59 results on '"García-Alfaro, P."'
Search Results
2. SCORPION Cyber Range: Fully Customizable Cyberexercises, Gamification and Learning Analytics to Train Cybersecurity Competencies
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Nespoli, Pantaleone, Albaladejo-González, Mariano, Valera, José Antonio Pastor, Ruipérez-Valiente, José A., Garcia-Alfaro, Joaquin, and Mármol, Félix Gómez
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Computer Science - Cryptography and Security ,Computer Science - Computers and Society - Abstract
It is undeniable that we are witnessing an unprecedented digital revolution. However, recent years have been characterized by the explosion of cyberattacks, making cybercrime one of the most profitable businesses on the planet. That is why training in cybersecurity is increasingly essential to protect the assets of cyberspace. One of the most vital tools to train cybersecurity competencies is the Cyber Range, a virtualized environment that simulates realistic networks. The paper at hand introduces SCORPION, a fully functional and virtualized Cyber Range, which manages the authoring and automated deployment of scenarios. In addition, SCORPION includes several elements to improve student motivation, such as a gamification system with medals, points, or rankings, among other elements. Such a gamification system includes an adaptive learning module that is able to adapt the cyberexercise based on the users' performance. Moreover, SCORPION leverages learning analytics that collects and processes telemetric and biometric user data, including heart rate through a smartwatch, which is available through a dashboard for instructors. Finally, we developed a case study where SCORPION obtained 82.10% in usability and 4.57 out of 5 in usefulness from the viewpoint of a student and an instructor. The positive evaluation results are promising, indicating that SCORPION can become an effective, motivating, and advanced cybersecurity training tool to help fill current gaps in this context., Comment: 31 pages
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- 2024
3. ZIRCON: Zero-watermarking-based approach for data integrity and secure provenance in IoT networks
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Faraj, Omair, Megías, David, and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security - Abstract
The Internet of Things (IoT) is integrating the Internet and smart devices in almost every domain such as home automation, e-healthcare systems, vehicular networks, industrial control and military applications. In these sectors, sensory data, which is collected from multiple sources and managed through intermediate processing by multiple nodes, is used for decision-making processes. Ensuring data integrity and keeping track of data provenance is a core requirement in such a highly dynamic context, since data provenance is an important tool for the assurance of data trustworthiness. Dealing with such requirements is challenging due to the limited computational and energy resources in IoT networks. This requires addressing several challenges such as processing overhead, secure provenance, bandwidth consumption and storage efficiency. In this paper, we propose ZIRCON, a novel zero-watermarking approach to establish end-to-end data trustworthiness in an IoT network. In ZIRCON, provenance information is stored in a tamper-proof centralized network database through watermarks, generated at source node before transmission. We provide an extensive security analysis showing the resilience of our scheme against passive and active attacks. We also compare our scheme with existing works based on performance metrics such as computational time, energy utilization and cost analysis. The results show that ZIRCON is robust against several attacks, lightweight, storage efficient, and better in energy utilization and bandwidth consumption, compared to prior art., Comment: Keywords: Data Integrity; Data Provenance; Internet of Things; Intrusion Detection; Cryptography; Zero-Watermarking
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- 2023
4. Repeated Purification versus Concatenated Error Correction in Fault Tolerant Quantum Networks
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Barbeau, Michel, Garcia-Alfaro, Joaquin, and Kranakis, Evangelos
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Quantum Physics ,Computer Science - Emerging Technologies - Abstract
Entanglement distribution is a core mechanism for the future quantum Internet. The quantum world is, however, a faulty environment. Hence, successful entanglement swapping is error-prone. The occurrence of quantum state errors can be mitigated using purification and error correction, which can be repeated in the former case and concatenated in the latter case. Repeated purification merges low-fidelity qubits into higher-quality ones, while concatenated error correction builds upon the redundancy of quantum information. In this article, we study in-depth and compare the two options: repeated purification and concatenated error correction. We consider using repeated purification and concatenated error correction to mitigate the presence of faults that occur during the establishment of Bell pairs between remote network nodes. We compare their performance versus the number of repetitions or concatenations, to reach a certain level of fidelity in quantum networks. We study their resource requirements, namely, their work memory complexity (e.g., number of stored qubits) and operational complexity (e.g., number of operations). Our analysis demonstrates that concatenated error correction, versus repeated purification, requires fewer iterations and has lower operational complexity than repeated purification to reach high fidelity at the expense of increased memory requirements., Comment: ACM Format, 21 pages, 14 figures, 1 table
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- 2023
5. A Survey on Cyber-Resilience Approaches for Cyber-Physical Systems
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Segovia-Ferreira, Mariana, Rubio-Hernan, Jose, Cavalli, Ana Rosa, and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security - Abstract
Concerns for the resilience of Cyber-Physical Systems (CPS)s in critical infrastructure are growing. CPS integrate sensing, computation, control, and networking into physical objects and mission-critical services, connecting traditional infrastructure to internet technologies. While this integration increases service efficiency, it has to face the possibility of new threats posed by the new functionalities. This leads to cyber-threats, such as denial-of-service, modification of data, information leakage, spreading of malware, and many others. Cyber-resilience refers to the ability of a CPS to prepare, absorb, recover, and adapt to the adverse effects associated with cyber-threats, e.g., physical degradation of the CPS performance resulting from a cyber-attack. Cyber-resilience aims at ensuring CPS survival by keeping the core functionalities of the CPS in case of extreme events. The literature on cyber-resilience is rapidly increasing, leading to a broad variety of research works addressing this new topic. In this article, we create a systematization of knowledge about existing scientific efforts of making CPSs cyber-resilient. We systematically survey recent literature addressing cyber-resilience with a focus on techniques that may be used on CPSs. We first provide preliminaries and background on CPSs and threats, and subsequently survey state-of-the-art approaches that have been proposed by recent research work applicable to CPSs. In particular, we aim at differentiating research work from traditional risk management approaches based on the general acceptance that it is unfeasible to prevent and mitigate all possible risks threatening a CPS. We also discuss questions and research challenges, with a focus on the practical aspects of cyber-resilience, such as the use of metrics and evaluation methods as well as testing and validation environments., Comment: ACM Computing Surveys, 56(8):1--37, 36 pages, 2 figures, 1 table
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- 2023
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6. A Quantum Algorithm for Shapley Value Estimation
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Burge, Iain, Barbeau, Michel, and Garcia-Alfaro, Joaquin
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Computer Science - Emerging Technologies ,Computer Science - Cryptography and Security ,Mathematics - Quantum Algebra - Abstract
The introduction of the European Union's (EU) set of comprehensive regulations relating to technology, the General Data Protection Regulation, grants EU citizens the right to explanations for automated decisions that have significant effects on their life. This poses a substantial challenge, as many of today's state-of-the-art algorithms are generally unexplainable black boxes. Simultaneously, we have seen an emergence of the fields of quantum computation and quantum AI. Due to the fickle nature of quantum information, the problem of explainability is amplified, as measuring a quantum system destroys the information. As a result, there is a need for post-hoc explanations for quantum AI algorithms. In the classical context, the cooperative game theory concept of the Shapley value has been adapted for post-hoc explanations. However, this approach does not translate to use in quantum computing trivially and can be exponentially difficult to implement if not handled with care. We propose a novel algorithm which reduces the problem of accurately estimating the Shapley values of a quantum algorithm into a far simpler problem of estimating the true average of a binomial distribution in polynomial time., Comment: 29 pages, 8 figures, 21 references, baseline (preprint) QCE 2023 (IEEE International Conference on Quantum Computing and Engineering) Technical Paper (Quantum Algorithms for Shapley Value Calculation)
