Identifying preferences regarding type of care and risk factors for institutionalization of elderly persons in dependency situations in Andalusia.
The data on 200,039 persons registered in the System ...for Autonomy and Dependency Care over the period 2007-2012 were analysed. The study population was described in terms of: age, dependency situation, preferences, support network and clinical factors at the time of inclusion in the study. Separate analysis was made for men and women. A logistic regression model was designed to determine the risk factors for institutionalization for each sex.
87,4% of women and 85,9% of men expressed their wish to receive care in their own home. The risk of institutionalization is three times higher among men than among women. Among women, the risks of institutionalization are: level of dependency, wishing to move into a residential care home, medium consistency and fragility of support network and being diagnosed with dementia. Among men, the risks are: wishing to move into a residential care home and low or medium consistency of support network.
Care in the home is the preferred alternative for elderly persons in dependency situations. The risk of institutionalization is conditioned more by the preferences of the person and their family and the characteristics of the support network than by individual's clinical condition.
Abstract only
10546
Background: Sunitinib (Sun) is a multitargeted tyrosine-kinase inhibitor approved for the treatment of renal cell carcinoma (RCC), GIST and pancreatic neuroendocrine tumors ...(pNETs). It is known that a polymorphism in Sun metabolizing gene CYP3A5, was associated with an increased risk of dose reductions due to toxicity (tox). Additionally, polymorphisms in VEGF-A and VEGFR2 were suggested to increase the risk of hypertension (HT) during treatment (García-Donas, et al. Lancet Oncol 2011). These data have not been validated so far. We aim to assess the value of these polymorphisms as markers of tox using a wide range of solid tumors treated with Sun. Methods: In this non-interventional and retrospective study, DNA was collected from 28 patients with different pathologies (16 pNETs, 5 medullary thyroid carcinomas, 2 NETs of the lung, 2 undifferentiated follicular carcinomas, 1 undifferentiated papillar carcinoma, 1 GIST, and 1 carcinoid of the rectum) treated with Sun in a daily practice setting. Genotyping for CYP3A5*1 allele (rs776746), VEGF-A -2578C>A (rs699947) and VEGFR2 Q472H (rs1870377) was performed. Associations between the genotypes and Sun dose reductions and HT were performed using univariable analyses. Results: In agreement with previous reports, we found that VEGF-A rs699947 conferred a statistically significant increased risk of developing HT during treatment (HR=9.8, 95%CI=1.2-82.0, P=0.034). CYP3A5*1 high metabolizing allele showed a trend towards the increase in the risk of Sun dose reductions due to tox (HR=2.4, 95%CI=0.8-6.8, P=0.11) with a median time to dose reduction of 7.0 months for wild type homozgygous patients and 4.6 months for heterozygous patients. A trend was also found on the relation between VEGF-A rs699947 A/A patients (HR=3.8, 95%CI=0.8-16.8, P=0.080) and dose reduction risk. No significant associations were found for VEGFR2 rs1870377. Conclusions: The present study suggests that VEGF-A rs699947 is a risk factor for Sun HT and has a role in other tox leading to dose reductions. Similarly, CYP3A5*1 shows a trend towards an increased risk of Sun dose reductions. If confirmed, these markers could be used to identify a subset of patients with an increased risk of Sun toxicity.
Is a strategy of bio-socio-ethic necessary? Alonso Trujillo, Federico; López Medel, Raquel; Asensio Fernández, Inmaculada ...
Enfermeria clinica,
01/2016, Letnik:
26, Številka:
1
Journal Article
Recenzirano
The aim of this paper is to assess the need for a common ethics strategy shared by 2 of the cornerstones of human welfare: the healthcare and social services sectors.
An observational cross-sectional ...descriptive study was performed by surveying social services and healthcare professionals. A purposive sampling technique was used. The questionnaire consisted of 10 questions about ethical conflicts in professional practice and respondents' views on a proposed shared approach to bioethics and ethics in social intervention.
124 professionals completed the questionnaire, 56% of the health sector and 44% of the social services sector. About 90% professionals surveyed had had to make difficult ethical decisions in their work and would welcome a common approach to ethics in the social services and healthcare sectors. 75% said that conflicts are occurring more frequently in both sectors simultaneously and that they were resolved preferably individually and independently.
The survey respondents believe that a common approach to tackling ethical conflicts in professional practice is required. Nevertheless, it is still rare for ethics committees to intervene in the conflict resolution process and for decision-making support and evaluation tools to be used.
