A cross-sectional study was performed including 53 patients with pure CNP and 281 with pure PNP attending in 104 pain clinics in Spain. The revised grading system proposed in 2008 to determine a definite, probable or possible diagnosis of NP was used. Pain features, psychological variables and QoL were assessed. Descriptive, bivariate and multivariate analyses were performed. Results: The prevalence of pure CNP and PNP amongst neuropathic pain patients was 2.4% (95% CI: 1.7;3.1) and 12.9% (95% CI: 1.5;14.3), respectively. Comorbid anxiety, depression or sleep disorders were high in both groups, but higher in CNP patients (51.1%, 71.4%, respectively). Pain intensity in PNP patients was associated with the presence of depression and sleep disturbances. However, in CNP patients, it was related with pain in the lower limbs. The impairment of QoL was greater in CNP patients than in PNP patients; pain location, presence of depression and sleep disturbance were the factors that most negatively affected QoL. Among PNP patients, women and those with higher pain intensity had worse QoL. Conclusion: Pain intensity and QoL are affected by different factors in patients suffering from CNP or PNP. Identifying these factors could serve to guide therapeutic strategies and improve the QoL of patients. Keywords: central neuropathic pain, peripheral neuropathic pain, pain intensity, quality of lif
Effectiveness of a physical exercise-based intervention delivered by an m-health system on biopsychosocial variables in patients with chronic pain from different origin
No full textObjectives The aim of the present thesis was to analyse the current situation of the use of m-Health technology for the self-management of chronic pain (CP) conditions and to evaluate the effectiveness of an m-Health system, called PainReApp, which was specifically developed to deliver a self-managed home exercise program (HEP) in a population with chronic low back pain (CLBP). To this end, we first carried out a systematic review of the literature (first paper), whose purpose was to analyse the current situation of the use of m-Health technologies for the self-management of CP conditions and its effects in terms of pain intensity, health-related quality of life (HRQoL), and functional disability. Second, we aimed to identify and compare physical activity (PA) levels according to the International Physical Activity Questionnaire (IPAQ) as well as the factors associated with each PA level among the general Spanish population diagnosed with CLBP (second paper). Subsequently, to achieve the main aim of the present thesis, we carried out a parallel-group, single-blinded, randomised controlled trial (RCT) with assessments of the participants at baseline, 3 months (T1), and 6 months (T2). This clinical trial was conducted between September 2021 and September 2023, and the target population included was people diagnosed with CLBP recruited and treated in the Rehabilitation Unit of the Hospital Universitario Puerta del Mar (Cádiz, Spain). From the baseline information of this study, we aimed to analyse the psychometric properties of the Pictorial Pain Interference Questionnaire (PPIQ), a measurement tool used to assess pain-related functional interference in people with CLBP (third paper). In relation to this, we identified factors potentially associated with pain-related functional interference in people with CLBP (fourth paper).Finally, to evaluate the effectiveness of the PainReApp application, we used longitudinal data (T1 and T2) from patients involved in the RCT. We compared this m-Health technology with the conventional intervention to deliver a self-managed HEP, in terms of pain-related, HRQoL, and biopsychosocial outcomes, in people with CLBP in outpatient settings (fifth paper).
Methods The systematic review of RCTs (first paper) was conducted following the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines. We included studies from four databases (PubMed, Web of Science, Scopus, and Physiotherapy Database [PEDro]). The eligibility criteria were based on the PICOS (Population; Intervention; Comparison; Outcomes; Study design) framework, as follows: (i) adults (>18 years) with any CP condition listed in the International Classification of Diseases 11th Revision (ICD-11); (ii) intervention includes mHealth systems based on mobile apps (monitoring pain, health-related outcomes, pain and behavioural self-management, and therapeutic approaches); (iii) comparison with conventional treatments or non-intervention; (iv) study outcomes: pain intensity, HRQoL, and functional disability; (v) study design corresponding to RCT. The methodological quality and risk of bias (RoB) of the included studies were assessed using the Checklist for Measuring Quality, the Oxford Centre of Evidence-Based Medicine Levels of Evidence (OCEBM), and Cochrane RoB 2.0.