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- 2023
7. Cyber-Physical Defense in the Quantum Era
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Barbeau, Michel and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security - Abstract
Networked-Control Systems (NCSs), a type of cyber-physical systems, consist of tightly integrated computing, communication and control technologies. While being very flexible environments, they are vulnerable to computing and networking attacks. Recent NCSs hacking incidents had major impact. They call for more research on cyber-physical security. Fears about the use of quantum computing to break current cryptosystems make matters worse. While the quantum threat motivated the creation of new disciplines to handle the issue, such as post-quantum cryptography, other fields have overlooked the existence of quantum-enabled adversaries. This is the case of cyber-physical defense research, a distinct but complementary discipline to cyber-physical protection. Cyber-physical defense refers to the capability to detect and react in response to cyber-physical attacks. Concretely, it involves the integration of mechanisms to identify adverse events and prepare response plans, during and after incidents occur. In this paper, we make the assumption that the eventually available quantum computer will provide an advantage to adversaries against defenders, unless they also adopt this technology. We envision the necessity for a paradigm shift, where an increase of adversarial resources because of quantum supremacy does not translate into higher likelihood of disruptions. Consistently with current system design practices in other areas, such as the use of artificial intelligence for the reinforcement of attack detection tools, we outline a vision for next generation cyber-physical defense layers leveraging ideas from quantum computing and machine learning. Through an example, we show that defenders of NCSs can learn and improve their strategies to anticipate and recover from attacks., Comment: 14 pages, 7 figures, 1 table, 4 boxes
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- 2022
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8. Ontology-based Attack Graph Enrichment
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Saint-Hilaire, Kéren, Cuppens, Frédéric, Cuppens, Nora, and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security - Abstract
Attack graphs provide a representation of possible actions that adversaries can perpetrate to attack a system. They are used by cybersecurity experts to make decisions, e.g., to decide remediation and recovery plans. Different approaches can be used to build such graphs. We focus on logical attack graphs, based on predicate logic, to define the causality of adversarial actions. Since networks and vulnerabilities are constantly changing (e.g., new applications get installed on system devices, updated services get publicly exposed, etc.), we propose to enrich the attack graph generation approach with a semantic augmentation post-processing of the predicates. Graphs are now mapped to monitoring alerts confirming successful attack actions and updated according to network and vulnerability changes. As a result, predicates get periodically updated, based on attack evidences and ontology enrichment. This allows to verify whether changes lead the attacker to the initial goals or to cause further damage to the system not anticipated in the initial graphs. We illustrate the approach under the specific domain of cyber-physical security affecting smart cities. We validate the approach using existing tools and ontologies., Comment: 18 pages, 3 figures, 1 table, conference paper (TIEMS Annual Conference, December 2021, Paris, France)
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- 2022
9. Vitamin D and adolescent idiopathic scoliosis, should we stop the hype? A cross-sectional observational prospective study based on a geometric morphometrics approach
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González-Ruiz, José María, Bastir, Markus, Pizones, Javier, Palancar, Carlos A., Toro-Ibacache, Viviana, García Alfaro, María Dolores, Moreno Manzanaro, Lucía, Sánchez Márquez, José Miguel, and Pérez Núñez, María Isabel
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- 2023
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10. Anonymous proof-of-asset transactions using designated blind signatures
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Sharma, Neetu, Sahu, Rajeev Anand, Saraswat, Vishal, and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security - Abstract
We propose a scheme to preserve the anonymity of users in proof-of-asset transactions. We assume bitcoin-like cryptocurrency systems in which a user must prove the strength of its assets (i.e., solvency), prior conducting further transactions. The traditional way of addressing such a problem is the use of blind signatures, i.e., a kind of digital signature whose properties satisfy the anonymity of the signer. Our work focuses on the use of a designated verifier signature scheme that limits to only a single authorized party (within a group of signature requesters) to verify the correctness of the transaction., Comment: 17 pages, extended conference version
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- 2020
11. Cyber-Resilience Evaluation of Cyber-Physical Systems
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Segovia, Mariana, Rubio-Hernan, Jose, Cavalli, Ana Rosa, and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security - Abstract
Cyber-Physical Systems (CPS) use computational resources to control physical process and provide critical services. For this reason, an attack in these systems may have dangerous consequences in the physical world. Hence, resilience is a fundamental property to ensure the safety of the people, the environment and the controlled physical process. In this paper, we present metrics to quantify the resilience level based on the design, structure, stability, and performance under the attack of a given CPS. The metrics provide reference points to evaluate whether the system is better prepared or not to face the adversaries. This way, it is possible to quantify the ability to recover from an adversary using its mathematical model based on switched linear systems and actuators saturation. Finally, we validate our approach using a numeric simulation on the Tennesse Eastman control challenge problem., Comment: 11 pages, 2 figures, 6 tables
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- 2020
12. Misconfiguration Management of Network Security Components
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Cuppens, Frédéric, Cuppens-Boulahia, Nora, and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security ,Mathematics - Logic - Abstract
Many companies and organizations use firewalls to control the access to their network infrastructure. Firewalls are network security components which provide means to filter traffic within corporate networks, as well as to police incoming and outcoming interaction with the Internet. For this purpose, it is necessary to configure firewalls with a set of filtering rules. Nevertheless, the existence of errors in a set of filtering rules is very likely to degrade the network security policy. The discovering and removal of these configuration errors is a serious and complex problem to solve. In this paper, we present a set of algorithms for such a management. Our approach is based on the analysis of relationships between the set of filtering rules. Then, a subsequent rewriting of rules will derive from an initial firewall setup -- potentially misconfigured -- to an equivalent one completely free of errors. At the same time, the algorithms will detect useless rules in the initial firewall configuration., Comment: 9 pages, 4 figures, 10 references, 7th International Symposium on System and Information Security (SSI), Sao Paulo, Brazil
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- 2019
13. Next Generation Resilient Cyber-Physical Systems
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Barbeau, Michel, Carle, Georg, Garcia-Alfaro, Joaquin, and Torra, Vicenç
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Computer Science - Cryptography and Security ,Computer Science - Computers and Society - Abstract
Cyber-Physical Systems (CPS) consist of distributed engineered environments where the monitoring and surveillance tasks are governed by tightly integrated computing, communication and control technologies. CPS are omnipresent in our everyday life. Hacking and failures of such systems have impact on critical services with potentially significant and lasting consequences. In this paper, we review which requirements a CPS must meet to address the challenges of tomorrow. Two key challenges are understanding and reinforcing the resilience of CPS., Comment: 6 pages, 45 references
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- 2019
14. Faking and Discriminating the Navigation Data of a Micro Aerial Vehicle Using Quantum Generative Adversarial Networks
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Barbeau, Michel and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security ,Computer Science - Machine Learning - Abstract
