Método de análisis diacrónico para la intervención en el alojamiento con criterios ecológicos. El caso de Madrid 1940–2100

Las evidencias del impacto sobre el medio ambiente asociado al funcionamiento de las ciudades hacen que sea urgente proponer medidas que reduzcan este consumo y mejoren la eficiencia del metabolismo urbano. La existencia de límites en la disponibilidad de recursos materiales y energéticos, plantea actualmente un reto importante al ser humano: ¿son posibles otras formas de organización más adecuadas a esta condición de limitación? Para dar respuesta, resulta fundamental conocer cómo interactuarán nuestros sistemas urbanos en un modelo económico de continuo desarrollo, con la población que alojan, y si podrán adaptarse a la capacidad de carga limitada del Planeta, evitando futuras situaciones de colapso anunciadas desde distintos ámbitos científicos. En ese contexto, la tesis formula un método de análisis del alojamiento que, mediante la evaluación a largo plazo, permita proponer medidas de intervención para reducir el consumo de recursos asociado a su funcionamiento. Se parte de un enfoque ecológico para definir el alojamiento como una parte fundamental del sistema urbano, que está compuesto por tres elementos: habitantes, viviendas y recursos naturales; por tanto, para reducir los impactos asociados al alojamiento es necesario tener en cuenta la diferente naturaleza de estos elementos y el carácter dinámico de las relaciones que se producen entre ellos. La Ecología, a través del estudio de los ecosistemas, ha identificado estrategias de supervivencia y adaptación ante los cambios y perturbaciones. La similitud entre los elementos de un ecosistema (población y soporte) y los del alojamiento (habitantes, viviendas y recursos naturales) permite verificar que la aplicación de estas estrategias al alojamiento puede conducir a situaciones más deseables en la relación de los sistemas urbanos con su entorno A partir de esta hipótesis, se propone un método de análisis diacrónico1 o a largo plazo, para conocer la evolución en el tiempo del alojamiento a través de la cuantificación de una serie de indicadores descriptivos de los habitantes, las viviendas y los recursos naturales. La aplicación de este método a un sistema urbano permitiría conocer las características de los elementos del sistema y, para un ámbito temporal de futuro, prever su evolución, identificar escenarios no deseables y proponer medidas de intervención que corrijan anticipadamente estas situaciones y eviten impactos ambientales innecesarios. La validación del método de análisis se realiza mediante la aplicación al caso de Madrid en periodo retrospectivo (de 1940 a 2010) A partir del estudio de la evolución en Madrid de los indicadores seleccionados, se proponen medidas de intervención en el alojamiento basadas en estrategias ecológicas que habrían conducido a una evolución alternativa con un impacto menor sobre el medio ambiente que la situación actual. El método de análisis se aplica con carácter prospectivo definiendo tres escenarios de futuro para Madrid hasta 2100. Para cada uno de ellos se analiza la evolución previsible de los indicadores y se proponen diferentes medidas de intervención que, desde el punto de vista ecológico, conducirían a una situación más adecuada. La tesis concluye en el interés de este método de análisis diacrónico que permite estimar posibilidades en la evolución futura del alojamiento, identificar las necesidades de recursos para responder a las demandas de los habitantes y, desde un enfoque ecológico, definir, cuantificar y evaluar posibles medidas de intervención que reduzcan los impactos ambientales. El método, por tanto, es una herramienta de interés para la toma de decisiones en la intervención en el alojamiento y en la planificación urbana a largo plazo. ABSTRACT Evidence of the impact on the environment associated with the operation of cities make it urgent to propose measures to reduce energy consumption and improve the efficiency of urban metabolism. The limited availability of materials and energy resources currently poses a significant challenge to human beings: are more appropriate forms of organization for this limitation possible? In response, it is essential to know how our urban systems with the population they host will interact in an economic model of continuous development and whether they can adapt to the limited endurance capacity of the planet, thus avoiding future collapse situations which are being announced from different scientific fields. In this context, the thesis puts forward a method of housing analysis that by a long term assessment will enable to propose intervention measures to reduce resource consumption associated with its operation. The thesis is based on an ecological approach to identify housing as a fundamental part of the urban system, which is composed of three elements: inhabitants, homes and natural resources. Therefore, in order to reduce the impacts associated with housing it is necessary to consider the characteristics of these elements and the dynamic nature of the relationships among them. Ecology, through the analysis of ecosystems, has identified strategies for survival and adaptation to changes and disturbances. The similarity between the elements of an ecosystem (population and support) and housing (inhabitants, homes and natural resources) enables to verify that the implementation of these strategies to housing can lead to better situations in the relationship existing between urban systems with their environment. From this hypothesis, a diachronic or long term analysis method is proposed to know the evolution of housing over time through the quantification of a descriptive indicators series of inhabitants, homes and natural resources. The implementation of this method to a urban system would allow better knowledge of the characteristics of these elements and forecast their development, identify undesirable scenarios and propose early intervention measures to correct these situations and avoid unnecessary environmental impacts. The validation of the method of analysis has been proved in the city of Madrid for the years 1940-2010. From the analysis of the evolution of the indicators selected, accommodation intervention measures are proposed based on ecological strategies that would have led to an alternative development having less impact on the environment than that of the current situation. The analysis method is implemented prospectively defining three future scenarios for the city of Madrid until 2100. The likely evolution of the indicators are analyzed for each scenario and various intervention measures that would lead to a better situation from an ecological point of view are proposed. The thesis conclusion states the interest of this diachronic analysis method to estimate potential future developments in the housing field, identify resource requirements to meet the demands of the citizens and, from an ecological approach, define, quantify and assess possible intervention measures to reduce environmental impacts. The method, therefore, is an interesting tool for decision-making process as for the intervention in housing and urban planning in the long term.