To identify the PA level groups (low, moderate, and high) according to the IPAQ score in people with CLBP, we carried out a cross-sectional study using the 2017 Spanish National Health Survey (SNHS 2017) (second paper). A descriptive analysis was performed, and the Pearson Chi-squared, likelihood ratio, and Kruskal-Wallis tests were used to compare the characteristics of the subjects classified into the three PA levels. Furthermore, factors related to each PA level (dependent variable) were analysed using a stepwise ordinal regression model, including sociodemographic and social factors, health-related status, comorbidities, and health use as independent variables.
The third and fourth papers were based on baseline data from people with CLBP who were involved and participated in the RCT. In the third paper, the main outcome was pain-related functional interference using the PPIQ. The following data were also collected: sociodemographic, anthropometric and clinical outcomes, pain intensity (Numeric Pain Rating Scale [NPRS]); physical functioning (30-s Arm Curl [30ACT], 30-s Chair Stand [30CST], and Timed Up-and-Go [TUG] tests) and fitness (IPAQ); HRQoL (Short-Form 12 Health Survey [SF-12v1]); sleep quality (12-item Medical Outcomes Study Sleep scale [12-MOS Sleep]); anxiety and depression (Hospital Anxiety and Depression Scale [HADS]); and social support (Duke-UNK Functional Social Support Questionnaire [DUKE-UNC-DSSI]). Internal consistency was analysed using Cronbach's alpha, and structural validity was analysed using exploratory factor analysis (EFA). Furthermore, we used bivariate analyses for evaluating the discriminant and convergent validity through a total of 13 hypothesis: H1) The PPIQ score would be higher in females than in males, H2) It is directly correlated with age, H3) a higher pain intensity (NPRS), H4) a longer time on the TUG test, H5) a higher score on HADS-A, H6) HADS-D, and H7) on index-9 (12-MOS Sleep), H8) it is indirectly correlated with higher number of repetitions in 30ACT and H9) 30CST, H10) a higher score on DUKE-UNC-DSSI, and H11) SF-12v1, H12) with higher total PA (metabolic equivalent of task [METs]), and H13) higher PA levels.
In the fourth paper, with the same study population (CLBP), a descriptive analysis was performed, the Pearson or Spearman correlation coefficients, and t-test and ANOVA tests were used to analyse the relationship between the PPIQ score (pain-related functional interference) and the rest of the study outcomes (sociodemographic data; pain intensity [NPRS], physical functioning [30ACT, 30CST, and TUG test] and fitness [IPAQ]; HRQoL [SF-12v1]; sleep quality [12-MOS Sleep]; anxiety and depression [HADS]; and social support [DUKE-UNC-DSSI]). The factors associated with pain-related functional interference were identified using a stepwise linear regression model.
Finally, the fifth paper included in this document was based on longitudinal data from the RCT. A total of ninety-nine adults (>18 years) with CLBP who could perform physical exercise, understand and write Spanish, and had a smartphone with Internet, were included. Participants were asked to perform a self-managed HEP in their outpatient settings, delivered by an m-Health app (intervention group [IG]) or conventional intervention (control group [CG]). The data measured in both groups were sociodemographic, anthropometric, pain intensity (NRPS), pain-related functional interference (PPIQ), HRQoL (SF-12v1), anxiety and depression (HADS), sleep quality (12-MOS Sleep), physical functioning (30ACT, 30CST, and TUG test), fitness (IPAQ), and social support (DUKE-UNC-DSSI) at baseline (T0), 3- (T1), and 6-months (T2). Parametric and non-parametric tests were used to compare baseline data between the study groups, as well as between participants who continued or dropped out of the intervention at 3 months. Intra- and inter-group differences were calculated using paired Student's t-test and Wilcoxon signed-rank test, and Student's t-test or Mann-Whitney U test at 3- and 6-months, respectively. Also, the simple generalised estimating equations (GEE) were used to analyse longitudinal data of study outcomes, considering within-participant correlation.