We show that the Quantum Generative Adversarial Network (QGAN) paradigm can be employed by an adversary to learn generating data that deceives the monitoring of a Cyber-Physical System (CPS) and to perpetrate a covert attack. As a test case, the ideas are elaborated considering the navigation data of a Micro Aerial Vehicle (MAV). A concrete QGAN design is proposed to generate fake MAV navigation data. Initially, the adversary is entirely ignorant about the dynamics of the CPS, the strength of the approach from the point of view of the bad guy. A design is also proposed to discriminate between genuine and fake MAV navigation data. The designs combine classical optimization, qubit quantum computing and photonic quantum computing. Using the PennyLane software simulation, they are evaluated over a classical computing platform. We assess the learning time and accuracy of the navigation data generator and discriminator versus space complexity, i.e., the amount of quantum memory needed to solve the problem., Comment: Accepted for publication in IEEE GLOBECOM 2019 Workshop on Quantum Communications and Information Technology 2019 (fifth QCIT workshop of the Emerging Technical Committee on Quantum Communications and Information Technology, QCIT-ETC, cf. http://qcit.committees.comsoc.org/qcit19-workshop/)
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- 2019
15. Error Tolerant Path Planning for Swarms of Micro Aerial Vehicles with Quality Amplification
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Barbeau, Michel, Garcia-Alfaro, Joaquin, Kranakis, Evangelos, and Santos, Fillipe
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Computer Science - Robotics ,Electrical Engineering and Systems Science - Systems and Control - Abstract
We present an error tolerant path planning algorithm for Micro Aerial Vehicle (MAV) swarms. We assume navigation without GPS-like techniques. The MAVs find their path using sensors and cameras, identifying and following a series of visual landmarks. The visual landmarks lead the MAVs towards their destination. MAVs are assumed to be unaware of the terrain and locations of the landmarks. They hold a priori information about landmarks, whose interpretation is prone to errors. Errors are of two types, recognition or advice. Recognition errors follow from misinterpretation of sensed data or a priori information, or confusion of objects, e.g., due to faulty sensors. Advice errors are consequences of outdated or wrong information about landmarks, e.g., due to weather conditions. Our path planning algorithm is cooperative. MAVs communicate and exchange information wirelessly, to minimize the number of recognition and advice errors. Hence, the quality of the navigation decision process is amplified. Our solution successfully achieves an adaptive error tolerant navigation system. Quality amplification is parameterized with respect to the number of MAVs. We validate our approach with theoretical proofs and numeric simulations., Comment: An early version of this paper appeared in the proceedings of IEEE GLOBECOM 2019, Waikoloa, Hawaii, Dec 9-14, 2019
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- 2019
16. Cyber-Physical Architecture Assisted by Programmable Networking
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Rubio-Hernan, Jose, Sahay, Rishikesh, De Cicco, Luca, and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security ,Computer Science - Systems and Control - Abstract
Cyber-physical technologies are prone to attacks, in addition to faults and failures. The issue of protecting cyber-physical systems should be tackled by jointly addressing security at both cyber and physical domains, in order to promptly detect and mitigate cyber-physical threats. Towards this end, this letter proposes a new architecture combining control-theoretic solutions together with programmable networking techniques to jointly handle crucial threats to cyber-physical systems. The architecture paves the way for new interesting techniques, research directions, and challenges which we discuss in our work., Comment: 8 pages, 3 figures, pre-print
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- 2018
17. Security of Cyber-Physical Systems. From Theory to Testbeds and Validation
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Rubio-Hernan, Jose, Rodolfo-Mejias, Juan, and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security - Abstract
Traditional control environments connected to physical systems are being upgraded with novel information and communication technologies. The resulting systems need to be adequately protected. Experimental testbeds are crucial for the study and analysis of ongoing threats against those resulting cyber-physical systems. The research presented in this paper discusses some actions towards the development of a replicable and affordable cyber-physical testbed for training and research. The architecture of the testbed is based on real-world components, and emulates cyber-physical scenarios commanded by SCADA (Supervisory Control And Data Acquisition) technologies. We focus on two representative protocols, Modbus and DNP3. The paper reports as well the development of some adversarial scenarios, in order to evaluate the testbed under cyber-physical threat situations. Some detection strategies are evaluated using our proposed testbed., Comment: 17 pages, 4 figures, 2 tables, Security of Industrial Control Systems & Cyber-Physical Systems , (http://www.ds.unipi.gr/cybericps2016/)
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- 2017
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18. An n-sided polygonal model to calculate the impact of cyber security events
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Gonzalez-Granadillo, Gustavo, Garcia-Alfaro, Joaquin, and Debar, Hervé
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Computer Science - Cryptography and Security - Abstract
This paper presents a model to represent graphically the impact of cyber events (e.g., attacks, countermeasures) in a polygonal systems of n-sides. The approach considers information about all entities composing an information system (e.g., users, IP addresses, communication protocols, physical and logical resources, etc.). Every axis is composed of entities that contribute to the execution of the security event. Each entity has an associated weighting factor that measures its contribution using a multi-criteria methodology named CARVER. The graphical representation of cyber events is depicted as straight lines (one dimension) or polygons (two or more dimensions). Geometrical operations are used to compute the size (i.e, length, perimeter, surface area) and thus the impact of each event. As a result, it is possible to identify and compare the magnitude of cyber events. A case study with multiple security events is presented as an illustration on how the model is built and computed., Comment: 16 pages, 5 figures, 2 tables, 11th International Conference on Risks and Security of Internet and Systems, (CRiSIS 2016), Roscoff, France, September 2016
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- 2017
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19. Geometric morphometrics of adolescent idiopathic scoliosis: a prospective observational study
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González-Ruiz, José María, Pérez-Núñez, Maria Isabel, García-Alfaro, Mª Dolores, and Bastir, Markus
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- 2021
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20. Quantum Computing Assisted Medium Access Control for Multiple Client Station Networks
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Barbeau, Michel, Cloutier, Steve R., and Garcia-Alfaro, Joaquin
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Computer Science - Emerging Technologies ,Quantum Physics - Abstract
A medium access control protocol based on quantum entanglement has been introduced by Berces and Imre (2006) and Van Meter (2012). This protocol entirely avoids collisions. It is assumed that the network consists of one access point and two client stations. We extend this scheme to a network with an arbitrary number of client stations. We propose three approaches, namely, the qubit distribution, transmit first election and temporal ordering protocols. The qubit distribution protocol leverages the concepts of Bell-EPR pair or W state triad. It works for networks of up to four CSs. With up to three CSs, there is no probability of collision. In a four-CS network, there is a low probability of collision. The transmit first election protocol and temporal ordering protocols work for a network with any number of CSs. The transmit first election builds upon the concept of W state of size corresponding to the number of client stations. It is fair and collision free. The temporal ordering protocol employs the concepts of Lehmer code and quantum oracle. It is collision free, has a normalized throughput of 100% and achieves quasi-fairness., Comment: 18 pages, 12 figures, 3 tables; manuscript under review
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- 2015
21. Proceedings 2014 International Workshop on Advanced Intrusion Detection and Prevention
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Garcia-Alfaro, Joaquin and Gür, Gürkan
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Computer Science - Cryptography and Security ,Computer Science - Networking and Internet Architecture ,Computer Science - Operating Systems ,Security - Abstract
This volume contains the proceedings of the 2014 International Advanced Intrusion Detection and Prevention (AIDP'14) Workshop, held in Marrakesh, Morocco, on the 5th of June 2014, in conjunction with the 29th IFIP TC-11 SEC 2014 International Conference. It includes a revised version of the papers selected for presentation at the work- shop.
