Impact of quality management systems in the performance of educational centers: educational policies and management processes.

In this paper, the findings of an I + D + i research are presented. In this study, an analysis was conducted to assess 14 educational centers where in one of two distinct quality systems had been implemented: the EFQM (European Foundation Quality Management) and el Proyecto de Calidad Integrado (PCI)-the Integrated Quality Project-promoted by the Horrêum Foundation (Álvarez and Santos, 2003; Villa and Marauri, 2004). The EFQM was first used by businesses before being recently transferred to the academics. It comprised nine factors that were translated in an educational context: leadership, policy and strategy, people, alliances and resources, processes, impact on people, impact on clients, impact on society, and key impacts of an organization. The first five factors examine the way activities are carried out and improved, and the final four focus on the impact, i.e., the effect of the organization's activities. Improvement is achieved through learning and innovation. The PCI (Muñoz and Sarasúa, 2005) has its educational origins in the Effective School Improvement model. Seven factors are analyzed (Sarasola et al., 2003; Villa et al., 2004): institutional approach, organizational structures, relationships and living together, counseling and tutoring, curriculum, family and the community (Martínez and Galíndez, 2003), and management and services. The study looks at the impact that the two aforementioned quality systems (EFQM and PCI) have had on educational centers. The term "impact" is understood as the changes experienced both inside and outside an educational center. It must be sustainable overtime, considering the changes and effects achieved, as evidence of improvement. The quantitative analysis focuses on two dimensions. The first addresses three key factors of educational policy: educational planning, communication, and support and rewards for teachers. The second comprises three factors linked to management processes in educational institutions: organizational climate, teaching and learning processes, and relationships with the community.

Estimación de la fracción atribuible poblacional debida a la obesidad en los ingresos hospitalarios por gripe valorada según el índice de masa corporal (IMC) y el CUN-BAE / Estimation of the population attributable fraction due to obesity in hospital admissions for flu valued according to Body Mass Index (BMI) and CUN-BAE

Introducción. La pandemia de la obesidad junto con la pandemia de gripe puede dar lugar a una importante carga de enfermedad. El índice de masa corporal (IMC) no correlaciona adecuadamente con el porcentaje de grasa corporal. El CUN-BAE es un estimador de grasa corporal para caucásicos que incluye el IMC, el sexo y la edad. El objeto de este trabajo es valorar la fracción atribuible poblacional de ingreso hospitalario por gripe debido a la grasa corporal medida con el IMC y el CUN-BAE. Metodología. Estudio multicéntrico de casos y controles. Los casos fueron ingresos hospitalarios con confirmación de gripe por PCR-RT entre 2009-2011. Empleando IMC o CUN-BAE, para cada categoría de adiposidad se calculó el riesgo de hospitalización por gripe mediante regresión logística condicional, y se estimó la fracción atribuible poblacional en el total de la muestra, en no vacunados y en menores de 65 años. Resultados. Se incluyeron 472 casos hospitalizados y 493 controles. La ORa de hospitalización por gripe, en comparación con el normopeso, se incrementó con cada nivel de IMC (ORa=1,26; 2,06 y 11,64) y de CUN-BAE (ORa=2,78; 4,29; 5,43 y 15,18). La fracción atribuible poblacional de hospitalización por gripe del CUN-BAE fue 3 veces superior que la estimada con el IMC (0,72 vs. 0,27), siendo similares las diferencias encontradas en no vacunados y en menores de 65 años. Conclusión. El IMC podría estar infraestimando la carga de enfermedad atribuible a la obesidad en la hospitalización por gripe. Se debería valorar adecuadamente el impacto de la obesidad y los criterios de recomendación vacunal