Results In the systematic review (first paper), a total of 22 RCTs, involving 2641 patients with different CP conditions listed in ICD-11 were included, including CLBP, chronic musculoskeletal pain (CMSP), chronic neck pain (CNP), unspecified CP, chronic pelvic pain (CPP), fibromyalgia (FM), interstitial cystitis/bladder pain syndrome (IC/BPS), irritable bowel syndrome (IBS), and osteoarthritis (OA). We found 23 m-Health systems that were used to conduct different CP self-management strategies, among which monitoring pain and symptoms, and home-based exercise programs were the most used. Beneficial effects of the use of m-Health systems in reducing pain intensity (CNP, FM, IC/BPS, and OA), HRQoL (CLBP, CNP, IBS, and OA), and functional disability (CLBP, CMSP, CNP, and OA) were found. Most of the included studies (18/22, 82%) reported medium methodological quality and were considered "highly recommendable" (level 2) according to the OCEBM; 7/22 (32%) studies had a low RoB, 10/22 (45%) had some concerns, and 5/22 (23%) had a high RoB.
The second paper showed that 30% of the subjects were classified as having a low level of PA, 53% as moderate, and 17% as high. Females predominated in the low- and moderate-PA groups, and the subjects in the high-PA group were younger. Subjects in the low PA group reported more use of pain-relief medication, more severe-extreme pain, more functional limitations, and worse quality of life and mental health. Fac¬tors more likely to be associated with higher levels of PA were being male, normal body mass index (BMI) or overweight, better health status, less pain, less physical and cognitive limitations, and more social support.
In the third paper, a total of 99 subjects with CLBP were included, with a mean age of 54.37(SD:12.44) years, and 67.7% were female. The EFA extracted two factors: "Physical function" (factor 1) and "Social and sleep" (factor 2), which explained 57.75% of the variance. The items included in factor 1 were related to physical functioning tasks, while factor 2 consisted of items more likely related to social and sleep issues. Excellent internal consistency was observed for the overall PPIQ score (Cronbach's alpha=0.866). Convergent validity was observed between the PPIQ and other functional measures (rho: 0.52 and -0.47 for the TUG and 30CST, respectively; p<0.001) and with the following variables: physical and mental component summaries of the SF12v1 (rho: -0. 55 and -0.52, respectively (p<0.001); anxiety and depression of the HADS (rho: 0.47 and 0.59 respectively (p<0.001); NPRS (rho: 0.45; p<0.001); and index 9 of the 12-MOS Sleep (r: 0.49; p<0.001).
The fourth paper showed that among the 99 participants with CLBP involved in the RCT, 37.4%, 27.3% and 35.4% of participants were classified into low, moderate, and high pain-related functional interference level groups, respectively. The linear regression analysis showed that higher pain-related functional interference (higher PPIQ score) was associated with higher pain intensity (B:0.724;p=0.026), worse sleep quality (B:0.077;p=0.012), worse HRQoL (physical (B:-0.539;p<0.001) and mental (B:-0.289;p<0.001)), and lower consumption of weak opioid (B:-3.408;p=0.037).
The RCT showed statistically significant within-group improvements (p<0.05) in BMI (T1 and T2) and physical functioning [30ACT (T1), 30CST (T1), and TUG (T2]) in the IG. Likewise, in the CG, statistically significant within-group improvements were observed in physical functioning [30ACT (T1 and T2), 30CST (T2), and TUG (T2)], physical component of HRQoL (T1), and sleep quality (T1). The inter-group analysis showed only a significant difference between the groups for 30ACT (p=0.038) at T1, favouring the IG. The effect evolution (group x time interaction) did not differ significantly for any of the outcomes.
Conclusions The following conclusions were drawn based on the results obtained.
- Beneficial effects of the use of m-Health systems to deliver self-management interventions in people with different CP conditions make the m-Health a promising alternative to improve pain intensity, HRQoL, and functional disability, and could be part of multimodal and biopsychosocial strategies. Furthermore, a wide variety of m-Health systems for the management of CP are available, ranging from the monitoring of pain and symptoms to therapeutic approaches, mainly based on exercise, education, and psychosocial components. Nevertheless, high-quality studies are needed to merge the evidence and recommendations for the use of mHealth systems in CP management.