The methylation status of the IGFBP-3 gene is strongly associated with cisplatin sensitivity in patients with non-small cell lung cancer (NSCLC). In this study, we found in vitro evidence that linked ...the presence of an unmethylated promoter with poor response to radiation. Our data also indicate that radiation might sensitize chemotherapy-resistant cells by reactivating IGFBP-3-expression through promoter demethylation, inactivating the PI3K/AKT pathway. We also explored the IGFBP-3 methylation effect on overall survival (OS) in a population of 40 NSCLC patients who received adjuvant therapy after R0 surgery. Our results indicate that patients harboring an unmethylated promoter could benefit more from a chemotherapy schedule alone than from a multimodality therapy involving radiotherapy and platinum-based treatments, increasing their OS by 2.5 y (p = .03). Our findings discard this epi-marker as a prognostic factor in a patient population without adjuvant therapy, indicating that radiotherapy does not improve survival for patients harboring an unmethylated IGFBP-3 promoter.
In the present work wear resistance of 4 μm uncoated tungsten carbide inserts (WC) and coated with TiN/TiAlNn multinanolayered or with commercial TiCN-Al2O3-TiN monolayers (TINAL) are examined. Life ...tests, cutting area temperature analysis, surface roughness measurements on work pieces, roughness measurements on the attacked surface, contact track analysis between chip-insert and chemical composition analysis (EDS) were carried out. Mechanical tests were conducted on AISI 4340 steel parts using cutting regime and applying high speed cutting (HSC). Machining results showed that for a distance of 8,000 m the inserts coated with 300 bilayers exhibited wear values of 0.117 mm, inserts coated with 200 bilayers showed values of 0.138 mm and those coated with TINAL presented wear values of 0.174 mm. Moreover, the temperature values for cutting speed at 176.6 m/mim for 300 bilayers was 522.6 oC, for 200 bilayers was 721.4 oC and 1,327.6 oC for inserts coated with TINAL. Lower temperatures, caused by a lower friction coeffi cient and cutting force, contribute to life-time increasing at WC inserts.
el texto Situaciones y retos de la investigación en Latinoamérica es el resultado de un grupo de docentes con experiencia y trayectoria en hacer y enseñar investigación en diferentes instituciones de ...Educación Superior. Uno de los asuntos que termina congregándolos como autores, es la profunda preocupación que como colectivo académico comparten en la formación de los futuros profesionales, especialistas, magísteres y doctores, aquellos que serán relevo generacional. El objetivo fundamental del texto es analizar las situaciones y retos de la investigación desde la fundamentación teórica y la práctica en el contexto contemporáneo. Está organizado en cuatro secciones y 16 capítulos. Cada sección aborda asuntos transversales que en conjunto son necesarios y suficientes para “entender” las implicaciones de la rigurosidad, disciplina, ética, sistematización y creatividad que la actividad investigativa requiere.
En el presente trabajo se muestran los resultados de la resistencia al desgaste de insertos de carburo de tungsteno (WC) sin recubrir y recubiertos con multinanocapas de TiN/TiAlNn con un espesor ...total promedio del recubrimiento de 4 ¿m, así como de insertos recubiertos con monocapas comerciales de TiCN-Al2O3-TiN (TINAL). Se realizaron ensayos de vida útil, análisis de temperatura en la zona de corte, mediciones de rugosidad superfi cial sobre la pieza y sobre los insertos en la superfi cie de ataque, análisis de huella de contacto entre viruta-insertos y análisis de composición química (EDS). Los ensayos se realizaron sobre piezas de acero AISI 4340 utilizando régimen de corte de acabado y aplicando altas velocidades de corte (HSC). Los resultados de mecanizado de acero, para un recorrido de 8.000 metros con diferentes insertos de carburo de tungsteno (WC), sin recubrimiento y recubiertos presentaron valores de desgaste de 0,117 mm y 0,138 mm; en relación a los insertos recubiertos con 300 y 200 bicapas de TiN/TiAlN, respectivamente. De igual manera, los insertos recubiertos con TINAL exhibieron valores de desgaste de 0,174 mm. Además, los valores de temperatura en la zona de corte y para una velocidad de corte de 176,6 m/mim fueron de 522,6 oC para los recubrimientos con 300 bicapas, de 721,4 oC para aquellos con 200 bicapas, y de 1.327,6 oC para los insertos recubiertos con TINAL. La disminución de la temperatura en la zona de corte, relacionada con un menor coefi ciente de fricción y una menor fuerza de corte, contribuyeron al alargamiento de la vida útil de los insertos.