Introduction. The obesity pandemic together with the influenza pandemic could lead to a significant burden of disease. The body mass index (BMI) does not discriminate obesity appropriately. The CUN-BAE has recently been used as an estimate of body fatness for Caucasians, including BMI, gender, and age. The aim of this study is to assess the population attributable fraction of hospital admissions due to influenza, due to the body fatness measured with the BMI, and the CUN-BAE. Methods. A multicentre study was conducted using matched case-controls. Cases were hospital admissions with the influenza confirmed by the RT-PCR method between 2009 and 2011. The risk of hospital admission and the population attribuible fraction were calculated using the BMI or the CUN-BAE for each adiposity category in a conditional logical regression analysis adjusted for confounding variables. The analyzes were estimated in the total sample, in unvaccinated people, and those less than 65 years-old. Results. A total of 472 hospitalised cases and 493 controls were included in the study. Compared to normal weight, the aOR of influenza hospital admissions increases with each level of BMI (aOR=1.26; 2.06 and 11.64) and CUN-BAE (aOR=2.78; 4.29; 5.43 and 15.18). The population attributable fraction of influenza admissions using CUN-BAE is 3 times higher than that estimated with BMI (0,72 vs. 0,27), with the differences found being similar the non-vaccinated and under 65 year-olds. Conclusion. The BMI could be underestimating the burden of disease attributable to obesity in individuals hospitalised with influenza. There needs to be an appropriate assessment of the impact of obesity and vaccine recommendation criteria

[Estimation of the population attributable fraction due to obesity in hospital admissions for flu valued according to Body Mass Index (BMI) and CUN-BAE]. / Estimación de la fracción atribuible poblacional debida a la obesidad en los ingresos hospitalarios por gripe valorada según el índice de masa corporal (IMC) y el CUN-BAE.

INTRODUCTION: The obesity pandemic together with the influenza pandemic could lead to a significant burden of disease. The body mass index (BMI) does not discriminate obesity appropriately. The CUN-BAE has recently been used as an estimate of body fatness for Caucasians, including BMI, gender, and age. The aim of this study is to assess the population attributable fraction of hospital admissions due to influenza, due to the body fatness measured with the BMI, and the CUN-BAE. METHODS: A multicentre study was conducted using matched case-controls. Cases were hospital admissions with the influenza confirmed by the RT-PCR method between 2009 and 2011. The risk of hospital admission and the population attribuible fraction were calculated using the BMI or the CUN-BAE for each adiposity category in a conditional logical regression analysis adjusted for confounding variables. The analyzes were estimated in the total sample, in unvaccinated people, and those less than 65 years-old. RESULTS: A total of 472 hospitalised cases and 493 controls were included in the study. Compared to normal weight, the aOR of influenza hospital admissions increases with each level of BMI (aOR=1.26; 2.06 and 11.64) and CUN-BAE (aOR=2.78; 4.29; 5.43 and 15.18). The population attributable fraction of influenza admissions using CUN-BAE is 3 times higher than that estimated with BMI (0,72 vs. 0,27), with the differences found being similar the non-vaccinated and under 65 year-olds. CONCLUSION: The BMI could be underestimating the burden of disease attributable to obesity in individuals hospitalised with influenza. There needs to be an appropriate assessment of the impact of obesity and vaccine recommendation criteria.

Cefalea en trueno secundaria a neumoencéfalo / Thunderclap headache secondary to pneumocephalus

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Mortalidad e ingresos hospitalarios por violencia de los menores de 15 años en la Comunidad Valenciana (2007-2011) / Mortality and hospital admissions by violence among children under 15 years in the Valencian Autonomous Community (2007-2011)

Introducción: la violencia contra la infancia jamás es justificable y puede prevenirse actuando sobre los desencadenantes de comportamientos violentos. Conocer su magnitud y características posibilita emprender cambios que contribuyan a reducir su frecuencia y gravedad. Métodos: se analiza la mortalidad y los ingresos hospitalarios por violencia en menores de 15 años en el periodo 2007-2011 en la Comunitat Valenciana. Resultados: se contabilizaron 12 defunciones y 156 ingresos. Murieron tres veces más niños que niñas. Los fallecimientos fueron más frecuentes en los menores de un año, seguido del grupo de 10-14 años. Los seis casos de suicidio ocurrieron en el grupo de 10-14 años y los métodos utilizados fueron: ahorcamiento, estrangulamiento o sofocación y saltar desde lugar elevado. Los homicidios fueron el doble en niños y niñas de 0-9 años. Ingresaron por violencia dos veces más las niñas, siete veces más en el grupo de 10-14 años, tres veces más los extranjeros, dos veces más los residentes en medio rural y dos veces más si tenían riesgo de exclusión social, siendo estas diferencias estadísticamente significativas. Los ingresos por violencia autoinfligida fueron el doble (intento de suicidio) que por agresiones. Conclusiones: el número de casos es de gran importancia epidemiológica y de salud pública. En la violencia contra la infancia se manifiestan los ejes de desigualdad en salud y la necesidad de mejorar la declaración y la coordinación de todos los ámbitos de la atención a los menores. Es relevante relacionar las distintas fuentes de información, devolverla a los profesionales y formarlos (AU)

