Efficacy of a dilemma-focused intervention for unipolar depression: study protocol for a multicenter randomized controlled trial

Background Depression is one of the more severe and serious health problems because of its morbidity, disabling effects and for its societal and economic burden. Despite the variety of existing pharmacological and psychological treatments, most of the cases evolve with only partial remission, relapse and recurrence. Cognitive models have contributed significantly to the understanding of unipolar depression and its psychological treatment. However, success is only partial and many authors affirm the need to improve those models and also the treatment programs derived from them. One of the issues that requires further elaboration is the difficulty these patients experience in responding to treatment and in maintaining therapeutic gains across time without relapse or recurrence. Our research group has been working on the notion of cognitive conflict viewed as personal dilemmas according to personal construct theory. We use a novel method for identifying those conflicts using the repertory grid technique (RGT). Preliminary results with depressive patients show that about 90% of them have one or more of those conflicts. This fact might explain the blockage and the difficult progress of these patients, especially the more severe and/or chronic. These results justify the need for specific interventions focused on the resolution of these internal conflicts. This study aims to empirically test the hypothesis that an intervention focused on the dilemma(s) specifically detected for each patient will enhance the efficacy of cognitive behavioral therapy (CBT) for depression. Design A therapy manual for a dilemma-focused intervention will be tested using a randomized clinical trial by comparing the outcome of two treatment conditions: combined group CBT (eight, 2-hour weekly sessions) plus individual dilemma-focused therapy (eight, 1-hour weekly sessions) and CBT alone (eight, 2-hour group weekly sessions plus eight, 1-hour individual weekly sessions). Method Participants are patients aged over 18 years meeting diagnostic criteria for major depressive disorder or dysthymic disorder, with a score of 19 or above on the Beck depression inventory, second edition (BDI-II) and presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct) as assessed using the RGT. The BDI-II is the primary outcome measure, collected at baseline, at the end of therapy, and at 3- and 12-month follow-up; other secondary measures are also used. Discussion We expect that adding a dilemma-focused intervention to CBT will increase the efficacy of one of the more prestigious therapies for depression, thus resulting in a significant contribution to the psychological treatment of depression. Trial registration ISRCTN92443999; ClinicalTrials.gov Identifier: NCT01542957.

La figura del mediador intercultural a les institucions escolars catalanes: perfil real i ideal segons els propis actors

A Catalunya, en els darrers anys, han anat proliferant una sèrie de «professionals» que realitzen, amb més o menys adequació a la definició teòrica, la funció de mediadors inter-culturals. Primerament, es tractava de gitanos, però darrerament, fruit de l’increment de la presència d’infants d’origen immigrant a les escoles catalanes, s’ha vist créixer el nombre i el protagonisme dels estrangers pel reconeixement que se’ls ha donat des de l’Administració i des de les institucions. Els mediadors han intentat intervenir en qüestions com ara la participació dels pares d’origen minoritari, l’adaptació del currículum a la diversitat cultural, la negociació de conflictes culturals, la desescolarització, l’absentisme i l’abandonament escolar dels alumnes durant el període d’escolarització obligatòria, la traducció lingüística i la interpretació sociocultural, etc. Concretament, la nostra recerca ha consistit en vint-i-set entrevistes en profunditat a mediadors interculturals de tot Catalunya.

Diversidad cultural e instituciones educativas en Cataluña: el mediador intercultural como nueva figura profesional