- Several biopsychoso¬cial aspects, such as gender, BMI, perceived health status, pain intensity and limitation by a health problem, and the perceived social support, were associated with different levels of PA in subjects with CLBP. Thus, understanding the influence of these factors on the level of PA among people with CLBP should be considered when establishing suitable and efficient public health strategies.
- The PPIQ has been shown to be a valid instrument with good psychometric properties for assessing pain-related functional interference in people with CLBP. Findings showed two-factor structure domains, "Physical function" and "Social and sleep", with excellent internal consistency for the overall score and both subscales. Furthermore, the pictorial nature of the questionnaire implies its potential as an alternative to language-based questionnaires for evaluating functional disabilities in people with CLBP when language or communication challenges exist.
- Beyond the pain experience and intensity among people with CLBP, several biopsychosocial factors associated with this condition and its related functional interference have been identified. Furthermore, higher pain intensity, poorer sleep quality, poorer HRQoL, and a weak opioid consumption have been associated with pain-related functional interference in our population with CLBP.
- A self-managed HEP could improve anthropometric, physical functioning, HRQoL, and sleep quality in people with CLBP, showing the beneficial effects of performing exercise and maintaining an active lifestyle in this population. Moreover, m-Health application (PainReApp) is not inferior to conventional intervention in terms of pain-related, HRQoL, and biopsychosocial outcomes. More advanced technological strategies are needed to improve clinical effectiveness, in which the presence of physiotherapists could be crucial for an adequate implementation
Factors associated with chronic pain in patients with bipolar depression: a cross-sectional study
No full textBackground: While pain is frequently associated with unipolar depression, few studies have investigated the link between pain and bipolar depression. In the present study we estimated the prevalence and characteristics of pain among patients with bipolar depression treated by psychiatrists in their regular clinical practice. The study was designed to identify factors associated with the manifestation of pain in these patients.-
Methods:Patients diagnosed with bipolar disorder (n=121) were selected to participate in a cross-sectional study in which DSM-IV-TR criteria were employed to identify depressive episodes. The patients were asked to describe any pain experienced during the study, and in the 6 weeks beforehand, by means of a Visual Analogical Scale (VAS).-
Results: Over half of the bipolar depressed patients (51.2%, 95% CI: 41.9%–60.6%), and 2/3 of the female experienced concomitant pain. The pain was of moderate to severe intensity and prolonged duration, and it occurred at multiple sites, significantly limiting the patient’s everyday activities. The most important factors associated with the presence of pain were older age, sleep disorders and delayed diagnosis of bipolar disorder.-
Conclusions: Chronic pain is common in bipolar depressed patients, and it is related to sleep disorders and delayed diagnosis of their disorder. More attention should be paid to study the presence of pain in bipolar depressed patients, in order to achieve more accurate diagnoses and to provide better treatment options.This work was partially supported by KRONIK 11/010
Music therapy for empathic communication between the primary caregiver and the pediatric oncologic patient in palliative care
No full textilustraciones, graficasLa presente investigación buscó promover una Comunicación Empática entre la díada compuesta por el Paciente Oncológico Pediátrico y su Cuidador Principal en un contexto de Cuidados Paliativos a favor del mejoramiento de la Calidad de Vida de la díada, a través de los cuatro métodos de la Musicoterapia. El proceso de investigación cualitativa con diseño de estudio de caso de tipo fenomenológico se llevó a cabo en la Fundación Hospital de la Misericordia – HOMI, de la ciudad de Bogotá, con un total de 10 participantes en un trabajo de 5 díadas, cada una conformada por un niño entre los 5 y 13 años que fue remitido a cuidados paliativos por su médico tratante, y su cuidador principal. La intervención musicoterapéutica se llevó a cabo por díadas, y el número de sesiones varió entre 4 y 8 dependiendo del caso, cada una con una duración