Introduction: violence against children is never justifiable and can be prevented by acting on the factors that trigger violent behaviors. Knowing the magnitude and nature of violence against children allows us to undertake the changes that will contribute to reduce their frequency and severity. Methods: in this paper, mortality and hospital admissions due to violence among children under 15 years from 2007 to 2011 in the Valencian Autonomous Community is analysed. Results: 12 deaths and 156 hospital admissions were registered. Boys' deaths were three times as frequent as those of girls. The deaths were more frequent in children under one year, followed by 10-14 years. The six cases of suicide occurred in the group of 10-14 years and the methods used were: hanging, strangulation or suffocation; and jumping from a high place. There were twice as many killings in children of 0-9 years. Girls were hospitalized due to violence twice as often as boys. Hospital admissions were 7 times as high in the group of 10-14 years, 3 times as high in foreigners, twice as high in residents in rural areas and twice as high if there was a risk of social exclusion, with these differences being statistically significant. Hospital admissions from self-inflicted violence were twice as high (attempted suicide with drugs) as those caused by assault (beating, stabbing and rape). Conclusions: the number of cases found is numerically small but of great epidemiological and public health significance. Axes of inequality in health due to violence in childhood are highlighted as well as the need of improving the notification of cases and the coordination in all areas related to childcare. Linking information sources and returning the information to professionals is relevant as well as training them (AU)

Directional flow sensing by passively stable larvae.

Mollusk larvae have a stable, velum-up orientation that may influence how they sense and react to hydrodynamic signals applied in different directions. Directional sensing abilities and responses could affect how a larva interacts with anisotropic fluid motions, including those in feeding currents and in boundary layers encountered during settlement. Oyster larvae (Crassostrea virginica) were exposed to simple shear in a Couette device and to solid-body rotation in a single rotating cylinder. Both devices were operated in two different orientations, one with the axis of rotation parallel to the gravity vector, and one with the axis perpendicular. Larvae and flow were observed simultaneously with near-infrared particle-image velocimetry, and behavior was quantified as a response to strain rate, vorticity and centripetal acceleration. Only flows rotating about a horizontal axis elicited the diving response observed previously for oyster larvae in turbulence. The results provide strong evidence that the turbulence-sensing mechanism relies on gravity-detecting organs (statocysts) rather than mechanosensors (cilia). Flow sensing with statocysts sets oyster larvae apart from zooplankters such as copepods and protists that use external mechanosensors in sensing spatial velocity gradients generated by prey or predators. Sensing flow-induced changes in orientation, rather than flow deformation, would enable more efficient control of vertical movements. Statocysts provide larvae with a mechanism of maintaining their upward swimming when rotated by vortices and initiating dives toward the seabed in response to the strong turbulence associated with adult habitats.

Investigation on the aerosol performance of dry powder inhalation hypromellose capsules with different lubricant levels.