Salud comunitaria y acción social en el control epidemiológico del tracoma infantil, España (1932-1939)

En el contexto de la endemia tracomatosa que afectó a diversas regiones españolas hasta la década de 1960, se analizan los determinantes epidemiológicos del tracoma infantil y su abordaje desde el modelo de asistencia preventiva que encerraba el concepto de salud comunitaria que se perfiló en el período de entreguerras. La detección precoz de casos, unida a actividades preventivas, educativas, terapéuticas y de inspección, como las que llevaron a cabo las enfermeras visitadoras, contribuyeron al control de la enfermedad. Los resultados reafirman la validez de las estrategias de intervención horizontal de mejora de las condiciones higiénicas y de los factores medioambientales que explicaban la prevalencia del tracoma.

Modeling the development of acquired clinical immunity to Plasmodium falciparum malaria

Individuals living in regions where malaria is endemic develop an acquired immunity to malaria which enables them to remain asymptomatic while still carrying parasites. Field studies indicate that cumulative exposure to a variety of diverse Plasmodium parasites is required for the transition from symptomatic to asymptomatic malaria. This study used a simulation model of the within-host dynamics of P. falciparum to investigate the development of acquired clinical immunity under different transmission conditions and levels of parasite diversity. Antibodies developed to P. falciparum erythrocyte membrane protein 1 (PfEMP1), a clonally variant molecule, were assumed to be a key human immunological response to P. falciparum infection, along with responses to clonally conserved but polymorphic antigens. The time to the development of clinical immunity was found to be proportional to parasite diversity and inversely proportional to transmission intensity. The effect of early termination of symptomatic infections by chemotherapy was investigated and found not to inhibit the host's ability to develop acquired immunity. However, the time required to achieve this state was approximately double that compared to when no treatment was administered. This study demonstrates that an immune response primarily targeted against PfEMP1 has the ability to reduce clinical symptoms of infections irrespective of whether treatment is administered, supporting its role in the development of acquired clinical immunity. The results also illustrate a novel use for simulation models of P. falciparum infections, investigation of the influence of intervention strategies on the development of naturally acquired clinical immunity.

Aggressive behaviour in the high-secure forensic setting: the perceptions of patients

Twenty-seven patients undergoing treatment in a high-secure forensic facility participated in focus group interviews to elicit their perceptions of (1) the factors leading to aggressive behaviour; and (2) strategies to reduce the risk of such behaviour. The focus group interviews were audiotaped, transcribed and analysed using content analysis. The participants identified that a combination of patient, staff and environmental factors contributed to violence in the study wards. The cause of aggressive behaviour centred around five major themes: the environment; empty days; staff interactions; medication issues; and patient-centred factors. Potential strategies identified by patients to reduce aggressive behaviour included: early intervention; the provision of meaningful activities to reduce boredom; separation of acutely disturbed patients; improved staff attitudes; implementation of effective justice procedures; and a patient advocate to mediate during times of conflict. Findings suggested that social and organizational factors need to be addressed to change the punitive subculture inherent in forensic psychiatric facilities, and to ensure a balance between security and effective therapy.