En Cataluña en los últimos años, han ido proliferando una serie de "profesionales" que realizan, con más o menos adecuación a la definición teórica de mediador intercultural, dicha función. Primeramente se trataba de gitanos, pero recientemente, fruto del incremento de la presencia del alumndado de origen inmigrante en las escuelas, se ha visto crecer el número y el protagonismo de los mediadores de extranjero, sobre todo por el reconocimiento que se les ha otorgado desde la administración y las instituciones. Concretamente, los mediadores interculturales han intentado intervenir en cuestiones como la participación de los padres de origen inmigrante en los centros escolares, la adaptación del currículum a la diversidad cultural, la negociación de conflictos "culturales" (el uso del pañuelo en las clases, los menús del comedor...), la desescolarización, absentismlo y abandono escolar de los alumnos durante el período de la escoalrización obligatoria, la traducción lingüística y la interpretación sociocultural., etc. Al ser una práctica nueva, está aún llena de interrogantes, pero, como no se estaba produciendo paralelamente una reflexión y clarificación de sus fundamentos, nos parecía un momento pertinente para examinarla. Así pues, pretendemos profundizar en esta figura a partir de un trabajo empírico que ha consistido en 22 entrevistas en profundidad a mediadores de origen inmigrante que trabajan en las instituciones escolares de Cataluña.

Conflictos culturales y mediación: el ejemplo de Cataluña

En Cataluña, en los últimos años, ha ido proliferando una serie de «profesionales » que realizan, con más o menos adecuación a la definición teórica de mediador intercultural, dicha función. Concretamente, los mediadores interculturales intervienen en cuestiones como la participación de los padres de origen minoritario en los centros escolares; la adaptación del currículum a la diversidad cultural; la negociación de conflictos «culturales» (la carne de cerdo en el comedor escolar, el uso del pañuelo...); la desescolarización; absentismo y abandono escolar de los alumnos durante el período de la escolarización obligatoria; la traducción lingüística y la interpretación sociocultural, etc. La experiencia adquirida1 nos indica de forma clara cuáles son los problemas que se producen con más frecuencia y las vías de solución que han resultado más eficaces.

La educación intercultural en los centros escolares españoles

Son muchas las iniciativas que sobre educación intercultural se están llevando a cabo en las escuelas de nuestro país. El panorama es variado y adaptado a las decisiones y a las necesidades que cada autonomía ha considerando relevantes. Consideramos interesante visibilizar las prácticas escolares que sobre interculturalidad se han realizado en los centros educativos españoles en las últimas décadas. Empezamos este escrito a través de un repaso de las políticas educativas que han dado cobertura a tales actuaciones para describir posteriormente las características concretas de la práctica escolar. Las líneas de análisis que vertebran estas acciones las hemos sintetizado en: I. Los planes de acogida, II. La atención a la diversidad lingüística y cultural, III. Las estructuras escolares cooperativas, IV. La participación de la comunidad educativa, V. La mediación intercultural y la resolución de conflictos, VI. La Formación de Profesorado, VII. Los observatorios de las diferentes comunidades. Podemos entender todas estas actuaciones desde dos enfoques diferenciados; uno más relacionado con la educación inclusiva y otro que actúa desde la educación compensatoria. Relacionamos al final las acciones de la interculturalidad educativa con los principios básicos de las comunidades de aprendizaje, considerándolas un soporte desde el que dar cobertura a las acciones educativas previamente descritas.

"Sobre tenir lo Studi de Lleyda en Tortosa"

The lower medieval Catalan model of the estudi general (university) exemplified by the case of Lleida emphasises the weight achieved by the students as a body, the jurisdictional conflicts and, especially, the serious economic difficulties, that poisoned the relations with the poorly paid teaching staff and made the centre impossible to run. In that sense, the monarchy’s incapacity to provide the jurisdictional and financial bases, pushed higher education under a growing ecclesiastical weight snd municipal dependence. The local government, for its part, would have to increase the means of taxation needed to produce the necessary financing. All together, this generated difficulties that would burden the estudis generals throughout the lower Middle ages and into modern centuries, until their closure in the 18th century.

Arqueologia y didactica del conflicto: el caso de la guerra civil espaÑola

Archaeology of conflict is an archaeological subfield which is related to heritage regarding or linked to war, violent situations or any kind of conflicts. Archaeology of conflict has shown an special development in relation to contemporary history. In Spain, archaeology of conflict has focused especially in sites related to Spanish Civil War and Francoist dictatorship, producing museal interventions and studies with educational possibilities which could stress in the teaching and learning of History and the promotion of Peace.