HPMC capsules are made by a dipping process and a surface lubricant for the mould pins is an essential processing aid for removing dried capsules shells. For the purpose of this study, the level was determined by quantifying methyloleate (MO) a component found in the lubricant but not in the hypromellose capsules. Here we investigated the influence of the lubricant, low (10.81 µg/capsule=60 mg/kg MO), medium (15.97 µg/capsule=90 mg/kg MO) and high (23.23 µg/capsule=127 mg/kg MO) content on powder (binary mixture of salbutamol: lactose, 1:50 w/w) aerosolization properties was investigated. Results indicated significantly lower emitted dose from capsules with 60 mg/kg MO. Furthermore, the 90 and 127 mg/kg MO level of lubricant capsules produced almost double the Fine Particle Dose & Fine Particle Fraction compared with the low level of lubricant. The data indicates that lubricant level within capsules has an influence on deposition profiles and amount of drug remaining in capsule and inhaler device after actuation. It is suggested lubricant levels greater than 60 mg/kg MO per capsule are required to minimise powder retention within capsules and maximise deposition profiles. AFM (atomic force microscopy) data suggest that internal surface roughness may be related with this phenomena.

Directional flow sensing by passively stable larvae.

Mollusc larvae have a stable, velum-up orientation that may influence how they sense and react to hydrodynamic signals applied in different directions. Directional sensing abilities and responses could affect how a larva interacts with anisotropic fluid motions, including those in feeding currents and in boundary layers encountered during settlement. Oyster larvae (Crassostrea virginica) were exposed to simple shear in a Couette device and to solid-body rotation in a single rotating cylinder. Both devices were operated in two different orientations, one with the axis of rotation parallel to the gravity vector, and one with the axis perpendicular. Larvae and flow were observed simultaneously with near-infrared particle-image velocimetry, and behaviors were quantified as a response to strain rate, vorticity, and centripetal acceleration. Only flows rotating about a horizontal axis elicited the diving response observed previously for oyster larvae in turbulence. The results provide strong evidence that the turbulence-sensing mechanism relies on gravity-detecting organs (statocysts) rather than mechanosensors (cilia). Flow sensing with statocysts sets oyster larvae apart from zooplankters such as copepods and protists that use external mechanosensors in sensing spatial velocity gradients generated by prey or predators. Sensing flow-induced changes in orientation, rather than flow deformation, would enable more efficient control of vertical movements. Statocysts provide larvae with a mechanism of maintaining their upward swimming when rotated by vortices and initiating dives toward the seabed in response to the strong turbulence associated with adult habitats.

Resucitación cardiopulmonar mediante ECMO percutáneo: una nueva herramienta en el laboratorio de hemodinámica / Cardiopulmonary resuscitation with percutaneous ECMO: a new tool for the hemodynamics laboratory

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Hydrodynamic sensing and behavior by oyster larvae in turbulence and waves.

Hydrodynamic signals from turbulence and waves may provide marine invertebrate larvae with behavioral cues that affect the pathways and energetic costs of larval delivery to adult habitats. Oysters (Crassostrea virginica) live in sheltered estuaries with strong turbulence and small waves, but their larvae can be transported into coastal waters with large waves. These contrasting environments have different ranges of hydrodynamic signals, because turbulence generally produces higher spatial velocity gradients, whereas waves can produce higher temporal velocity gradients. To understand how physical processes affect oyster larval behavior, transport and energetics, we exposed larvae to different combinations of turbulence and waves in flow tanks with (1) wavy turbulence, (2) a seiche and (3) rectilinear accelerations. We quantified behavioral responses of individual larvae to local instantaneous flows using two-phase, infrared particle-image velocimetry. Both high dissipation rates and high wave-generated accelerations induced most larvae to swim faster upward. High dissipation rates also induced some rapid, active dives, whereas high accelerations induced only weak active dives. In both turbulence and waves, faster swimming and active diving were achieved through an increase in propulsive force and power output that would carry a high energetic cost. Swimming costs could be offset if larvae reaching surface waters had a higher probability of being transported shoreward by Stokes drift, whereas diving costs could be offset by enhanced settlement or predator avoidance. These complex behaviors suggest that larvae integrate multiple hydrodynamic signals to manage dispersal tradeoffs, spending more energy to raise the probability of successful transport to suitable locations.

Cost-effectiveness Analysis with Influence Diagrams.