Broader or deeper? Exploring the most effective intervention profile for public small business support

Most advanced economies offer publicly financed advice services to start-up firms and SMEs. In England, local or regional Business Links organisations have provided these services, and divided their support into nonintensive one-off contacts providing information or advice and more intensive support involving a diagnostic process and repeated interaction with firms. A key choice for Business Link managers is how to shape their intervention strategies, balancing resources between intensive and nonintensive support. Drawing on resource dependency theory, we develop a typology of intervention strategies for Business Links in England which reflects differences in the breadth and depth of the support provided. We then test the impacts of these alternative intervention models on client companies using both subjective assessments by firms and econometric treatment models that allow for selection bias. Our key empirical result is that Business Links’ choice of intervention strategy has a significant effect both on actual and on perceived business outcomes, with our results emphasising the value of depth over breadth. The implication is that where additional resources are available for business support these should be used to deepen the assistance provided rather than extend assistance to a wider group of firms.

The identification of early factors related to academic achievement among deaf students

The purpose of this research study was to examine specific factors believed to be related to academic achievement in deaf children. More specifically, this research sought to determine whether there was a significant difference in achievement between those students whose parents use oral communication only and those whose parents use some type of sign language. An additional purpose of this research was to determine if there was a significant difference in academic achievement with those deaf students who used amplification devices early in life. This study also sought to determine whether providing early intervention program which emphasizes and enables parents to develop a language rich environment had a significant impact on the academic achievement of deaf children and whether the age at which initial services are received influence deaf student's subsequent academic achievement. This study examined the relationship, if any, between intellectual ability and academic achievement among deaf children. Finally, this study sought to investigate the relationship between the degree of hearing loss and academic achievement. ^ Purposive sampling was used to select subjects for this study. All 228 eligible Deaf/Hard of Hearing (DHH) students enrolled in a Broward County Public School were included in the original sample. Sixty-one students actually participated in this study. A correlational method of statistical analysis as well as a cross classification (crosstabs) was used to analyze the data. ^ The results show that academic achievement in the areas of reading and mathematics was significantly related to parental mode of communication and the mode of communication used in school. Academic achievement, in the area of reading, was also signficantly related to intellectual ability. The reading achievement was also found to be significantly related to degree of hearing loss. Written language was not significantly related to any factors investigated in this study. ^ Additional research should be conducted to further investigate the low academic achievement among deaf children. The diversity among signing systems at school and between home and school should also be analyzed. Finally, future studies should examine curriculum and instruction methods to increase the academic achievement of deaf children. ^

Biomarker Testing and Pre-emptive Therapy in Preventing Heart Failure

In an attempt to reduce the heart failure epidemic,screening and prevention will become an increasing focus ofmanagement in the wider at-risk population. Refining riskprediction through the use of biomarkers in isolation or incombination is emerging as a critical step in this process.The utility of biomarkers to identify disease manifestationsbefore the onset of symptoms and detrimental myocardialdamage is proving to be valuable. In addition, biomarkers thatpredict the likelihood and rate of disease progression over timewill help streamline and focus clinical efforts and therapeuticstrategies. Importantly, several recent early intervention studiesusing biomarker strategies are promising and indicate thatnot only can new-onset heart failure be reduced but also thedevelopment of other cardiovascular conditions.

Vocational Rehabilitation in Early Psychosis: Cluster Randomised Trial

Background Individual placement and support (IPS) is effective in helping patients return to work but is poorly implemented because of clinical ambivalence and fears of relapse. Aims To assess whether a motivational intervention (motivational interviewing) directed at clinical staff to address ambivalence about employment improved patients’ occupational outcomes. Method Two of four early intervention teams that already provided IPS were randomised to receive motivational interviewing training for clinicians, focused on attitudinal barriers to employment. The trial was registered with the International Standard Randomised Controlled Trial Register (ISRCTN71943786). Results Of 300 eligible participants, 159 consented to the research. Occupational outcomes were obtained for 134 patients (85%) at 12-month follow-up. More patients in the intervention teams than in the IPS-only teams achieved employment by 12 months (29/68 v. 12/66). A random effects logistic regression accounting for clustering by care coordinator, and adjusted for participants’ gender, ethnicity, educational and employment history and clinical status scores, confirmed superiority of the intervention (odds ratio = 4.3, 95% CI 1.5-16.6). Conclusions Employment outcomes were enhanced by addressing clinicians’ ambivalence about their patients returning to work.

