Co-occurring addictive and psychiatric disorders. A practice-based handbook from a european perspective

This book provides a comprehensive, state of the art overview covering both the diagnosis and the treatment of dual disorders ��� joint psychiatric and substance use disorders ��� in a way that is highly relevant to clinical work and the organization of health care systems. It is designed to meet the real need for an European perspective on dual disorders, taking into account the realities of European treatment organization. All chapters have been written by European authors and, in addition to a comprehensive overview of the specific topics, highlight available European treatment programs, guidelines and European research. Dual disorders are increasingly encountered by health professionals working in mental health and addiction care, and they represent a formidable challenge for caregivers, care organizations, and society as a whole. During the past decade, various approaches and programs have been designed to challenge the traditional gap between addiction treatment and mental health care. The overwhelming majority of the programs, however, have emanated from the United States. Given the vast differences between the European and U.S. health contexts, it can be questioned whether these American oriented treatment programs can seamlessly be implemented in European countries. Therefore, Co-occuring Addictive and Psychiatric Disorders ��� A Practice-Based Handbook from a European Perspective represents a timely and much needed addition to literature on dual disorders.

Management of ST-elevation myocardial infarction according to European and American guidelines.

AIMS To highlight differences between the most recent guidelines of the European Society of Cardiology (ESC) and the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) on the management of ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS ESC 2012 and ACCF/AHA 2013 guidelines on the management of STEMI were systematically reviewed for consistency. Recommendations were matched, directly compared in terms of class of recommendation and level of evidence, and classified as "identical", "overlapping", or "different". Out of 32 recommendations compared, 26 recommendations (81%) were classified as identical or overlapping, and six recommendations (19%) were classified as different. Most diverging recommendations were related to minor differences in class of recommendation between the two documents. This applies to recommendations for reperfusion therapy >12 hours after symptom onset, immediate transfer of all patients after fibrinolytic therapy, rescue PCI for patients with failed fibrinolysis, and intra-aortic balloon pump use in patients with cardiogenic shock. More substantial differences were observed with respect to the type of P2Y12 inhibitor and duration of dual antiplatelet therapy. CONCLUSIONS The majority of recommendations for the management of STEMI according to ESC and ACCF/AHA guidelines were identical or overlapping. Differences were explained by gaps in available evidence, in which case expert consensus differed between European and American guidelines due to divergence in interpretation, perception, and culture of medical practice. Systematic comparisons of European and American guidelines are valuable and indicate that interpretation of available evidence leads to agreement in the vast majority of topics. The latter is indirect support for the process of review and guideline preparation on both sides of the Atlantic.

Teaching practice recommendations: prevention and screening

The aim of this article is to provide guidance to family doctors on how to tutor students about effective screening and primary prevention. Family doctors know their patients and adapt national and international guidelines to their specific context, risk profile, sex and age as well as to the prevalence of the disorders under consideration. Three cases are presented to illustrate guideline use according to the level of evidence (for a 19-year-old man, a 60-year-old woman, and an 80-year-old man). A particular strength of family medicine is that doctors see their patients over the years. Thus they can progressively go through the various prevention strategies, screening, counselling and immunisation, accompanying their patients with precious advice for their health throughout their lifetime.

Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland: A survey on patterns of practice