BACKGROUND: Cost-effectiveness analysis (CEA) is used increasingly in medicine to determine whether the health benefit of an intervention is worth the economic cost. Decision trees, the standard decision modeling technique for non-temporal domains, can only perform CEA for very small problems. OBJECTIVE: To develop a method for CEA in problems involving several dozen variables. METHODS: We explain how to build influence diagrams (IDs) that explicitly represent cost and effectiveness. We propose an algorithm for evaluating cost-effectiveness IDs directly, i.e., without expanding an equivalent decision tree. RESULTS: The evaluation of an ID returns a set of intervals for the willingness to pay - separated by cost-effectiveness thresholds - and, for each interval, the cost, the effectiveness, and the optimal intervention. The algorithm that evaluates the ID directly is in general much more efficient than the brute-force method, which is in turn more efficient than the expansion of an equivalent decision tree. Using OpenMarkov, an open-source software tool that implements this algorithm, we have been able to perform CEAs on several IDs whose equivalent decision trees contain millions of branches. CONCLUSION: IDs can perform CEA on large problems that cannot be analyzed with decision trees.

Características clínicas y epidemiológicas de carcinoma basoescamoso en cinco años en un hospital de alta complejidad / Clinical and epidemiological features of basosquamous carcinoma in five years in a high complexity hospital

Introducción: el carcinoma basoescamoso es un tipo histológico poco frecuente y de mal pronóstico, presenta características clínicas e histológicas intermedias entre carcinoma espinocelular y basocelular; su diagnóstico es mediante la biopsia y el tratamiento es principalmente quirúrgico. Objetivo: determinar características epidemiológicas y clínicas de casos de carcinomas basoescamosos, diagnosticados en el Hospital Dr. Hernán Henríquez Aravena de Temuco, durante el período 2003-2007 y comparar nuestra realidad con la literatura. Materiales y Métodos: estudio descriptivo retrospectivo, donde se incluyeron todos los individuos con diagnóstico histológico de carcinoma basoescamoso, registrados entre 2003 y 2007 en el Hospital Dr. Hernán Henríquez Aravena de Temuco. Se estudiaron las variables epidemiológicas de sexo y edad al momento del diagnóstico; apellidos mapuches y las variables clínicas de ubicación, forma de presentación (única o múltiple) y correlación clínico-histológica. Resultados: se encontraron 36 casos, 52,8% presentó sexo masculino, el promedio de edades al diagnóstico fue de 74,6 años. 5,6% tenía algún apellido mapuche. Un 80,6% se presentó en cabeza y cuello. En un 63,9% de los casos, el diagnóstico clínico en base a la morfología de la lesión, fue de carcinoma basocelular, no existiendo correlación clínico-histológica en ningún caso. Discusión: los resultados obtenidos por nosotros, mantienen la tendencia respecto de lo que se registra en la literatura en cuanto a: distribución por sexo, edad y ubicación. No encontramos trabajos donde se hable de las características de esta enfermedad en población mapuche. La macroscopía lleva a confusión diagnóstica, por lo que en todos los casos el diagnóstico es histológico.

Introduction: basosquamous cell carcinoma is a rare and poor prognosis histological type, that presents intermediate clinical and histological features between squamous and basal cell carcinoma. The diagnosis is made by biopsy, and the treatment is primarily surgical. Objective: determine epidemiological and clinical characteristics of cases of diagnosed basosquamous cell carcinomas, at Dr. Hernán Henríquez Aravena Hospital of Temuco, during the period 2003-2007 and proceed to compare the results with the literature. Materials and Methods: a retrospective review including all individuals with histological confirmation of basosquamous carcinoma, between 2003 and 2007 at Dr. Hernán Henríquez Aravena Hospital of Temuco. Were considered epidemiological variables of sex, age at diagnosis and mapuche surname, and clinical variables of location of the lesion, presentación (single or multiple) and the clinical-pathologic correlation. Results: 36 cases were found, 52.8% male, the average age at diagnosis was 74.6 years. 5.6% had a mapuche surname. 80.6% occurred in the head and neck. In the 63.9% of the cases, the clinical diagnosis based on the morphology of the lesion was basal cell carcinoma. We did not found clinical-pathologic correlation in any case. Discussion: our results maintain the trend recorded in the literature in relation to sex distribution, age of presentation and location. We did not found works about characteristics of this disease in mapuche population. The macroscopic diagnosis leads to confusion, so the diagnosis it has to be histological in every case.