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- 2014
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22. Historia clínica y receta electrónica: riesgos y beneficios detectados desde su implantación. Diseño, despliegue y usos seguros
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Rosa María Añel Rodríguez, Irene García Alfaro, Rafael Bravo Toledo, and José Daniel Carballeira Rodríguez
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Information systems ,Medical informatics applications ,Electronic medical record ,Electronic prescribing ,Patient safety ,Primary Health Care ,Medicine (General) ,R5-920 - Abstract
Resumen: Las nuevas tecnologías de la información han transformado la manera de prestar la asistencia en los servicios de salud, impregnando casi todos los aspectos de la atención sanitaria. A medida que la complejidad del sistema aumenta, es más difícil trabajar de manera óptima sin la asistencia de las nuevas tecnologías. Su implantación supone un avance, bien por el adelanto que entraña el uso adecuado de cualquier nueva tecnología en el cuidado de la salud, bien por el desarrollo de aplicaciones específicas que mejoran la seguridad de la asistencia. Sin embargo, factores como un diseño incorrecto, implementación y mantenimiento deficientes, capacitación inadecuada, junto al exceso de confianza y dependencia, pueden hacer que las tecnologías comprometan, más que favorecer, la seguridad del paciente.Este artículo describe los efectos beneficiosos, y los que no lo son tanto, de la introducción en nuestro país de la historia clínica y la receta electrónicas en la calidad y la seguridad de la asistencia sanitaria. Abstract: New information technologies have transformed the way care is delivered within health services, permeating almost every aspect of health care. As the complexity of the system increases, it becomes more difficult to work optimally without the assistance of new technologies. Although its implementation represents a breakthrough, either because of the advancement involved in the proper use of any technology in health care, or because of the development of specific applications that improve patient safety, other factors such as incorrect design, implementation and poor maintenance, inadequate training, along with overconfidence and dependency, can make technologies compromise patient safety.This article describes the beneficial effects, and those that are not so, of the introduction in our country of the electronic medical record and the electronic prescription on the healthcare quality and safety.
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- 2021
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23. Manejo diagnóstico y terapéutico actual de la fractura de los primeros pasos
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Sandra Llorente Pelayo, Juan Rodríguez Fernández, M. Teresa Leonardo Cabello, Mónica Rubio Lorenzo, M. Dolores García Alfaro, and Carmelo Arbona Jiménez
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Toddler's fracture ,Tibia fracture ,Diagnosis ,Management ,Pediatrics ,RJ1-570 - Abstract
Resumen: Introducción: La fractura de los primeros pasos o fractura de toddler es una fractura espiroidea de tibia propia de la primera infancia. El objetivo es analizar su incidencia y el manejo diagnóstico y terapéutico actual. Pacientes y métodos: Estudio descriptivo retrospectivo de los pacientes de 0 a 3 años diagnosticados en un hospital terciario entre los años 2013 y 2017. Resultados: Registrados 53 pacientes (10,6 casos/año), con una mediana de edad de 2 años y ligero predominio masculino. La radiografía inicial resultó normal en el 24,5%. Con la aproximación inicial, el 69,8% de los pacientes se diagnosticaron de fractura, el 11,3% de sospecha de fractura y el 18,9% de contusión. El 22% precisaron prueba de control; 10 radiografía (patológica 90%) y 5 ecografía (patológica 80%, 3 de ellos con radiografía inicial normal). El 80,8% de los pacientes se inmovilizaron con férula frente al 19,2% en los que se realizó inmovilización flexible o no inmovilización. Se encontraron complicaciones en el 21,4% de los pacientes inmovilizados con férula, fundamentalmente úlceras por presión (19%), que fueron más frecuentes en este grupo que en los no inmovilizados (21,4 vs. 0%; p = 0,006), sin diferencias significativas en cuanto a tiempo hasta carga. Conclusiones: La radiografía simple tiene una sensibilidad limitada para el diagnóstico de la fractura de los primeros pasos. En el grupo de pacientes con radiografía normal el uso de ecografía puede contribuir al diagnóstico y a evitar radiación adicional. Aunque el tratamiento más común de esta fractura sigue siendo la inmovilización con férula, la alternativa sin inmovilización rígida no parece obtener peores resultados, incluso parece presentar menor morbilidad asociada al tratamiento. Abstract: Introduction: Toddler's fracture is an accidental spiral tibial fracture, characteristic of the early childhood. The objective of this study is to determine the incidence and current diagnosis and management of this disorder. Patients and methods: A retrospective study was conducted on a sample of patients aged 0-3 years diagnosed with a toddler's fracture in a tertiary hospital between years 2013 and 2017. Results: A total of 53 patients were registered (10.6 cases per year). The median age was 2 years, with a slight male predominance. The initial radiograph was normal in 24.5% of patients. With the initial approach, 69.8% of patients were diagnosed with fracture, 11.3% with suspected fracture, and 18.9% with contusion. A follow-up was required in 22% required a control test, using radiographs in 10 patients (pathological 90%), and ultrasound in 5 (pathological 80%, 3 of them with normal initial radiography). The large majority (80.8%) of the patients were immobilised with a cast, while flexible immobilisation or non-immobilisation was used in 19.2%. Complications were found in a 21.4% of patients immobilised with splint, mainly skin injuries (19%). These were more frequent in this group than in those that were not immobilised (21.4% vs. 0%, P = .006); with no significant differences in time to weight-bearing. Conclusions: Radiography has a limited sensitivity for the diagnosis of toddler's fracture. In the group of patients with normal radiography, the use of ultrasound can be helpful to the diagnosis and avoid additional radiation. Even though the most common treatment continues to be immobilisation with a splint, the alternative without rigid immobilisation does not seem to give worse results, even with lower morbidity associated with the treatment.
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- 2020
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24. Current diagnosis and management of toddler's fracture
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Sandra Llorente Pelayo, Juan Rodríguez Fernández, M. Teresa Leonardo Cabello, Mónica Rubio Lorenzo, M. Dolores García Alfaro, and Carmelo Arbona Jiménez
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Fractura de los primeros pasos ,Fractura de tibia ,Diagnóstico ,Manejo terapéutico ,Pediatrics ,RJ1-570 - Abstract
Introduction: Toddler's fracture is an accidental spiral tibial fracture, characteristic of the early childhood. The objective of this study is to determine the incidence and current diagnosis and management of this disorder. Patients and methods: A retrospective study was conducted on a sample of patients aged 0–3 years diagnosed with a toddler's fracture in a tertiary hospital between years 2013 and 2017. Results: A total of 53 patients were registered (10.6 cases per year). The median age was 2 years, with a slight male predominance. The initial radiograph was normal in 24.5% of patients. With the initial approach, 69.8% of patients were diagnosed with fracture, 11.3% with suspected fracture, and 18.9% with contusion. A follow-up was required in 22% through a control test, using radiographs in 10 patients (pathological 90%), and ultrasound in 5 (pathological 80%, 3 of them with normal initial radiography). The large majority (80.8%) of the patients were immobilised with a cast, while flexible immobilisation or non-immobilisation was used in 19.2%. Complications were found in a 21.4% of patients immobilised with splint, mainly skin injuries (19%). These were more frequent in this group than in those that were not immobilised (21.4% vs. 0%, P = .006); with no significant differences in time to weight-bearing. Conclusions: Radiography has a limited sensitivity for the diagnosis of toddler's fracture. In the group of patients with normal radiography, the use of ultrasound can be helpful to the diagnosis and avoid additional radiation. Even though the most common treatment continues to be immobilisation with a splint, the alternative without rigid immobilisation does not seem to give worse results, even with lower morbidity associated with the treatment. Resumen: Introducción: La fractura de los primeros pasos o fractura de toddler es una fractura espiroidea de tibia propia de la primera infancia. El objetivo es analizar su incidencia y el manejo diagnóstico y terapéutico actual. Pacientes y métodos: Estudio descriptivo retrospectivo de los pacientes de 0 a 3 años diagnosticados en un hospital terciario entre los años 2013 y 2017. Resultados: Registrados 53 pacientes (10,6 casos/año), con una mediana de edad de 2 años y ligero predominio masculino. La radiografía inicial resultó normal en el 24,5%. Con la aproximación inicial, el 69,8% de los pacientes se diagnosticaron de fractura, el 11,3% de sospecha de fractura y el 18,9% de contusión. El 22% precisaron prueba de control; 10 radiografía (patológica 90%) y 5 ecografía (patológica 80%, 3 de ellos con radiografía inicial normal). El 80,8% de los pacientes se inmovilizaron con férula frente al 19,2% en los que se realizó inmovilización flexible o no inmovilización. Se encontraron complicaciones en el 21,4% de los pacientes inmovilizados con férula, fundamentalmente úlceras por presión (19%), que fueron más frecuentes en este grupo que en los no inmovilizados (21,4 vs. 0%; p = 0,006), sin diferencias significativas en cuanto a tiempo hasta carga. Conclusiones: La radiografía simple tiene una sensibilidad limitada para el diagnóstico de la fractura de los primeros pasos. En el grupo de pacientes con radiografía normal el uso de ecografía puede contribuir al diagnóstico y a evitar radiación adicional. Aunque el tratamiento más común de esta fractura sigue siendo la inmovilización con férula, la alternativa sin inmovilización rígida no parece obtener peores resultados, incluso parece presentar menor morbilidad asociada al tratamiento.