Con el fin de dinamizar la ganadería bovina colombiana, y en un esfuerzo conjunto de los sectores oficial y privado, se están adelantando procesos de investigación y transferencia de tecnología en el ...nivel de empresas agropecuarias. Parte de ese proceso ha sido la caracterización de los principales sistemas productivos ganaderos en 22 microrregiones del trópico bajo. La información obtenida se ha aplicado a evaluaciones ex-ante de las alternativas tecnológicas generadas. El Valle del Cesar, localizado al norte de Colombia, ha sido tradicionalmente una microrregión de tradición agrícola que cambió el uso del suelo, dedicándolo en gran parte a la ganadería bovina debido a la fluctuación de los precios del mercado y a aspectos de tipo social.Este estudio, que incluye el análisis de factibilidad de algunas alternativas tecnológicas, presenta los principales resultados del análisis ex-ante realizado, usando un modelo de optimización lineal alimentado con la información técnico-económica correspondiente a los tres cultivos principales de la zona: arroz, algodón y sorgo, y de acuerdo con los parámetros de forraje y manejo animal de los dos sistemas de producción bovina predominantes en la zona: doble propósito y ceba. Por su parte, en el sistema de doble propósito se evaluó el efecto de la introducción de leguminosas arbóreas como la acacia forrajera (Leucaena leucocephala) y herbáceas como la 'campanita' (Clitoria ternatea) en praderas de pasto Angleton (Dichantium aristatum), así como el efecto en el sistema si se modifican los parámetros de natalidad y mortalidad de terneros. En los sistemas agrícolas, con el fin de hacerlos más competitivos frente al sistema de doble propósito, se evaluaron escenarios de reducción de costos de producción y aumento de productividad. Los resultados indican que, en la actualidad, este sistema ganadero presenta las mejores rentabilidades debido a una demanda de mano de obra menor y a la flexibilidad para la producción de carne y leche, si bien depende de los cambios en los precios de los productos. Se encontró que el sistema presenta un gran potencial de desarrollo al incorporar en las praderas de Angleton la leguminosa 'campanita', asociación con la cual se obtendría un incremento del 194% en el ingreso neto anual. La aplicación del modelo también demostró la atractiva posibilidad de establecer en la zona el sistema de lechería bajo la modalidad de dos ordeños diarios, sistema que estaría compitiendo favorablemente con el sistema de doble propósito. AbstractModel to improve the livestock and crop production systems in Valle del Cesar, ColombiaColombia is going through a dynamic research and technology transfer effort in order to improve its livestock enterprise.Animal production systems of twenty-two ecoregions in the lowland tropics are being characterized for ex-ante analysis to define technological alternatives.The Valley of Cesar in northern Colombia is a micro-region where agriculture has been its traditional production system, but now, 80% of the land has pastures.This valley was taken as a case study and we use an optimization model to evaluate its major agricultural crops: rice, cotton, sorghum, and also, livestock productions systems: dual-purpose and beef. Additionally, was evaluated the feasibility of applying new and improved technologies.The evaluation of the dual-purpose system included the introduction of Leucaena leucocephala as a protein bank of Angleton pastures and of mixed pastures like Angleton with Clitoria ternatea.Changes in calving and mortality rates were also evaluated by the model. By the other hand, the analysis of crop sensitivity included reduction of production costs and increments in productivity, in order to establish the competitivity level of these systems, faced to dual purpose cattle productions. The results indicate that this is the most profitable system of the major agricultural products for the Valley of Cesar under current productivity levels, input costs, and sale prices. Improvement of Angleton pastures through establishment of Clitoria ternatea associations for dual purpose systems would result in an increment of 194% in annual net income. On the other hand, the annual net income of the system can be increased.The optimization model is a management tool that contributes to identify the activities showing the best potential to get higher economic profit, as well as to determine new technologies that offer better possibilities for production and adoption.
In this paper, wear resistance of 4 μm uncoated tungsten carbide inserts (WC) and coated with (TiN/TiAlN)n multinanolayered or with commercial TiCN-Al2O3-TiN monolayers (TINAL) are examined. Life ...tests, cutting area temperature analysis, surface roughness measurements on work pieces, roughness measurements on the attacked surface, contact track analysis between chip-insert and chemical composition analysis were carried out. Mechanical tests were conducted on AISI 4340 steel parts using cutting regime and applying high speed cutting. The machining results showed that for a distance of 8,000 m the inserts coated with 300 bilayers exhibited wear values of 0.117 mm, inserts coated with 200 bilayers showed values of 0.138 mm and those coated with TINAL presented wear values of 0.174 mm. Moreover, the temperature values for cutting speed at 176.6 m/mim for 300 bilayers was 522.6°C, for 200 bilayers was 721.4 °C and 1,327.6°C for inserts coated with TINAL. Lower temperatures, caused by a lower friction coefficient and cutting force, contribute to life-time increasing at WC inserts.
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