Referenciação de crianças com problemas de comunicação e linguagem a partir dos cuidados de saúde primários

Os problemas de comunicação e linguagem (PCL) podem limitar a atividade e participação de um indivíduo ao longo da sua vida. Todavia, a intervenção precoce tem-se provado bastante eficaz nestes casos. Os médicos de família (MF) encontram-se numa posição privilegiada para deteção e referenciação destes problemas em idades precoces. Porém, há evidências de que a sua participação neste processo tem sido reduzida, nomeadamente no que respeita à referenciação para serviços de Intervenção Precoce. Assim, esta investigação pretende compreender qual o papel que os MF consideram ter relativamente a este processo e quais os fatores que podem influenciar a referenciação de crianças com suspeita de PCL. Este estudo teve como base um desenho de investigação descritivo, transversal e observacional. Recorreu-se a um método de amostragem por redes para a distribuição de um questionário On-line. O instrumento foi construído pela autora e é de caráter maioritariamente quantitativo, embora integre uma questão qualitativa de resposta semiaberta. Dos questionários enviados foram devolvidos 55. A resposta semiaberta foi preenchida por 16 dos 55 MF. Os resultados demonstram que a maioria dos MF valoriza bastante ou muito a sua participação na deteção de PCL e considera importante detetar precocemente estes problemas. Para além disso, valorizam bastante ou muito a colaboração em equipa e do terapeuta da fala. A grande parte sente-se influenciada pela preocupação dos pais, pela satisfação com os serviços e com os resultados da Escala de Avaliação de Desenvolvimento de Mary Sheridan Modificada para a referenciação de crianças com PCL. Para além disso, identificam barreiras relacionadas com recursos humanos, serviços, conhecimentos relacionados com o processo de referenciação, burocracia, lentidão do processo e com a atitude dos pais. Considera-se que este estudo pode constituir um ponto de partida para futuras investigações, para a adequação de estratégias institucionais e implementação de práticas que aproximem profissionais e serviços, de forma a melhorar o processo de referenciação de crianças com PCL a partir dos cuidados de saúde primários.

The Effects of the Project Approach on Children in Inclusive Early Childhood Classrooms

Research on the impact of the Project Approach on young children with disabilities or children who are at-risk is limited. Mixed methods were used to study the impact of the Project Approach on the social interactions, challenging behaviors, and language development of eight focal children in two inclusive classrooms. Child participants were two children with IEPs and two children identified as at-risk from each class. Adult participants were six professionals who received high quality supports to implement the Project Approach. Adults were interviewed prior to the beginning of the study and again mid-, and post-implementation. Choice time observations were videotaped twice per week over 14 weeks to assess the impact of the Project Approach on play levels and MLUm. Results revealed that social interactions, challenging behaviors, vocabulary, MLUm, were positively impacted following implementation of the Project Approach. Limitations of the study and suggestions for research and practice are discussed.

Evaluation of circulating endothelial progenitor cells by multicolor flow cytometry in chronic kidney disease patients

