Autodeterminación en personas con discapacidad intelectual y del desarrollo: revisión del concepto, su importancia y retos emergentes

Los avances en la conceptualización de la discapacidad intelectual y el auge de movimientos de autodefensa y empoderamiento han influido, indudablemente, en la comprensión e importancia de constructos como la autodeterminación. En este trabajo el objetivo central es aportar una actualización sobre la forma de entender el constructo y la importancia del desarrollo de la autodeterminación en los diferentes contextos de vida de las personas y, en concreto, de las personas con discapacidad intelectual. Igualmente, se complementa dicha actualización del estado de la cuestión mostrando los resultados obtenidos en un estudio en el que se exploraban las percepciones de las propias personas con discapacidad, sus familiares y los profesionales que trabajan con ellas sobre la importancia que otorgan a la autodeterminación. Todo ello permite poner de relieve las necesidades y retos que los profesionales y familiares se encuentran para transformar esa importancia atribuida a la autodeterminación en la creación de oportunidades para su promoción. Se discute sobre la necesidad de seguir ahondando para conocer y dar respuestas a dichos retos

Autodeterminación en personas con discapacidad intelectual y del desarrollo: revisión del concepto, su importancia y retos emergentes

Los avances en la conceptualización de la discapacidad intelectual y el auge de movimientos de autodefensa y empoderamiento han influido, indudablemente, en la comprensión e importancia de constructos como la autodeterminación. En este trabajo el objetivo central es aportar una actualización sobre la forma de entender el constructo y la importancia del desarrollo de la autodeterminación en los diferentes contextos de vida de las personas y, en concreto, de las personas con discapacidad intelectual. Igualmente, se complementa dicha actualización del estado de la cuestión mostrando los resultados obtenidos en un estudio en el que se exploraban las percepciones de las propias personas con discapacidad, sus familiares y los profesionales que trabajan con ellas sobre la importancia que otorgan a la autodeterminación. Todo ello permite poner de relieve las necesidades y retos que los profesionales y familiares se encuentran para transformar esa importancia atribuida a la autodeterminación en la creación de oportunidades para su promoción. Se discute sobre la necesidad de seguir ahondando para conocer y dar respuestas a dichos retos

Integrating sustainability and social commitment transversal competence across civil engineering curricula through case studies and a common evaluation rubric

The Civil Engineering School of Barcelona has a long tradition applying own experiences from international co-operation for development projects to teaching and learning activities. The continuous work carried out in this line has been supported by three pillars: i) motivated lecturers and professors, ii) institutional framework (including support for teaching innovation and Int. Cooperation for Development), and iii) increased networking with Education for Development (ED) partners. This paper presents a number of teaching materials, i.e. Case Studies, developed within an ED initiative supported by the Municipality of Barcelona during 2016-2017. The approach adopted is aligned with the European Global Dimension in Engineering Education (GDEE) initiative. Specifically, seven case studies are introduced, covering from first year of civil engineering to compulsory/master courses. The case studies include different kind of activities, which can be integrated and evaluated within the course, but also under the framework of a common evaluation rubric divided in three levels (basic, intermediate, final). This rubric makes operative the definition of Sustainability and Social Commitment cross-cutting competence at the Universitat Politècnica de Catalunya, UPC (one of the common competencies to all UPC studies). The teaching materials are the result of collaborative experiences of School’s students, lectures and professors. Some of them have been already implemented successfully in previous years and others are being tested during the year in course. This paper discusses about drivers and barriers for the development, application and consolidation of these materials.Postprint (published version

Promoting self-determination skills in the classroom: the Self-determined Learning Model of Instruction (Spanish version)

Within Spanish context, initiatives to promote self-determination in educational settings still lacking despite of the availability of instruments designed to enable the instruction of self-determination skills, such as the Self-Determined Learning Model of Instruction. This evidence-based practice enables teachers to instruct students to develop self-determination actions and skills. This study aims to present the Spanish translated and adapted version of the afore mentioned program/tool, in an effort to improve the focus of self-determination instruction in the Spanish educational context by providing practitioners with a model of instruction intended to teach skills associated with the promotion and enhancement of self-determined action.La promoción de la autodeterminación en contexto escolar sigue siendo una tarea pendiente en el contexto español, junto a la existencia de diferentes instrumentos centrados en la enseñanza de habilidades relacionadas con la conducta autodeterminada. Algunos, como el Self-Determined Learning Model of Instruction o Modelo de Enseñanza/Aprendizaje de la Autodeterminación han demostrado su eficacia en el fomento de dichas habilidades en contexto estadounidense. El presente estudio pretende dar a conocer la versión adaptada de dicho modelo de intervención, su modo de implementación, así como las evidencias empíricas que avalan su eficacia, a fin de ofrecer un instrumento de intervención que los profesionales educativos puedan usar en contexto escolar.