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- 2020
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25. On the Use of Latency Graphs for the Construction of Tor Circuits
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Castillo-Perez, Sergio and Garcia-Alfaro, Joaquin
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Computer Science - Cryptography and Security - Abstract
The use of anonymity-based infrastructures and anonymisers is a plausible solution to mitigate privacy problems on the Internet. Tor (short for The onion router) is a popular low-latency anonymity system that can be installed as an end-user application on a wide range of operating systems to redirect the traffic through a series of anonymising proxy circuits. The construction of these circuits determines both the latency and the anonymity degree of the Tor anonymity system. While some circuit construction strategies lead to delays which are tolerated for activities like Web browsing, they can make the system vulnerable to linking attacks. We evaluate in this paper three classical strategies for the construction of Tor circuits, with respect to their de-anonymisation risk and latency performance. We then develop a new circuit selection algorithm that considerably reduces the success probability of linking attacks while keeping a good degree of performance. We finally conduct experiments on a real-world Tor deployment over PlanetLab. Our experimental results confirm the validity of our strategy and its performance increase for Web browsing., Comment: 34
- Published
- 2012
26. Evaluation of Anonymized ONS Queries
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Garcia-Alfaro, Joaquin, Barbeau, Michel, and Kranakis, Evangelos
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Computer Science - Cryptography and Security ,Computer Science - Networking and Internet Architecture - Abstract
Electronic Product Code (EPC) is the basis of a pervasive infrastructure for the automatic identification of objects on supply chain applications (e.g., pharmaceutical or military applications). This infrastructure relies on the use of the (1) Radio Frequency Identification (RFID) technology to tag objects in motion and (2) distributed services providing information about objects via the Internet. A lookup service, called the Object Name Service (ONS) and based on the use of the Domain Name System (DNS), can be publicly accessed by EPC applications looking for information associated with tagged objects. Privacy issues may affect corporate infrastructures based on EPC technologies if their lookup service is not properly protected. A possible solution to mitigate these issues is the use of online anonymity. We present an evaluation experiment that compares the of use of Tor (The second generation Onion Router) on a global ONS/DNS setup, with respect to benefits, limitations, and latency., Comment: 14 pages
- Published
- 2009
27. A Survey on Cross-Site Scripting Attacks
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Garcia-Alfaro, Joaquin and Navarro-Arribas, Guillermo
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Computer Science - Cryptography and Security - Abstract
Web applications are becoming truly pervasive in all kinds of business models and organizations. Today, most critical systems such as those related to health care, banking, or even emergency response, are relying on these applications. They must therefore include, in addition to the expected value offered to their users, reliable mechanisms to ensure their security. In this paper, we focus on the specific problem of cross-site scripting attacks against web applications. We present a study of this kind of attacks, and survey current approaches for their prevention. Applicability and limitations of each proposal are also discussed., Comment: 15 pages
- Published
- 2009
28. Reliable Process for Security Policy Deployment
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Preda, Stere, Cuppens-Boulahia, Nora, Cuppens, Frederic, Garcia-Alfaro, Joaquin, and Toutain, Laurent
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Computer Science - Cryptography and Security ,Computer Science - Software Engineering - Abstract
We focus in this paper on the problem of configuring and managing network security devices, such as Firewalls, Virtual Private Network (VPN) tunnels, and Intrusion Detection Systems (IDSs). Our proposal is the following. First, we formally specify the security requirements of a given system by using an expressive access control model. As a result, we obtain an abstract security policy, which is free of ambiguities, redundancies or unnecessary details. Second, we deploy such an abstract policy through a set of automatic compilations into the security devices of the system. This proposed deployment process not only simplifies the security administrator's job, but also guarantees a resulting configuration free of anomalies and/or inconsistencies., Comment: 12 pages
- Published
- 2009
29. Impact Of Vulvovaginal Atrophy Of Menopause In Spanish Women: Prevalence And Symptoms According To The EVES Study
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Santiago Palacios, MD, PhD, Silvia P. González, MD, PhD, Micaela Fernández-Abellán, MD, Montserrat Manubens, MD, PhD, Pascual García-Alfaro, MD, C.Argudo Prieto, L.Baquedano Mainar, J.Calleja Abu-Amshah, M.J.Cancelo Hidalgo, C. Castelo-Branco i Flores, P.Coronado Martin, M.Correa Rancel, M.Fernández Abellán, J.M.Fernández Moya, P.García Alfaro, M.González Fernández, S.González Rodríguez, E.Iglesias Bravo, P.Llaneza Coto, M.Manubens Grau, P.Marín Sánchez, N.Mendoza Ladrón de Guevara, B.Otero García-Ramos, S. Palacios, J.C.Presa Lorite, R.Sánchez Borrego, S.Sánchez Méndez, and F.Vázquez Fernández
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Medicine - Abstract
Introduction: The prevalence of menopausal women with confirmed vulvovaginal atrophy (VVA) oscillates between 67–98%. Aim: To assess the prevalence of postmenopausal women with VVA confirmed by gynecologic clinical assessment among all women attending menopause centers in Spain, as well as to describe the impact of VVA on quality of life and sexual functioning. Methods: Women aged 45–75 years old with the last menstrual period >12 months before were included in a cross-sectional study. Main Outcome Measures: Women with ≥1 VVA symptoms filled out a number of questionnaires, including EuroQoL, Day-to-Day Impact of Vaginal Aging, Female Sexual Function Index, and Female Sexual Distress Scale-revised. A gynecologic examination was performed to confirm diagnosis. Results: 1,177 evaluable patients were included. VVA was confirmed in 87.3% of the patients. Almost 80% of women who acknowledged being sexually active (n = 717) presented pain during intercourse. As compared with patients without confirmed VVA (n = 66), patients with confirmed VVA (n = 1,028) were significantly older (P < .0001), had lower rates of sexual activity (P < .05), and used more VVA treatments (P < .05). Severe vaginal atrophy and severe vulvar atrophy were more prevalent in VVA-confirmed women (P < .0001, in both cases). No differences regarding the confirmation of VVA were observed for EuroQoL and Day-to-Day Impact of Vaginal Aging quality-of-life questionnaires. Sexual function measured through the Female Sexual Function Index score was significantly reduced in sexually-active patients with confirmed VVA (P < .05). Conclusion: VVA signs and symptoms are highly prevalent in Spanish postmenopausal women. Confirmation of VVA diagnosis was associated with impaired sexual function. The early recognition of VVA symptoms should be actively promoted in medical practice, instead of waiting until signs appear to exclude other reasons for VVA and to manage treatment effectively.Palacios S, González SP, Fernández-Abellán M, et al. Impact of Vulvovaginal Atrophy of Menopause in Spanish Women: Prevalence and Symptoms According to the EVES Study. Sex Med 2019;7:207–216. Key Words: Vulvovaginal Atrophy, Prevalence, Menopause, EQ5D3L, DIVA, Gynecologic Exam
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- 2019
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30. Aggregating and Deploying Network Access Control Policies
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Garcia-Alfaro, Joaquin, Cuppens, Frederic, and Cuppens-Boulahia, Nora