INTRODUCTION External beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), is an established treatment option for nonmetastatic prostate cancer. Despite high-level evidence from several randomized trials, risk group stratification and treatment recommendations vary due to contradictory or inconclusive data, particularly with regard to EBRT dose prescription and ADT duration. Our aim was to investigate current patterns of practice in primary EBRT for prostate cancer in Switzerland. MATERIALS AND METHODS Treatment recommendations on EBRT and ADT for localized and locally advanced prostate cancer were collected from 23 Swiss radiation oncology centers. Written recommendations were converted into center-specific decision trees, and analyzed for consensus and differences using a dedicated software tool. Additionally, specific radiotherapy planning and delivery techniques from the participating centers were assessed. RESULTS The most commonly prescribed radiation dose was 78 Gy (range 70-80 Gy) across all risk groups. ADT was recommended for intermediate-risk patients for 6 months in over 80���% of the centers, and for high-risk patients for 2 or 3 years in over 90���% of centers. For recommendations on combined EBRT and ADT treatment, consensus levels did not exceed 39���% in any clinical scenario. Arc-based intensity-modulated radiotherapy (IMRT) is implemented for routine prostate cancer radiotherapy by 96���% of the centers. CONCLUSION Among Swiss radiation oncology centers, considerable ranges of radiotherapy dose and ADT duration are routinely offered for localized and locally advanced prostate cancer. In the vast majority of cases, doses and durations are within the range of those described in current evidence-based guidelines.

Variation in Current Management of Term and Late-Preterm Neonates at Risk for Early-Onset Sepsis "An International Survey and Review of Guidelines"

BACKGROUND Uncertainty about the presence of infection results in unnecessary and prolonged empiric antibiotic treatment of newborns at risk for early-onset sepsis (EOS). This study evaluates the impact of this uncertainty on the diversity in management. METHODS A web-based survey with questions addressing management of infection risk-adjusted scenarios was performed in Europe, North America, and Australia. Published national guidelines (n=5) were reviewed and compared to the results of the survey. RESULTS 439 Clinicians (68% were neonatologists) from 16 countries completed the survey. In the low-risk scenario, 29% would start antibiotic therapy and 26% would not, both groups without laboratory investigations; 45% would start if laboratory markers were abnormal. In the high-risk scenario, 99% would start antibiotic therapy. In the low-risk scenario, 89% would discontinue antibiotic therapy before 72 hours. In the high-risk scenario, 35% would discontinue therapy before 72 hours, 56% would continue therapy for five to seven days, and 9% for more than 7 days. Laboratory investigations were used in 31% of scenarios for the decision to start, and in 72% for the decision to discontinue antibiotic treatment. National guidelines differ considerably regarding the decision to start in low-risk and regarding the decision to continue therapy in higher risk situations. CONCLUSIONS There is a broad diversity of clinical practice in management of EOS and a lack of agreement between current guidelines. The results of the survey reflect the diversity of national guidelines. Prospective studies regarding management of neonates at risk of EOS with safety endpoints are needed.

Using the results of routine laboratory workplace surveillance activities to assess compliance with recommended biosafety guidelines

The biological safety profession has historically functioned within an environment based on recommended practices rather than regulations, so summary data on compliance or noncompliance with recommended practices is largely absent from the professional literature. The absence of safety performance outcome data is unfortunate since the concept of biosafety containment is based on a combination of facility based controls and workplace practices, and persistent failures in either type of controls could ultimately result in injury or death. In addition, the number of laboratories requiring biosafety containment is likely to grow significantly in the coming years in the wake of the terrorist events of 2001. In this study, the outcomes of 768 biosafety level 2 (BSL-2) safety surveys were analyzed for commonalities and trends. Items of non-compliance noted were classified as facility related or practice related. The most frequent item of noncompliance encountered was the failure to re-certify biosafety cabinetry. Not surprisingly, the preponderance of the other frequent items of non-compliance encountered were practice related, such as general housekeeping orderly, changes in compliance levels, as well as establish trends in the elements of items of non-compliance during the sequential survey period. The findings described in this study are significant because, for the first time, the outcomes of compliance with recommended biosafety practices can be characterized and thus used as the basis for focused interventions. Since biosafety is heavily reliant on adherence to specific safety practices, the ability to focus interventions on objectively identified practice-related items of non-compliance can assist in the reduction of worker risk in this area experiencing tremendous growth. The information described is also of heighten importance given the number of workplaces expected to involve potentially infectious agents in the coming years. ^

Current United States stem cell policy considerations and a recommendation for an alternative policy based on guidelines from existing international policies