Características clínicas y epidemiológicas de carcinoma basoescamoso en cinco años en un hospital de alta complejidad / Clinical and epidemiological features of basosquamous carcinoma in five years in a high complexity hospital

Introducción: el carcinoma basoescamoso es un tipo histológico poco frecuente y de mal pronóstico, presenta características clínicas e histológicas intermedias entre carcinoma espinocelular y basocelular; su diagnóstico es mediante la biopsia y el tratamiento es principalmente quirúrgico. Objetivo: determinar características epidemiológicas y clínicas de casos de carcinomas basoescamosos, diagnosticados en el Hospital Dr. Hernán Henríquez Aravena de Temuco, durante el período 2003-2007 y comparar nuestra realidad con la literatura. Materiales y Métodos: estudio descriptivo retrospectivo, donde se incluyeron todos los individuos con diagnóstico histológico de carcinoma basoescamoso, registrados entre 2003 y 2007 en el Hospital Dr. Hernán Henríquez Aravena de Temuco. Se estudiaron las variables epidemiológicas de sexo y edad al momento del diagnóstico; apellidos mapuches y las variables clínicas de ubicación, forma de presentación (única o múltiple) y correlación clínico-histológica. Resultados: se encontraron 36 casos, 52,8% presentó sexo masculino, el promedio de edades al diagnóstico fue de 74,6 años. 5,6% tenía algún apellido mapuche. Un 80,6% se presentó en cabeza y cuello. En un 63,9% de los casos, el diagnóstico clínico en base a la morfología de la lesión, fue de carcinoma basocelular, no existiendo correlación clínico-histológica en ningún caso. Discusión: los resultados obtenidos por nosotros, mantienen la tendencia respecto de lo que se registra en la literatura en cuanto a: distribución por sexo, edad y ubicación. No encontramos trabajos donde se hable de las características de esta enfermedad en población mapuche. La macroscopía lleva a confusión diagnóstica, por lo que en todos los casos el diagnóstico es histológico.(AU)

Introduction: basosquamous cell carcinoma is a rare and poor prognosis histological type, that presents intermediate clinical and histological features between squamous and basal cell carcinoma. The diagnosis is made by biopsy, and the treatment is primarily surgical. Objective: determine epidemiological and clinical characteristics of cases of diagnosed basosquamous cell carcinomas, at Dr. Hernán Henríquez Aravena Hospital of Temuco, during the period 2003-2007 and proceed to compare the results with the literature. Materials and Methods: a retrospective review including all individuals with histological confirmation of basosquamous carcinoma, between 2003 and 2007 at Dr. Hernán Henríquez Aravena Hospital of Temuco. Were considered epidemiological variables of sex, age at diagnosis and mapuche surname, and clinical variables of location of the lesion, presentación (single or multiple) and the clinical-pathologic correlation. Results: 36 cases were found, 52.8% male, the average age at diagnosis was 74.6 years. 5.6% had a mapuche surname. 80.6% occurred in the head and neck. In the 63.9% of the cases, the clinical diagnosis based on the morphology of the lesion was basal cell carcinoma. We did not found clinical-pathologic correlation in any case. Discussion: our results maintain the trend recorded in the literature in relation to sex distribution, age of presentation and location. We did not found works about characteristics of this disease in mapuche population. The macroscopic diagnosis leads to confusion, so the diagnosis it has to be histological in every case.(AU)

Characterization of the startup transient electrokinetic flow in rectangular channels of arbitrary dimensions, zeta potential distribution, and time-varying pressure gradient.