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Computer Science - Cryptography and Security ,Computer Science - Networking and Internet Architecture - Abstract
The existence of errors or inconsistencies in the configuration of security components, such as filtering routers and/or firewalls, may lead to weak access control policies -- potentially easy to be evaded by unauthorized parties. We present in this paper a proposal to create, manage, and deploy consistent policies in those components in an efficient way. To do so, we combine two main approaches. The first approach is the use of an aggregation mechanism that yields consistent configurations or signals inconsistencies. Through this mechanism we can fold existing policies of a given system and create a consistent and global set of access control rules -- easy to maintain and manage by using a single syntax. The second approach is the use of a refinement mechanism that guarantees the proper deployment of such a global set of rules into the system, yet free of inconsistencies., Comment: 9 pages
- Published
- 2008
31. Preventing Coordinated Attacks Via Distributed Alert Exchange
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Garcia-Alfaro, Joaquin, Jaeger, Michael A., Muehl, Gero, and Borrell, Joan
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Computer Science - Cryptography and Security ,Computer Science - Networking and Internet Architecture - Abstract
Attacks on information systems followed by intrusions may cause large revenue losses. The prevention of both is not always possible by just considering information from isolated sources of the network. A global view of the whole system is necessary to recognize and react to the different actions of such an attack. The design and deployment of a decentralized system targeted at detecting as well as reacting to information system attacks might benefit from the loose coupling realized by publish/subscribe middleware. In this paper, we present the advantages and convenience in using this communication paradigm for a general decentralized attack prevention framework. Furthermore, we present the design and implementation of our approach based on existing publish/subscribe middleware and evaluate our approach for GNU/Linux systems., Comment: 19 pages, proposal reviewed
- Published
- 2008
32. Investigating Human Torso Asymmetries: An Observational Longitudinal Study of Fluctuating and Directional Asymmetry in the Scoliotic Torso
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José María González-Ruiz, María Isabel Pérez-Núñez, María Dolores García-Alfaro, and Markus Bastir
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scoliosis ,directional asymmetry ,fluctuating asymmetry ,geometric morphometrics ,Mathematics ,QA1-939 - Abstract
The presence of directional and fluctuating asymmetry in adolescent idiopathic scoliosis has not been deeply studied. We aimed to test the presence of both in a scoliosis group and a control group. 24 patients with adolescent idiopathic scoliosis and 24 control subjects were subjected to geometric morphometrics analyses to address our main hypotheses and to make qualitative visualizations of the 3D shape changes in patients with scoliosis. Our results support the hypothesis that both asymmetric traits are present in the scoliosis and control groups, but to a greater degree in patients. A qualitative visualization tool that allows us to measure the impact that directional and fluctuating asymmetry have on the 3D shape of our patients has been developed. Adolescent idiopathic scoliosis is the result of developmental instabilities during growth and the visualization of the 3D shape changes in response to both asymmetric variables has shown different morphological behaviors. Measuring these variables is important, as they can prevent the localization and deformation that is expected to occur during the course of scoliosis in every individual patient and therefore acts as a key clinical finding that may be used in the prognosis of the condition.
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- 2021
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33. PlA2 Polymorphism of Platelet Glycoprotein IIb/IIIa and C677T Polymorphism of Methylenetetrahydrofolate Reductase (MTHFR), but Not Factor V Leiden and Prothrombin G20210A Polymorphisms, Are Associated with More Severe Forms of Legg–Calvé–Perthes Disease
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María Dolores García-Alfaro, María Isabel Pérez-Nuñez, María Teresa Amigo, Carmelo Arbona, María Ángeles Ballesteros, and Domingo González-Lamuño
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Legg–Calvé–Perthes disease ,gene polymorphism ,heritable thrombophilia ,Pediatrics ,RJ1-570 - Abstract
The possible association of common polymorphic variants related to thrombophilia (the rs6025(A) allele encoding the Leiden mutation, rs1799963(A), i.e., the G20210A mutation of the prothrombin F2 gene, the rs1801133(T) variant of the methylenetetrahydrofolate reductase (MTHFR) gene that encodes an enzyme involved in folate metabolism, and rs5918(C), i.e., the ‘A2’ allele of the platelet-specific alloantigen system that increases platelet aggregation induced by agonists), with the risk of Legg–Calvé–Perthes disease (LCPD) and the degree of hip involvement (Catterall stages I to IV) was analyzed in a cohort study, including 41 children of ages 2 to 10.9 (mean 5.4, SD 2.2), on the basis of clinical and radiological criteria of LCPD. In 10 of the cases, hip involvement was bilateral; thus, a total of 51 hips were followed-up for a mean of 75.5 months. The distribution of genotypes among patients and 118 controls showed no significant differences, with a slightly increased risk for LCPD in rs6025(A) carriers (OR: 2.9, CI: 0.2–47.8). Regarding the severity of LCPD based on Catterall classification, the rs1801133(T) variant of the MTHFR gene and the rs5918(C) variant of the platelet glycoprotein IIb/IIIa were associated with more severe forms of Perthes disease (Catterall III–IV) (p < 0.05). The four children homozygous for mutated MTHFR had a severe form of the disease (Stage IV of Catterall) and a higher risk of non-favorable outcome (Stulberg IV–V).
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- 2021
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34. Dispensación de medicamentos de prescripción y resolución de incidencias a partir de la entrada en vigor de la directiva 2011/62/UE.
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José Daniel Carballeira Rodríguez and Irene García Alfaro
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trazabilidad ,dispensación de urgencia ,resolución de incidencias ,Pharmacy and materia medica ,RS1-441 - Published
- 2018
35. Detección de duplicidades terapéuticas en farmacia comunitaria: Importancia del seguimiento farmacoterapéutico en pacientes atendidos por varios especialistas. Posibles mejoras.
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Irene García Alfaro and José Daniel Carballeira Rodríguez
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Paciente polimedicado ,seguimiento farmacoterapéutico ,duplicidad terapéutica ,receta electrónica ,registro y comunicación de incidencias ,cadena de bloques ,Pharmacy and materia medica ,RS1-441 - Abstract
Los pacientes mayores de 65 años con patologías crónicas, polimedicados y que se ven obligados a acudir a diferentes especialistas, son el colectivo más propenso a sufrir no sólo problemas relacionados con los medicamentos, sino también errores de prescripción. Estos errores son detectados por el farmacéutico comunitario, ya que suele ser el primer profesional sanitario con el que tienen contacto tras la consulta con el especialista. En este caso clínico, detectamos una duplicidad de antiespasmódicos urinarios en un paciente que había acudido a la farmacia preocupado por diversos problemas de salud y al que se le ofreció participar en nuestro servicio de seguimiento farmacoterapéutico. La incidencia fue solventada, pero consideramos que el tiempo de resolución podría ser menor con ligeras modificaciones en el sistema de comunicación entre el farmacéutico y otros profesionales sanitarios, aumentando así la calidad de la asistencia sanitaria y la eficiencia del sistema nacional de salud.