Experiencias de la participación militar española en misiones internacionales (2000-2012)

Este estudio sobre las Fuerzas Armadas españolas aborda, mediante un centenar de entrevistas en profundidad, el análisis de las experiencias vividas en operaciones internacionales. Con ello se ha analizado el contacto con otros actores, su acomodo y comprensión de las normas de enfrentamiento, sus motivaciones, impresiones y experiencias, los rendimientos personales y grupales, el grado de cumplimiento de los objetivos de la misión y los problemas familiares y psicológicos que puedan haber generado la participación en una misión de este tipo. El resultado de este estudio de caso se integra en un estudio internacional comparado denominado Lessons Learned on Asymmmetric Warfare y auspiciado por el RC nº1 de ISA y el Working Group Military Profession de ERGOMAS.

Aggressivity, violence, sociability and conflict resolution: What genes can tell us.

Conflicts are inherent to the human condition, as they are for all living beings. Disputes about resources or access to mating partners are among the most common causes of conflict. Conflict is herein defined as a struggle or contest between individuals or parties, and may involve a variety of aggressive behaviours. In humans, aggressiveness, violence and conflicts, including individual predisposal to conflict resolution, have traditionally been said to have deep cultural roots, but recent research in both neuroscience and genetics has shown the influence of genes on such complex behavioural traits. In this paper, recent data on the genetic aspects of these interrelated behaviours will be put together, including the effects of particular genes, the influence of stress and gender on gene regulation, and gene-environment interactions, all of which may influence biological predisposal to conflict resolution. Other genetically influenced behavioural aspects involved in conflicts and conflict resolution, such as sociability, will also be discussed. The importance of taking into account genetic and biological data to provide strategies for conflict resolution will be highlighted.

Development process and initial validation of the ethical conflict in nursing questionnaire-critical care version

Background: Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables"frequency" and"degree of conflict". In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable"exposure to conflict", as well as considering six"types of ethical conflict". An instrument was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV). Methods: The sample comprised 205 nursing professionals from the critical care units of two hospitals in Barcelona (Spain). The ECNQ-CCV presents 19 nursing scenarios with the potential to produce ethical conflict in the critical care setting. Exposure to ethical conflict was assessed by means of the Index of Exposure to Ethical Conflict (IEEC), a specific index developed to provide a reference value for each respondent by combining the intensity and frequency of occurrence of each scenario featured in the ECNQ-CCV. Following content validity, construct validity was assessed by means of Exploratory Factor Analysis (EFA), while Cronbach"s alpha was used to evaluate the instrument"s reliability. All analyses were performed using the statistical software PASW v19. Results: Cronbach"s alpha for the ECNQ-CCV as a whole was 0.882, which is higher than the values reported for certain other related instruments. The EFA suggested a unidimensional structure, with one component accounting for 33.41% of the explained variance. Conclusions: The ECNQ-CCV is shown to a valid and reliable instrument for use in critical care units. Its structure is such that the four variables on which our model of ethical conflict is based may be studied separately or in combination. The critical care nurses in this sample present moderate levels of exposure to ethical conflict. This study represents the first evaluation of the ECNQ-CCV.

Development process and initial validation of the ethical conflict in nursing questionnaire-critical care version