Embryonic stem cell research is a widely debated topic in modern politics and religion. Differing views on the fetal rights conflict with the rights of an embryo. Those who believe an embryo has the same human qualities as a fetus accordingly believe embryonic stem cell research is unethical because it destroys a potential human life. However, scientists advocate the embryo does not have human qualities and should be used for valuable research in the stem cell field. Stem cell research may lead to vast developments in medical treatments, including cancer and brain conditions and injuries that are currently incurable. ^ The current stem cell policy introduced by President Bush in 2001 in an attempt to balance the moral issues with the need for scientific research has broad negative implications on the furthering of stem cell research. There is a limited diversity of available stem cell lines, there may be constitutional issues, there is an increasing disparity between the public and private research spheres, and the U.S. is struggling to maintain its scientific community. The U.S. must develop a new stem cell research policy that will balance the interest of science and public health with the moral issues that concern the public. ^ The United Kingdom allows researchers great liberty in conducting research, permitting the creation of embryos for the sole purpose of research, while Germany is equally conservative in their laws, as their policies support the philosophy that all embryos deserve the protection of full life. The United States should adopt a policy that takes the "middle ground" approach and permit research on excess embryos created for IVF purposes, rather than simply discarding those potentially valuable research tools. ^

Perceived risk and outcome expectancy on the practice of home infusion technique in a hemophilia population

This study described home infusion techniques and practices, measured the perceived risk of HIV and hepatitis transmission to self and others, and measured the outcome expectancy of following risk reduction guidelines for 90 hemophilia patients and/or their infusion assistants. It also assessed general knowledge of HIV and hepatitis information for the same population.^ The study subjects were hemophilia patients or their infusion assistants from the Gulf States Hemophilia Center in Houston, the El Paso Satellite Hemophilia Clinic in El Paso, or Texas members of the Women Outreach Network of the National Hemophilia Foundation (WONN) group. Each subject was interviewed either by telephone or in person. The questionnaire used was developed for the study and consisted of 60 items. These items assessed general demographics for the patients and assistants, including questions about their training to do infusions as well as the actual practices, measured perceived personal risk for the transmission of HIV or hepatitis to the assistants, perceived risk of transmission of HIV or hepatitis to others for assistants and self-infusers, and the outcome expectancy for following recommended risk reduction guidelines also for both groups.^ The theoretical framework used assumed that perceived risk and outcome expectancy would be predictive of behavior. The findings did not support this theory. Instead, the findings suggest that infusion behavior is habitual in nature; most respondents perform exactly the same behavior for every infusion. Since none of the variables selected were predictive of the compliance behavior for home infusion the teaching method should be directed towards mastery learning, or learning that will incorporate the correct behavior into a habitual pattern of home infusion. ^

ATTITUDES TOWARD AND UTILIZATION OF NON-INVASIVE PRENATAL TESTING FOR CHROMOSOME ANEUPLOIDY AMONG OB/GYNS

Prenatal diagnosis is traditionally made via invasive procedures such as amniocentesis and chorionic villus sampling (CVS). However, both procedures carry a risk of complications, including miscarriage. Many groups have spent years searching for a way to diagnose a chromosome aneuploidy without putting the fetus or the mother at risk for complications. Non-invasive prenatal testing (NIPT) for chromosome aneuploidy became commercially available in the fall of 2011, with detection rates similar to those of invasive procedures for the common autosomal aneuploidies (Palomaki et al., 2011; Ashoor et al. 2012; Bianchi et al. 2012). Eventually NIPT may become the diagnostic standard of care and reduce invasive procedure-related losses (Palomaki et al., 2011). The integration of NIPT into clinical practice has potential to revolutionize prenatal diagnosis; however, it also raises some crucial issues for practitioners. Now that the test is clinically available, no studies have looked at the physicians that will be ordering the testing or referring patients to practitioners who do. This study aimed to evaluate the attitudes of OB/GYN���s and how they are incorporating the test into clinical practice. Our study shows that most physicians are offering this new, non-invasive technology to their patients, and that their practices were congruent with the literature and available professional society opinions. Those physicians who do not offer NIPT to their patients would like more literature on the topic as well as instructive guidelines from their professional societies. Additionally, this study shows that the practices and attitudes of MFMs and OBs differ. Our population feels that the incorporation of NIPT will change their practices by lowering the amount of invasive procedures, possibly replacing maternal serum screening, and that it will simplify prenatal diagnosis. However, those physicians who do not offer NIPT to their patients are not quite sure how the test will affect their clinical practice. From this study we are able to glean how physicians are incorporating this new technology into their practice and how they feel about the addition to their repertoire of tests. This knowledge gives insight as to how to best move forward with the quickly changing field of prenatal diagnosis.