aproximada de una hora. Todos los procesos se iniciaron en modalidad intrahospitalaria; sin embargo, la quinta díada recibió el alta y continuó su proceso de manera domiciliaria. Se utilizaron como instrumentos de registro, organización y análisis de datos herramientas tales como la entrevista semiestructurada; un protocolo de seguimiento que integra la escala visual análoga, reporte de dolor y náuseas, categorías de análisis, Cuestionario Hospitalario de Ferrari y los Perfiles Psicosonoros de Grados de Conexión Vincular de Pellizzari. El proceso de Análisis por medio de Matrices - elaboradas por la autora, - permitió describir el impacto positivo de la Musicoterapia en las habilidades de Comunicación Empática desde la Expresión Afectiva y la Disponibilidad Comunicativa entre la Díada, y, por ende, el favorecimiento en la percepción subjetiva de su calidad de vida. (Texto tomado de la fuente)The present research sought to promote Empathic Communication between the dyad composed of the Pediatric Oncology Patient and his Primary Caregiver in a Palliative Care context in favor of the improvement of the Quality of Life of the dyad, through the four methods of Music Therapy. The qualitative research process with a phenomenological case study design was carried out at the Fundación Hospital de la Misericordia - HOMI, in the city of Bogotá, with a total of 10 participants in a work of 5 dyads, each one formed by a child between 5 and 13 years old who was referred to palliative care by his treating physician, and his main caregiver. The music therapy intervention was carried out in dyads, and the number of sessions varied between 4 and 8 depending on the case, each lasting approximately one hour. All the processes were initiated in the in-hospital modality; however, the fifth dyad was discharged and continued its process at home. Tools such as the semi-structured interview, a follow-up protocol that integrates the visual analog scale, pain and nausea report, analysis categories, Ferrari's Hospital Questionnaire and Pellizzari's Psychosounding Profiles of Degrees of Bonding Connection were used as instruments for recording, organizing, and analyzing data. The analysis process by means of Matrices - elaborated by the author - allowed describing the positive impact of Music Therapy on the Empathic Communication skills from the Affective Expression and the Communicative Availability among the Dyad, and therefore, the improvement in the subjective perception of their quality of life.MaestríaMagíster en MusicoterapiaInvestigación Cualitativa Fenomenológica.Musicoterapia Clínic
A Therapeutic Alternative in the Management of Fibromyalgia
No full textIntroduction: Fibromyalgia is a condition that affects up to 5% of the population and causes significant deterioration of the quality of life for the sufferer, so it is a therapeutic challenge. The objective of the present study was to describe the experience of the AtlasPROfilax® method in patients with fibromyalgia diagnosed according to the criteria of the American College of Reumatology (ACR) 2010.Methodology: A cross - sectional study with 63 patients with fibromyalgia was done. Patients were monitored two and six months after applying the AtlasPROfilax® method, in order to evaluate the pain level by visual analogue scale VAS and reevaluate ACR criteria in the follow-up appointment.Results: The average age of patients was 48.5 SD 12.6 years, 95.24% were female. 100% of patients improved pain (initial VAS of 8 vs 4 and 3 after two and six months respectively) and these were significant results. A reduction of widespread pain index as well as a reduction in the presence of symptoms such as fatigue, non-restorative sleep and cognitive disorders that are typical of fibromyalgia were also found in 46% of casesConclusion: This study has provided evidence of the effectiveness of the neuromuscular stimulation method of the suboccipital musculature called AtlasPROfilax® in the treatment of fibromyalgia. Randomized and controlled studies are required to demonstrate the medium and long term effectiveness of this therapeutic alternative
A Therapeutic Alternative in the Management of Fibromyalgia
No full textIntroduction: Fibromyalgia is a condition that affects up to 5% of the population and causes significant deterioration of the quality of life for the sufferer, so it is a therapeutic challenge. The objective of the present study was to describe the experience of the AtlasPROfilax® method in patients with fibromyalgia diagnosed according to the criteria of the American College of Reumatology (ACR) 2010.