- Published
- 2018
36. Prescripción inadecuada en pacientes polimedicados mayores de 64 años en atención primaria
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Josefina Filomena Paci, Marta García Alfaro, Francisco Javier Redondo Alonso, and María Isabel Fernández San-Martín
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Prescripción inadecuada ,Polimedicación ,Ancianos ,Atención primaria ,Medicine (General) ,R5-920 - Abstract
Objetivo: Describir la prescripción inadecuada (PI) en la población polimedicada mayor de 64 años en atención primaria mediante los criterios STOPP/START. Diseño: Descriptivo, transversal y multicéntrico. Emplazamiento: Cuatro centros urbanos de atención primaria de Barcelona. Participantes: Selección aleatoria de pacientes mayores de 64 años con más de 5 fármacos prescritos durante al menos 6 meses (n = 467). Mediciones principales: Se estudiaron los principales problemas de salud, fármacos prescritos de forma crónica y el porcentaje de PI mediante los criterios STOPP/START. Se consideró porcentaje de PI al porcentaje de pacientes con incumplimiento de al menos un criterio STOPP o START, y se calculó con un IC del 95%. Para el análisis estadístico se utilizó chi-cuadrado. Resultados: La edad media fue de 77,3 (± 7,0 DE), con una media de 8,9 (± 2,8 DE) fármacos prescritos. La PI fue mayor a mayor número de fármacos prescritos (p
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- 2015
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37. Plasma homocysteine levels and handgrip strength in postmenopausal women
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García-Alfaro, P., primary, Rodriguez, I., additional, and Pérez-López, F. R., additional
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- 2022
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38. Relationship between handgrip strength and endogenous hormones in postmenopausal women
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García-Alfaro, Pascual, García, Sandra, Rodriguez, Ignacio, Bergamaschi, Luciana, and Pérez-López, Faustino R.
- Abstract
The results of this study showed that studied ovarian steroids, adrenal hormones, insulin-like growth factor-1, parathormone, and vitamin D were not associated with handgrip strength.
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- 2023
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39. Encefalopatía hiperamoniémica: valoración y manejo nutricional a propósito de un caso Hyperammonemic encephalopathy: nutritional assessment and management of a case
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R. Oliva Rodríguez, Y. Suleiman Martos, J. L. Pereira Cunnil, P. Serrano Aguayo, C. García Alfaro, and P. P. García Luna
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Déficit de OTC ,Hiperamoniemia ,Adulto ,OTC deficiency ,Hyperammonemia ,Adult ,Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
El déficit de Ornitintranscarbamilasa (OTC) es un trastorno del ciclo de la urea ligado al cromosoma X. Se manifiesta en el varón como hiperamoniemia severa en los primeros días de vida. En la mujer la enfermedad es más leve. Diversas situaciones pueden provocar una descompensación con hiperamoniemia que puede ser letal o provocar daños neurológicos permanentes. Presentamos una mujer de 36 años que ingresó para cirugía y que sufrió una descompensación coincidiendo con infección de la herida quirúrgica. La hiperamoniemia provocó un deterioro neurológico con disminución del nivel de conciencia, tetraparesia y disfagia neurógena. Con tratamiento, que consistió en dieta hipoproteica, quelantes de amonio y medidas dialíticas, se consiguió controlar la hiperamoniemia y mejorar el estado neurológico. Este caso ilustra la importancia del soporte nutricional especializado de los pacientes con trastornos del ciclo de la urea en el ámbito hospitalario por darse frecuentemente situaciones que favorecen las descompensaciones.OTC deficiency is a disorder of the urea cycle X-linked. It is manifested in men as severe hyperammonemia in the first days of life. In women the disease is milder severity. Various conditions cause decompensation with hyperammonemia. It could be fatal or cause permanent neurological damage. We report a 36 years old woman admitted for surgery, she suffered a decompensation in conjunction with surgical wound infection. Hyperammonemia caused neurological deterioration with decreased level of consciousness, tetraparesis and neurogenic dysphagia. The treatment consisting of low-protein diet, ammonium chelating drugs and dialytic measures, was effective in controlling hyperammonaemia and improving neurological status. This case illustrates the importance of nutritional support of patients with disorders of the urea cycle in the hospital because the descompensations are more frecuent here.
- Published
- 2012
40. Gender Influences Cerebral Oxygenation After Red Blood Cell Transfusion in Patients with Severe Traumatic Brain Injury
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Arellano-Orden, Victoria, Leal-Noval, Santiago R., Cayuela, Aurelio, Muñoz-Gómez, Manuel, Ferrándiz-Millón, Carmen, García-Alfaro, Claudio, Marín-Caballos, Antonio, Domínguez-Roldán, José Ma., and Murillo-Cabezas, Francisco
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- 2011
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41. Invasive and noninvasive assessment of cerebral oxygenation in patients with severe traumatic brain injury
- Author
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Leal-Noval, Santiago R., Cayuela, Aurelio, Arellano-Orden, Victoria, Marín-Caballos, Antonio, Padilla, Vicente, Ferrándiz-Millón, Carmen, Corcia, Yael, García-Alfaro, Claudio, Amaya-Villar, Rosario, and Murillo-Cabezas, Francisco
- Published
- 2010
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42. Symptom severity and quality of life in the management of vulvovaginal atrophy in postmenopausal women
- Author
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Nick, Panaya, Santiago, Palacios, Nico, Bruyniks, Martire, Particco, Nappi, Rossella E., Argudo, Prieto, Baqueda, L., Becorpi, A. M., Benedetti Panici, P., Benedetto, C., Biglia, N., Busacca, M., Cagnacci, A., Calleja Abu-Amshah, J., Cancelo Hidalgo, M. J., Castelo Branco i Flores, C., Cianci, A., Cicinelli, E., Coronado Martin, P., Correa Rancel, M., De Seta, F., Di Carlo, C., Fernández Abellán, M., Fernández Moya, J. M., Gambacciani, M., García Alfaro, P., González Fernández, M., González Rodríguez, S., Guida, M., Iglesias Bravo, E., Llaneza Coto, P., Luisi, S., Manubens Grau, M., Marchesoni, D., Marín Sánchez, P., Mendoza Ladrón de Guevara, N., Nappi, R., Otero García- Ramos, B., Paoletti, A. M., Palacios, S., Pellegrino, A., Presa Lorite, J. C., Remorgida, V., Salvatore, S., Sánchez Borrego, R., Sánchez Méndez, S., Seracchioli, R., Stomati, M., Surico, N., Vázquez Fernández, F., and P. Villa.