Guidelines for Accessibility to Microblogging: an Integral Approach

Microblogging is one of the most popular user-generated media, hence its accessibility has a large impact for users. However, the accessibility of this medium is poor in practice, due to the combination of bad practices by different agents ranging from the providers that host microblogging services to prosumers that post contents to them. Here we present an accessibility-oriented model of microblogging services, analyze the impact of its components, and propose guidelines for each of them to meet accessibility requirements. In particular, we base on an study we have performed on Twitter, one of the most-relevant microblogging platform, to identify good and bad practices in microblogging content generation regarding accessibility in microblogging content generation.

"Deporte inclusivo en la escuela": dise��o y an��lisis de un programa de intervencion para promover la inclusi��n del alumnado con discapacidad en Educaci��n F��sica

La Educaci��n F��sica se muestra, a priori, como un ��rea id��nea para trabajar intervenciones educativas para facilitar la inclusi��n de alumnos con discapacidad. Sin embargo, poco se conoce sobre el potencial que presentan los deportes adaptados y paral��mpicos como contenido para fomentar la sensibilizaci��n y concienciaci��n del alumnado sin discapacidad, especialmente en situaciones inclusivas de pr��ctica. Por otro lado, la actitud del docente y su formaci��n se presentan como claves en este contexto, ya que es quien en ��ltima instancia selecciona los contenidos a trabajar. Entendemos que en EF disponemos de una ocasi��n ��nica en el curriculum para fomentar la participaci��n activa y efectiva del alumno con discapacidad en clase (especialmente a nivel de desarrollo de la competencia motriz, entre otras), si bien esto depende de factores relacionados con los dos agentes anteriores. Es por todo ello que la Educaci��n F��sica, como protagonista y como contenido, se muestra como un contexto adecuado para la investigaci��n de los procesos de inclusi��n de alumnos con discapacidad en el ��mbito educativo. Este trabajo de investigaci��n pretende arrojar luz a los interrogantes que condicionan y limitan este contexto, desde una perspectiva multidisciplinar, con distintas metodolog��as, sobre los tres agentes indicados. La falta de consenso en la literatura en cuanto a las caracter��sticas y tipo de intervenciones eficaces para facilitar esta sensibilizaci��n del alumnado, unido a que es un ��mbito relativamente reciente como tema de investigaci��n, nos ha impulsado a trabajar en esta l��nea. El primer objetivo de este trabajo de investigaci��n fue dise��ar e implementar un programa de sensibilizaci��n y concienciaci��n hacia la discapacidad basado en los deportes adaptados en el ��rea de Educaci��n F��sica para alumnos de secundaria y bachillerato. Inicialmente, se realiz�� una b��squeda bibliogr��fica tanto a nivel nacional como internacional, con el fin de definir las caracter��sticas principales que aporta la literatura cient��fica en este aspecto. Apoy��ndonos por un lado, en el programa educativo Paralympic School Day (CPI, 2004) y por otro, en la citada revisi��n, desarrollamos un planteamiento inicial de estructura y fases. Dicho proyecto, fue presentado al Comit�� Paral��mpico Espa��ol y a las federaciones deportivas espa��olas para personas con discapacidad, con la finalidad de recabar su apoyo institucional en forma de aval y recursos no solo a nivel econ��mico sino tambi��n como apoyo log��stico y de difusi��n. Tras su aprobaci��n y gracias tambi��n al apoyo de la UPM, la Fundaci��n Sanitas y Liberty Seguros, se procedi�� a