Background: Ethical conflicts are arising as a result of the growing complexity of clinical care, coupled with technological advances. Most studies that have developed instruments for measuring ethical conflict base their measures on the variables"frequency" and"degree of conflict". In our view, however, these variables are insufficient for explaining the root of ethical conflicts. Consequently, the present study formulates a conceptual model that also includes the variable"exposure to conflict", as well as considering six"types of ethical conflict". An instrument was then designed to measure the ethical conflicts experienced by nurses who work with critical care patients. The paper describes the development process and validation of this instrument, the Ethical Conflict in Nursing Questionnaire Critical Care Version (ECNQ-CCV). Methods: The sample comprised 205 nursing professionals from the critical care units of two hospitals in Barcelona (Spain). The ECNQ-CCV presents 19 nursing scenarios with the potential to produce ethical conflict in the critical care setting. Exposure to ethical conflict was assessed by means of the Index of Exposure to Ethical Conflict (IEEC), a specific index developed to provide a reference value for each respondent by combining the intensity and frequency of occurrence of each scenario featured in the ECNQ-CCV. Following content validity, construct validity was assessed by means of Exploratory Factor Analysis (EFA), while Cronbach"s alpha was used to evaluate the instrument"s reliability. All analyses were performed using the statistical software PASW v19. Results: Cronbach"s alpha for the ECNQ-CCV as a whole was 0.882, which is higher than the values reported for certain other related instruments. The EFA suggested a unidimensional structure, with one component accounting for 33.41% of the explained variance. Conclusions: The ECNQ-CCV is shown to a valid and reliable instrument for use in critical care units. Its structure is such that the four variables on which our model of ethical conflict is based may be studied separately or in combination. The critical care nurses in this sample present moderate levels of exposure to ethical conflict. This study represents the first evaluation of the ECNQ-CCV.

Evaluation of markets for irrigation water in the internal river basins of Catalonia, Spain

Irrigated agriculture has come under close scrutiny in Europe recently because of its high share of total water consumption and its apparent inefficiency. Several water policies have been advocated, in particular the use of economic instruments such as water markets. This paper simulates the impact of a policy based upon water markets on agricultural production in the internal river basins of Catalonia (Spain). This zone presents certain particularities that make it very interesting to study: competition between sectors for the resource (agriculture-urban consumption-recreational uses), recent periods of resource insufficiency and conflicts between irrigators as a result of the measures taken by the hydraulic administration in drought situations. The results show that these markets would guarantee an optimal reassignment of the resource in situations of supply restrictions, and although compared to the situation without markets they would not mean higher economic profits for the irrigators, they could prevent conflicts between them. Nevertheless, doubts exist about their acceptance by irrigators

La cultura marittima nei progetti di rigenarazione urbana del porto vecchio, Barcellona

Port cities have represented one of the first forms of urbanization in which maritime culture has had an important role in the construction of the city. This culture has often been the foundation of an evolving tendency confronted with other lines of development, against which it has alternately integrated itself creatively, or has had to compete. The study of the multiplicity of these evolving processes, with their corresponding conflicts, can be useful to develop a critical vision of the grand transformations of industrial ports in urban areas and to initiate a critical reflection which would help to interpret current tendencies. The Barcelona case seems to be exemplary because the new projects for the transformation of the old port, focused on providing a service for luxury boats, have reopened a discussion on urban transformation works carried out in the past and have mostly revealed that the relationship between the port and the city is in constant evolution.For this reason there is a discussion about the extent to which large scale port transformations can have repercussions on maritime culture in a locality and what the role of maritime culture is with respect to fundamental economic strategies linked mostly to the construction of the post-Fordist city

World Polarization in carbon emissions, potential conflict and groups: an updated revision

Typically, conflicts in world environmental negotiations are related, amongst other aspects, to the level of polarization of the countries in groups with conflicting interests. Given the predictable relationship between polarization and conflict, it would seem logical to evaluate the degree to which the distribution of countries – for example, in terms of their CO2 emissions per capita – would be structured through groups which in themselves are antagonistic, as well as their evolution over time. This paper takes the concept of polarization to explore this distribution for the period 1992-2010, looking at different analytic approaches related to the concept. Specifically, it makes a comparative evaluation of the results associated with endogenous multi-polarization measures (i.e. EGR and DER indices), exogenous measures (i.e. Z-K or multidimensional index) and strict bipolarization measures (i.e. Wolfson’s measure). Indeed, the interest lies not only in evaluating the global situation of polarization by comparing the different approaches and their temporal patterns, but also in examining the explanatory capacity of the different proxy groups used as a possible reference for designing global environmental policy from a group premise. JEL codes: D39; Q43; Q56. Key words: polarization; carbon emissions; conflict;

Campesinos, Estado y mercado. La conflictividad forestal en el Noroeste de España, León (1870­ ¿1936)

Peer-reviewed