Methodology: A cross - sectional study with 63 patients with fibromyalgia was done. Patients were monitored two and six months after applying the AtlasPROfilax® method, in order to evaluate the pain level by visual analogue scale VAS and reevaluate ACR criteria in the follow-up appointment.
Results: The average age of patients was 48.5 SD 12.6 years, 95.24% were female. 100% of patients improved pain (initial VAS of 8 vs 4 and 3 after two and six months respectively) and these were significant results. A reduction of widespread pain index as well as a reduction in the presence of symptoms such as fatigue, non-restorative sleep and cognitive disorders that are typical of fibromyalgia were also found in 46% of cases
Conclusion: This study has provided evidence of the effectiveness of the neuromuscular stimulation method of the suboccipital musculature called AtlasPROfilax® in the treatment of fibromyalgia. Randomized and controlled studies are required to demonstrate the medium and long term effectiveness of this therapeutic alternative
Herramienta multimedia para la prevención y/o disminución de situaciones o casos de grooming a través de la comunicación entre padres e hijos en la localidad de Kennedy, Bogotá
No full textEl internet ha traído múltiples beneficios a la sociedad rompiendo las
barreras del conocimiento y permitiéndonos acercarnos a personas
que están a miles de kilómetros, sin embargo, ha abierto la posibilidad
a personas mal intencionadas para causar daño especialmente a
menores de edad, razón por la que hoy se habla de problemáticas
como el cyberbullying, sexting, ciberacoso, grooming, entre otros.
Este tipo de problemáticas pueden llegar a ser tan graves que
trascienden la pantalla y logran causar daños psicológicos y físicos
como el abuso sexual en menores. Esta es la principal causa que
motivó a contribuir a la prevención de la problemática del grooming,
entiéndase como la acción de un adulto de hacerse pasar por un
menor de edad con el objetivo de obtener imágenes del adolescente
desnudo o realizando algún acto sexual y en algunos casos logrando
la violación del menor. En este marco de ideas el proyecto genera una
alternativa para prevenir el grooming en niños entre los doce a catorce
años, teniendo como premisa la importancia de la comunicación entre
padres e hijas como factor preventivo.
Para esto se utilizan dos metodologías, la de Bruno Munari y
la de Asimov con el fin de llegar a un resultado óptimo. Siguiendo este
orden, se analiza el panorama desde un nivel global y se logra enfocar
la problemática en un contexto local (Localidad de Kennedy en
Bogotá). Se da inicio a la investigación de este tema subdividiendo el
caso de estudio en cinco ámbitos, educativo, social, salud, legal, y
personal, ahondando las causas y consecuencias relacionadas al
16
grooming, es en esta parte donde se analiza en qué eslabón podemos
ser partícipes, se tiene en cuenta algunos productos desarrollados
desde el diseño digital y se evalúan sus pros y contra para construir
un prototipo acorde a las necesidades de los usuarios. Respondiendo
a la pregunta, ¿Cómo se puede reforzar la confianza entre usuarios
tan diferentes y que se genere un interés mutuo? Surge la idea de
realizarlo a través de un espacio de esparcimiento alrededor de un
juego de mesa que conlleva detrás todo un universo de
conocimientos.The internet has brought multiple benefits to society breaking down
the barriers of knowledge and allowing us to get close to people who
are thousands of kilometers away, however, it has opened the
possibility for ill-intentioned people to cause harm especially to
underage, therefore, today it talk about problems like cyberbullying,
sexting, cyberbullying, grooming, among others. getting closer
These types of problems can become so serious that they transcend
the screen and manage to cause psychological and physical damage
such as sexual abuse of underage. This is the main cause that
motivated us to contribute to the prevention of the grooming problem,
understood as the action of an adult to impersonate an underage with
the objective of obtaining naked images of the underage or performing
a sexual act and in some cases achieving a rape. Within this
framework of ideas, the project generates an alternative to prevent
grooming in girls between the ages of twelve and fourteen, taking as
a premise the importance of communication between parents and
daughters as a preventive factor.