The solution to the startup transient EOF in an arbitrary rectangular microchannel is derived analytically and validated experimentally. This full 2D transient solution describes the evolution of the flow through five distinct periods until reaching a final steady state. The derived analytical velocity solution is validated experimentally for different channel sizes and aspect ratios under time-varying pressure gradients. The experiments used a time resolved micro particle image velocimetry technique to calculate the startup transient velocity profiles. The measurements captured the effect of time-varying pressure gradient fields derived in the analytical solutions. This is tested by using small reservoirs at both ends of the channel which allowed a time-varying pressure gradient to develop with a time scale on the order of the transient EOF. Results showed that under these common conditions, the effect of the pressure build up in the reservoirs on the temporal development of the transient startup EOF in the channels cannot be neglected. The measurements also captured the analytical predictions for channel walls made of different materials (i.e., zeta potentials). This was tested in channels that had three PDMS and one quartz wall, resulting in a flow with an asymmetric velocity profile due to variations in the zeta potential between the walls.

Calidad de vida relacionada con la salud en la diabetes mellitus tipo 1 / Health related quality of life in type 1 diabetes mellitus

Introducción: El impacto diario del tratamiento de la DM1 en los aspectos psicosociales de los pacientes, demostrado científicamente, y la necesidad de un abordaje preventivo y educativo en los procesos de cuidado de esta enfermedad crónica llevan a considerar la importancia del estudio de la calidad de vida relacionada con la salud (CVRS) durante las etapas de la infancia y la adolescencia. Objetivos: a) Evaluar las dimensiones de la CVRS más afectadas por la enfermedad, y b) determinar su variación en función del período escolar, el sexo y el número de años de diagnóstico. Material y método: Estudio descriptivo de carácter aplicado. La muestra la constituyen 126 pacientes de 6 a 18 años con DM1, controlados en 4 hospitales públicos de Extremadura. El cuestionario de medida de la CVRS aplicado es la versión española del EQ-5D-Y.ResultadosLa dimensión más afectada para el total de la muestra es la ansiedad/depresión, con una diferencia significativa en el grupo de adolescentes (p=0,004). Conclusiones: Es necesario considerar la CVRS en la etapa de la adolescencia, poniendo especial atención al ámbito psicosocial en la propuesta de tratamiento y en el diseño de intervenciones educativas(AU)

Introduction: The daily impact of DM1 treatment on the psychological aspects of patients, scientifically proven, and the need for preventive and educational approaches in the care processes of this chronic disease, leads to consider the importance of studying the health-related quality of life (HRQOL) during the childhood and adolescence stages. Objectives: a) To assess the dimensions of HRQoL most affected by the disease, and b) to determine its variation as a function of the school year, sex and number of years from diagnosis. Material and method: An applied-descriptive study was used. The sample consisted of 126 patients from 6 to 18 years with type 1 diabetes, controlled in four public hospitals in Extremadura. The questionnaire measuring HRQoL is the Spanish version of EQ-5D-Y.ResultsThe most affected dimension for the total sample is anxiety/depression, with a significant difference in the adolescent group (P=0.004). Conclusions: It is necessary to consider the HRQOL assessment should be considered in adolescence, with special attention to the psychological aspects in the proposed treatment and design of educational interventions(AU)

[Health related quality of life in type 1 diabetes mellitus]. / Calidad de vida relacionada con la salud en la diabetes mellitus tipo 1.

INTRODUCTION: The daily impact of DM1 treatment on the psychological aspects of patients, scientifically proven, and the need for preventive and educational approaches in the care processes of this chronic disease, leads to consider the importance of studying the health-related quality of life (HRQOL) during the childhood and adolescence stages. OBJECTIVES: a) To assess the dimensions of HRQoL most affected by the disease, and b) to determine its variation as a function of the school year, sex and number of years from diagnosis. MATERIAL AND METHOD: An applied-descriptive study was used. The sample consisted of 126 patients from 6 to 18 years with type 1 diabetes, controlled in four public hospitals in Extremadura. The questionnaire measuring HRQoL is the Spanish version of EQ-5D-Y. RESULTS: The most affected dimension for the total sample is anxiety/depression, with a significant difference in the adolescent group (P=.004). CONCLUSIONS: It is necessary to consider the HRQOL assessment should be considered in adolescence, with special attention to the psychological aspects in the proposed treatment and design of educational interventions.

Ecografía de mama. Controversias / Controversies in breast sonography

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