Routine cerebrospinal fluid parameters as biomarkers in first-episode psychosis: A prospective observational study

In recent years, multiple studies have investigated the role of biomarkers in first-episode psychosis (FEP) to facilitate early diagnosis, disease stratification, therapeutic choice and outcome prediction. Few studies have focused on cerebrospinal fluid (CSF) investigations. In this prospective observational study, 95 FEP inpatients were followed up for one year. A lumbar puncture was performed at index admission (baseline) to study the CSF parameters (glucose, total proteins, lactate dehydrogenase [LDH], and pleocytosis). At the baseline visit, the clinical assessment included prodromal (psychotic and non-psychotic) symptoms before the psychotic outbreak and psychopathology at admission. The SCID-I was administered to obtain a clinical diagnosis at baseline and at 12 months. The relationship between prodromal and psychopathology symptoms at the baseline visit was tested with multiple linear regression. Multinomial logistic regression was also used to explore the association between CSF biomarkers and longitudinal diagnoses at follow-up (schizophrenia/schizoaffective disorder vs unipolar/bipolar depression vs other psychoses). Higher CSF glucose was associated with depressive (Standardized beta = 0.27, p = 0.041) and disorganized/concrete symptoms (Standardized beta = 0.33, p = 0.023) and lower CSF LDH was associated with prodromal symptoms (Standardized beta = −0.25, p = 0.042). Lower LDH concentrations were also associated with social withdrawal (r = −0.342, p = 0.001). CSF glucose was a predictor of the long-term diagnosis (lower CSF concentrations were associated with schizophrenia or schizoaffective disorder diagnoses [OR = 0.88, CI95%: 0.77–0.99). Our study suggests that CSF biomarkers that involve bioenergetic systems are associated with prodromal symptoms and the phenotype of psychotic disorders during the early stages of the disease

Ibrutinib in Combination With Rituximab for Indolent Clinical Forms of Mantle Cell Lymphoma (IMCL-2015): A Multicenter, Open-Label, Single-Arm, Phase II Trial

Ibrutinib; Mantle cell lymphomaIbrutinib; Linfoma de células del mantoIbrutinib; Limfoma de cèl·lules de mantellPURPOSE The need for an individualized management of indolent clinical forms in mantle cell lymphoma (MCL) is increasingly recognized. We hypothesized that a tailored treatment with ibrutinib in combination with rituximab (IR) could obtain significant responses in these patients. METHODS This is a multicenter single-arm, open-label, phase II study with a two-stage design conducted in 12 Spanish GELTAMO sites (ClinicalTrials.gov identifier: NCT02682641). Previously untreated MCL patients with indolent clinical forms defined by the following criteria were eligible: no disease-related symptoms, nonblastoid variants, Ki-67 < 30%, and largest tumor diameter ≤ 3 cm. Both leukemic non-nodal and nodal subtypes were recruited. Patients received ibrutinib 560 mg once daily and a total of eight doses of rituximab 375 mg/m2. Ibrutinib could be discontinued after 2 years in the case of sustained undetectable minimal residual disease (MRD). The primary end point was the complete response (CR) rate achieved after 12 cycles according to Lugano criteria. RESULTS Fifty patients with MCL (male 66%; median age 65 years) were enrolled. After 12 cycles of treatment, 42 (84%; 95% CI, 74 to 94) patients had an overall response, including 40 (80%; 95% CI, 69 to 91) with CR. Moreover, undetectable MRD in peripheral blood was achieved in 87% (95% CI, 77 to 97) of cases. At 2 years, 24 of 35 evaluable patients (69%) could discontinue ibrutinib because of undetectable MRD. Four patients had disease progression; three were non-nodal MCL and carried high genomic complexity and TP53 mutations at enrollment. No unexpected toxicity was seen except one patient with severe aplastic anemia. CONCLUSION Frontline IR combination achieves a high rate of CRs and undetectable MRD in indolent clinical forms of MCL. Discontinuation seems appropriate in cases with undetectable MRD, except for TP53-mutated cases.The funding for the IMCL-2015 was obtained through unrestricted Janssen Clinical Investigator-Initiated Study (IIS) Research Support

Long-term effects of intermittent adolescent alcohol exposure in male and female rats

Alcohol is a serious public health concern that has a differential impact on individuals depending upon age and sex. Patterns of alcohol consumption have recently changed: heavy episodic drinking—known as binge-drinking—has become most popular among the youth. Herein, we aimed to investigate the consequences of intermittent adolescent alcohol consumption in male and female animals. Thus, Wistar rats were given free access to ethanol (20% in drinking water) or tap water for 2-h sessions during 3 days, and for an additional 4-h session on the 4th day; every week during adolescence, from postnatal day (pnd) 28–52. During this period, animals consumed a moderate amount of alcohol despite blood ethanol concentration (BEC) did not achieve binge-drinking levels. No withdrawal signs were observed: no changes were observed regarding anxiety-like responses in the elevated plus-maze or plasma corticosterone levels (pnd 53–54). In the novel object recognition (NOR) test (pnd 63), a significant deficit in recognition memory was observed in both male and female rats. Western Blot analyses resulted in an increase in the expression of synaptophysin in the frontal cortex (FC) of male and female animals, together with a decrease in the expression of the CB2R in the same brain region. In addition, adolescent alcohol induced, exclusively among females, a decrease in several markers of dopaminergic and serotonergic neurotransmission, in which epigenetic mechanisms, i.e., histone acetylation, might be involved. Taken together, further research is still needed to specifically correlate sex-specific brain and behavioral consequences of adolescent alcohol exposure

Patterns of change in treatment, response, and outcome in patients with follicular lymphoma over the last four decades: a single-center experience.