For this, two methodologies are used, that of Bruno Munari and that
of Asimov in order to reach an optimal result. Following this order, the
panorama is analyzed from a global level and it is possible to focus
the problem in a local context (Kennedy locality in Bogotá). The
investigation of this topic begins by subdividing the case study into five
areas, educational, social, health, legal, personal, delving into the
causes and consequences related to grooming, it is in this part where
it is analyzed in which link we can participate, it is had in some
products developed from the digital design and its pros and cons are
evaluated to build a prototype according to the needs of the users.
Answering the question, how can trust between such different users
be strengthened and mutual interest generated? The idea arises of
doing it through a recreational space around a board game that carries
behind a whole universe of knowledge.Aval del Proyecto 5
Dedicatoria 9
Agradecimientos 11
Abstract 17
Tabla de contenido 19
Listado de figuras 232
Listado de tablas 23
Listado de anexos 24
1. Formulación del proyecto 25
1.1 Introducción 25
1.2 Justificación 26
1.3 Definición del problema 29
1.3.1 Antecedentes del problema 29
1.3.2 Descripción del problema 32
1.3.3 Formulación del problema 33
1.4 Hipótesis de la investigación 35
1.4.1 Hipótesis explicativa 37
1.4.1 Hipótesis propositiva 37
1.5 Objetivos 39
1.5.1 Objetivo general 39
1.5.2 Objetivos específicos 39
1.6 Planteamiento metodológico 40
1.7 Alcances y limitaciones 42
2. Base teórica del proyecto 43
2.1 Marco referencial 44
2.1.1 Antecedentes 44
2.1.1.1 Linea del tiempo 52
2.1.2 Marco teórico contextual 55
2.1.2.1 Metodologias usadas en el grooming 57
2.1.3 Marco teórico disciplinar 58
2.1.3.1 El grooming desde la psicologia 59
2.1.3.2 El grooming desde la pedagogia 60
2.1.3.3 Metodologías pedagógicas para generar un modelo de
capacitación 61
2.1.3.4 El grooming desde el diseño 61
2.1.4 Marco conceptual 62
2.1.5 Marco institucional 65
2.1.6 Marco legal 67
2.2 Estado del arte 72
2.4 Caracterización de usuario 79
3. Desarrollo de la metodología, análisis y presentación de
resultados 83
3.1 Criterios de diseño 84
3.1.1 Árbol de objetivos de diseño 86
3.1.2 Requerimientos y determinantes de diseño 88
3.2 Hipótesis de producto 89
3.3 Fase de planeación y morfología 91
3.3.1 Estudio de factibilidad 91
3.3.2 Diseño preliminar 92
3.3.3 Planeación del proceso de producción 93
3.3.4 Planeación del proceso de distribución 93
3.3.5 Planeación de consumo 93
3.3.5 Planeación del retiro del producto 95
3.4 Fase de diseño detallado 95
3.4.1 Preparación del diseño 95
3.4.2 Diseño total de subsistemas 95
3.4.3 Diseño total de los componentes 96
3.4.4 Construcción experimental 95
3.4.5 Planeación del retiro del producto 95
3.5 Resultados de los testeos 86
3.6 Desarrollo y análisis Etapa X4 87
3.7 Resultados de los testeos 87
3.7.1 Primer testeo 91
3.7.2 Segundo testeo 92
3.7.3 Testeos adicionales 92
3.8 Prestaciones del producto 93
3.8.1 Aspectos morfológicos 94
3.8.2 Aspectos técnico-funcionales 94
3.8.3 Aspectos de usabilidad 94
4. Conclusiones 95
4.1 Conclusiones 95
4.2 Estrategia de mercado 96
4.2.1 Segmentos de cliente 96
4.2.2 Propuesta de valor 97
4.2.3 Canales 97
4.2.4 Relaciones con los clientes 99
4.2.5 Fuentes de ingresos 101
4.2.6 Actividades clave 101
4.2.7 Recursos clave 103
4.2.8 Socios clave 104
4.2.9 Estructura de costes 106
4.3 Consideraciones 106
Referencias 107
Anexos 122PregradoDiseñador(a) Digital y MultimediaTrabajo de grado Tecnologías para producción multimedi