Endothelial dysfunction and impaired endothelial regenerative capacity play a key role in the pathogenesis of cardiovascular disease, which is one of the major causes of mortality in chronic kidney disease (CKD) patients. Circulating endothelial cells (CEC) may be an indicator of vascular damage, while circulating endothelial progenitor cells (EPC) may be a biomarker for vascular repair. However, the simultaneously evaluation of CEC and EPC circulating levels and its relation were not previously examined in CKD population. A blood sample (18ml) of healthy subjects (n=10), early CKD (n=10) and advanced CKD patients (n=10) was used for the isolation of early and late EPCs, CECs, and hematopoietic cells, identified by flow cytometry (BD FACSCanto™ II system) using a combination of fluorochrome-conjugated primary antibodies: CD31-PE, CD45-APC Cy7, CD34-FITC, CD117-PerCp Cy5.5, CD133-APC, CD146-Pacific Blue, and CD309-PECy7. Exclusion of dead cells was done according to a fixable viability dye staining. This eightcolor staining flow cytometry optimized protocol allowed us to accurate simultaneously identify EPCs, CECs and hematopoietic cells. In addition, it was also possible to distinguish the two subpopulations of EPCs, early and late EPCs subpopulation, by CD45intCD31+CD34+CD117-CD133+CD309-CD146- and CD45intCD31+CD34+CD117-CD133-CD309+CD146- multiple labeling, respectively. Moreover, the identification of CECs and hematopoietic cells was performed by CD45-CD31+CD34-/lowCD117-CD133-CD309-CD146+ and CD34+CD117+, respectively. The levels of CECs were non-significantly increased in early CKD (312.06 ± 91.34) and advanced CKD patients (191.43±49.86) in comparison with control group (103.23±24.13). By contrast, the levels of circulating early EPCs were significantly reduced in advanced CKD population (17.03±3.23) in comparison with early CKD (32.31±4.97), p=0.04 and control group (36.25 ± 6.16), p=0.03. In addition the levels of late EPCs were significantly reduced in both advanced (6.60±1.89), p=0.01, and early CKD groups (8.42±2.58), p=0.01 compared with control group (91.54±29.06). These results were accompanied by a dramatically reduction in the recruitment, differentiation and regenerative capacity indexes in CKD population. Taken together, these results suggest an imbalance in the process of endothelial repairment in CKD population, and further propose that the indexes of recruitment, differentiation and regenerative capacity of EPCs, may help to select the patients to benefit from guiding intervention strategies to improve cardiovascular health by inducing vascular protection.

“Enjoy your baby” Internet-based CBT for mothers with babies: a feasibility randomised control trial

Background: Postnatal depression is a global health problem with lasting effects on the family. Government policy is focussed on early intervention and increasing access to psychological therapies. There is a growing evidence base for the use of computerised CBT packages and this study investigated the feasibility of a CBT-based self-help internet intervention for new mothers. Objective: To assess the ability to recruit mothers, deliver an internet course, obtain follow-up data and evaluate what mothers think of the course. Design: A feasibility randomised control design was used to compare a waiting list control group (delayed access= DA) to the Enjoy Your Baby course (immediate access= IA). Measures were administered at baseline and 8 week follow-up. Methods: Adverts were placed in the Metro freesheet, on charity web pages, on social media, posters were put up in the community, and leaflets were handed out at mother and baby groups. Participants had to be 18 years old or over with a child less than 18 months old. The IA arm was given access to the course straight away. After 8 weeks all participants were asked to recomplete the original measures and those in the IA arm also gave feedback on the course. Participants in the DA arm were given access after recompleting the questionnaires. Due to a lack of follow-up data a small discussion group was conducted. Intervention: The course contains 4 core modules including helping mothers understand why they feel the way they do and helping them build closeness to their babies. Additional modules, worksheets and homework tasks were available. The DA group were given a list of additional support resources and services, and encouraged to seek additional help if required. All participants received weekly automated emails for 12 weeks as they worked through the course. It was not possible to deliver individualised support. 34 Results: Despite using a number of recruitment strategies, recruitment was lower and slower than anticipated, and attrition was high. 41 women, primarily recruited via the internet, were randomised (IA n=21, DA n=20). No significant differences were observed between participants in either arm at baseline and no statistically significant differences were identified when the demographics and baseline measures of participants who logged-on to the course were compared to those who did not, or when participants who completed follow-up measures were compared to those who did not. Pre and post intervention scores on the EPDS approached statistical significance (P=.059, r=.444) favouring the intervention arm. The discussion group suggested strengths of the course and recommended areas for improvement, including making the course more mobile friendly. Conclusion: Internet interventions show promise; however it is difficult to recruit mothers, engagement is low and attrition high. A number of recommendations are made and a further pilot or an internal pilot of a larger substantive study should be conducted to confirm recruitment and retention. Trial ID: ISRCTN90927910.

Todos os sentidos no coração: Estudo de caso de intervenção precoce em criança com paralisia cerebral

Dissertação de Mestrado apresentada no Instituto Superior de Psicologia Aplicada para obtenção do grau de Mestre na especialidade de Psicologia Clínica conforme

Resolução de conflitos internacionais: estudo com militares em missões de paz

Tese de Doutoramento em Psicologia na área de especialidade em Psicologia Comunitária