Although the introduction of immunotherapy has improved outcomes for follicular lymphoma (FL) patients, histological transformation (HT) and early relapse still confer a poor prognosis. We sought to describe the patterns of change in treatment, response, and outcome of FL patients at our institution over the last four decades. Seven hundred and twenty-seven patients (389 F/338 M; median age, 57 years) consecutively diagnosed with grade 1-3a FL between 1980 and 2017, categorized into four decades according to the time of diagnosis, constituted the study population. Clinical characteristics, treatment, response, absolute and relative survival, HT, second malignancies (SM), and causes of death were assessed. Median OS for the entire cohort was 17.6 years. From decade 1 to 4, there was an increase in the complete response rate (48 to 70%), progression-free survival (40 to 56% at 5 years), OS (77 to 86% at 5 years), and relative survival ratio (0.83 to 0.94 at 5 years), with no significant differences in the risk of HT or SM. Lymphoma remained the most common cause of death in all four decades. These findings illustrate the overall improvement in outcome for FL patients, but support the need for further research into risk stratification and management

Risk factors for mortality in patients with acute leukemia and bloodstream infections in the era of multiresistance

Objectives: We assess the epidemiology and risk factors for mortality of bloodstream infection (BSI) in patients with acute leukemia (AL). Methods: Prospectively collected data of a cohort study from July 2004 to February 2016. Multivariate analyses were performed. Results: 589 episodes of BSI were documented in 357 AL patients, 55% caused by gram-positive bacteria (coagulase-negative staphylococci 35.7%, Enterococcus spp 10.8%) and 43.5% by gram-negative bacteria (E. coli 21%, PA 12%). We identified 110 (18.7%) multidrug-resistant (MDR) microorganisms, especially MDR-Pseudomonas aeruginosa (7%) and extended-spectrum beta-lactamase producing Enterobacteriaceae (7%). The 30-day mortality was 14.8%. Age (OR 3.1; 95% CI 1.7–5.7); chronic lung disease (4.8; 1.1–21.8); fatal prognosis according to McCabe index (13.9; 6.4–30.3); shock (3.8; 1.9–7.7); pulmonary infection (3.6; 1.3–9.9); and MDR-PA infections with inappropriate treatment (12.8; 4.1–40.5) were related to mortality. MDR-PA BSI was associated to prior antipseudomonal cephalosporin use (9.31; 4.38–19.79); current use of betalactams (2.01; 1.01–4.3); shock (2.63; 1.03–6.7) and pulmonary source of infection (9.6; 3.4–27.21). Conclusions: MDR organisms were commonly isolated in BSI in AL. Inappropriate empiric antibiotic treatment for MDR-PA is the primary factor related to mortality that can be changed. New treatment strategies to improve the coverage of MDR-PA BSI should be considered in those patients with risk factors for this infection

Patterns of sedentary behavior in overweight and moderately obese users of the Catalan primary-health care system

Background and objectives Prolonged sitting time (ST) has negative consequences on health. Changing this behavior is paramount in overweight/obese individuals because they are more sedentary than those with normal weight. The aim of the study was to establish the pattern of sedentary behavior and its relationship to health, socio-demographics, occupation, and education level in Catalan overweight/obese individuals. Methods A descriptive study was performed at 25 healthcare centers in Catalonia (Spain) with 464 overweight/moderately obese patients, aged25 to 65 years. Exclusion criteria were chronic diseases which contraindicated physical activity and language barriers. Face-to-face interviews were conducted to collect data on age, gender, educational level, social class, and marital status. Main outcome was ‘sitting time’ (collected by the Marshall questionnaire); chronic diseases and anthropometric measurements were registered. Results 464 patients, 58.4% women, mean age 51.9 years (SD 10.1), 76.1% married, 60% manual workers, and 48.7% had finished secondary education. Daily sitting time was 6.2 hours on working days (374 minutes/day, SD: 190), and about 6 hours on non-working ones (357 minutes/day, SD: 170). 50% of participants were sedentary 6 hours. The most frequent sedentary activities were: working/academic activities around 2 hours (128 minutes, SD: 183), followed by watching television, computer use, and commuting. Men sat longer than women (64 minutes more on working days and 54 minutes on non-working days), and individuals with office jobs (91 minutes), those with higher levels of education (42 minutes), and younger subjects (25 to 35 years) spent more time sitting. Conclusions In our study performed in overweight/moderately obese patients the mean sitting time was around 6 hours which was mainly spent doing work/academic activities and watching television. Men, office workers, individuals with higher education, and younger subjects had longer sitting time. Our results may help design interventions targeted at these sedentary patients to decrease sitting time.