- Subjects
Quality of life ,medicine.medical_specialty ,Hormone Replacement Therapy ,Cross-sectional study ,Sexual Behavior ,Sexual function ,medicine.medical_treatment ,Severity of Illness Index ,General Biochemistry, Genetics and Molecular Biology ,Vulva ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,Internal medicine ,Severity of illness ,Non-hormonal treatment ,medicine ,Humans ,030212 general & internal medicine ,Aged ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Hormone replacement therapy (menopause) ,Middle Aged ,Postmenopause ,Distress ,Cross-Sectional Studies ,Dyspareunia ,Treatment Outcome ,Settore MED/40 - GINECOLOGIA E OSTETRICIA ,medicine.anatomical_structure ,Vagina ,Vulvovaginal atrophy ,Female ,Hormonal treatment ,Atrophy ,Symptom Assessment ,business - Abstract
To evaluate the association between treatments for vulvovaginal atrophy (VVA) and symptom frequency and severity, quality of life (QoL) and sexual functioning in postmenopausal women.Cross-sectional survey conducted in postmenopausal women aged 45-75 years. Data on demographic and clinical variables, as well as vaginal, vulvar and urinary symptoms were collected. The EuroQoL questionnaire (EQ5D3L), the Day-to-Day Impact of Vaginal Aging (DIVA), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale - revised (FSDS-R) were filled out.Association between treatments for VVA and symptom frequency.Women on VVA treatment presented with more severe symptoms. The sexual function score was higher in the treated women (FSFI: 15.6 vs 16.7; p = 0.010), as was the score for sexual distress (FSDS-R: 9.2 vs 12.3, p 0.0005). The systemic hormone group presented with fewer VVA symptoms, lower vaginal impact (DIVA), and better sexual function (FSFI and FSDS-R) and vaginal health. The rates of sexual distress and vulvar atrophy were higher in the non-hormonal treatment group. No significant differences were found according to treatment duration.Postmenopausal women with VVA receiving treatment complained of more severe symptoms than those untreated. Women on systemic treatment had fewer and milder VVA symptoms and presented with better vaginal and vulvar health than women on other treatments. Many women request effective local treatment too late, when VVA symptoms are already severe. Our data suggest that VVA treatments should ideally be initiated when symptoms commence and cause distress, rather than later, when symptoms may have become more severe and even a cause of intolerable distress for the woman.
- Published
- 2019
43. Manejo diagnóstico y terapéutico actual de la fractura de los primeros pasos
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Llorente Pelayo, Sandra, Rodríguez Fernández, Juan, Leonardo Cabello, M. Teresa, Rubio Lorenzo, Mónica, García Alfaro, M. Dolores, and Arbona Jiménez, Carmelo
- Abstract
La fractura de los primeros pasos o fractura de toddleres una fractura espiroidea de tibia propia de la primera infancia. El objetivo es analizar su incidencia y el manejo diagnóstico y terapéutico actual.
- Published
- 2020
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44. MAMMOGRAPHIC PARAMETERS AND ENDOGENOUS HORMONES ASSOCIATION IN POSTMENOPAUSAL WOMEN.
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García-Alfaro, Pascual, RodríguezGarcía, Ignacio, Browne, Jean L., and Xauradó, Rafael Fábregas
- Abstract
Objectives:To examine the association between endogenous hormones with mammographic breast density, glandular volume and breast volume in postmenopausal women.
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- 2023
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45. Hipertensión arterial y síndrome de apneas-hipoapneas del sueño en atención primaria
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Bayó Llibre, J., Riel Cabrera, R., Mellado Breña, E., Filomena Paci, J., Priego Artero, M., García Alfaro, F.J., Grau Granero, J.M., Vázquez González, D., López Solana, J., and Fernández San Martín, M.I.
- Abstract
El síndrome de apneas-hipoapneas del sueño (SAHS) es frecuente en pacientes hipertensos e influye en una mayor incidencia de morbimortalidad cardiovascular. El objetivo es conocer cuál es el perfil clínico de hipertensos con SAHS en comparación con hipertensos sin SAHS para conocer qué variables han de permitir orientar su cribado desde Atención Primaria.
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- 2015
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46. Prescripción inadecuada en pacientes polimedicados mayores de 64 años en atención primaria
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Filomena Paci, Josefina, García Alfaro, Marta, Redondo Alonso, Francisco Javier, and Fernández San-Martín, María Isabel
- Abstract
Describir la prescripción inadecuada (PI) en la población polimedicada mayor de 64años en atención primaria mediante los criterios STOPP/START.
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- 2015
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47. Historia clínica y receta electrónica: riesgos y beneficios detectados desde su implantación. Diseño, despliegue y usos seguros
- Author
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Añel Rodríguez, Rosa María, García Alfaro, Irene, Bravo Toledo, Rafael, and Carballeira Rodríguez, José Daniel
- Abstract
Las nuevas tecnologías de la información han transformado la manera de prestar la asistencia en los servicios de salud, impregnando casi todos los aspectos de la atención sanitaria. A medida que la complejidad del sistema aumenta, es más difícil trabajar de manera óptima sin la asistencia de las nuevas tecnologías. Su implantación supone un avance, bien por el adelanto que entraña el uso adecuado de cualquier nueva tecnología en el cuidado de la salud, bien por el desarrollo de aplicaciones específicas que mejoran la seguridad de la asistencia. Sin embargo, factores como un diseño incorrecto, implementación y mantenimiento deficientes, capacitación inadecuada, junto al exceso de confianza y dependencia, pueden hacer que las tecnologías comprometan, más que favorecer, la seguridad del paciente.
- Published
- 2021
- Full Text
- View/download PDF
48. Enfermedad de Mondor: a propósito de un caso
- Author
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García Alfaro, Pascual, Sule Salvado, María Ángeles, and Manubens Grau, Montserrat
- Published
- 2017
- Full Text
- View/download PDF
49. The use of the directed acyclic graph to disentangle confounding variables from causal factors in observational studies.
- Author
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Pérez-López FR, Rodríguez I, and García-Alfaro P
- Subjects
- Humans, Female, Confounding Factors, Epidemiologic, Observational Studies as Topic, Causality
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no competing interest.
- Published
- 2024
- Full Text
- View/download PDF
50. Asprosin levels in women with and without the polycystic ovary syndrome: a systematic review and meta-analysis.
- Author
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Pérez-López FR, López-Baena MT, Pérez-Roncero GR, Chedraui P, Varikasuvu SR, and García-Alfaro P
- Subjects
- Female, Humans, Cholesterol, HDL, Insulin, Luteinizing Hormone, Insulin Resistance, Polycystic Ovary Syndrome complications, Polycystic Ovary Syndrome metabolism
- Abstract
Objective: This systematic review and meta-analysis aimed at summarizing the evidence concerning circulating asprosin, and related endocrine and metabolites in women with and without the polycystic ovary syndrome (PCOS). Method: We performed a comprehensive literature search in Pubmed, Web of Science, Scielo, and Chinese National Knowledge Infrastructure for studies published until May 20, 2022, that evaluated circulating asprosin levels in women with and without PCOS, regardless of language. The quality of studies was assessed with the Newcastle-Ottawa Scale. Random-effects models were used to estimate mean differences (MD) or standardized MD (SMD) and their 95% confidence interval (CI). Results: We evaluated eight studies reporting 1,050 PCOS cases and 796 controls of reproductive age. Participants with PCOS were younger (MD = -2.40 years, 95% CI -2.46 to -2.33), with higher values of asprosin (SMD = 2.57, 95% CI 1.64-3.50), insulin (SMD = 2.73, 95% CI 1.18-4.28), homeostatic model assessment of insulin resistance (SMD = 2.70, 95% CI 0.85-4.55), luteinizing hormone (SMD = 2.33, 95% CI 0.60-4.06), total testosterone (SMD = 4.06, 95% CI 1.89-6.22), dehydroepiandrosterone sulfate (SMD = 2.38, 95% CI 0.37-4.40), and triglycerides (SMD = 1.20, 95% CI 0.13 to 2.27). Moreover, PCOS women had lower circulating levels of sex hormone-binding globulin (SMD = -3.36, 95% CI -4.92 to -1.80), and high-density lipoprotein-cholesterol (SMD = -0.85, 95% CI -1.69 to -0.01); with no significant differences observed for glucose, total cholesterol, and low-density lipoprotein-cholesterol levels. Conclusion: Circulating asprosin levels were significantly higher in women with PCOS as compared to those without the syndrome.
- Published
- 2023
- Full Text
- View/download PDF
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