dise��ar el programa. Para el desarrollo de los materiales did��cticos se contact�� con expertos en la materia de EF y Actividad F��sica Adaptada tanto del ��mbito educativo (profesores de educaci��n secundaria y profesorado universitario) como del deportivo a nivel nacional. A su vez, se comenz�� a difundir entre el profesorado de los centros con el fin de detectar su inter��s en participar durante el curso acad��mico (2012-2013) en el programa ���Deporte Inclusivo en la Escuela���. Con la finalizaci��n del desarrollo de los materiales did��cticos, se visit�� a los centros educativos para presentar el dossier informativo donde se explicaba el programa, as�� como las caracter��sticas y fases para su implementaci��n. El programa est�� fundamentado en la Teor��a del Contacto (Allport, 1954) y basado en los deportes adaptados y paral��mpicos, planteado con una metodolog��a inclusiva, seleccionando la informaci��n, la simulaci��n y el contacto directo como estrategias para el fomento de la sensibilizaci��n y concienciaci��n hacia la inclusi��n. En la reuni��n celebrada en la Facultad de Ciencias de la Actividad F��sica y del Deporte (INEF-UPM) en febrero de 2013, se coordin�� junto con el profesorado la implementaci��n del programa en cada uno de los 13 centros educativos, con acciones concretas como la adecuaci��n de la propuesta did��ctica en la planificaci��n anual del profesor, el pr��stamo de material o la ponencia del deportista paral��mpico entre otras cuestiones. Para la consecuci��n del objetivo 2 de este trabajo, analizar el efecto del programa en los distintos agentes implicados en el mismo, alumnos sin discapacidad, profesorado de EF y alumnos con discapacidad, se calendariz�� la toma de datos y la administraci��n de las diferentes herramientas metodol��gicas para antes (pretest) como despu��s de la intervenci��n (posttets). En el caso de los alumnos sin discapacidad (N= 1068), se analiz�� el efecto de la intervenci��n sobre la actitud hacia la inclusi��n, utilizando el cuestionario ���Children Attitude Integrated Physical Education-Revised��� (CAIPE-R; Block, 1995) de car��cter cuantitativo tras su validaci��n y adaptaci��n al contexto espa��ol. Los resultados mostraron cambios significativos positivos en la actitud el grupo que mantuvo un contacto no estructurado con alumnos con discapacidad. En esta muestra tambi��n se midi�� la actitud hacia el juego cooperativo con compa��eros con discapacidad en clases de EF usando el cuestionario ���Children's Beliefs Toward Cooperative Playing With Peers With Disabilities in Physical Education��� (CBIPPD-MPE; Obrusnikova, Block, y Dillon, 2010). El desarrollo de un sistema de categor��as fundamentado en la Teor��a del Comportamiento Planificado (Azjen, 1991) sirvi�� como base para el an��lisis de las creencias del alumnado sin discapacidad. Tras la intervenci��n, las creencias conductuales emergentes se mantuvieron, excepto en el caso de los factores identificados como obst��culos de la inclusi��n. En el caso de las creencias normativas tambi��n se mantuvieron tras la intervenci��n y respecto a las creencias de control, los alumnos identificaron al profesor como principal agente facilitador de la inclusi��n. En el caso de los profesores de EF participantes en el programa (N=18), se analiz�� el efecto del programa en su actitud hacia la inclusi��n de alumnos con discapacidad en EF con el cuestionario ���Attitud toward inclusion of individual with physical disabilities in Physical Education��� (ATISDPE-R; Kudl����ek, V��lkov��, Sherrill, Myers, y French, 2002). Los resultados mostraron que no se produjeron diferencias significativas tras la intervenci��n en la actitud general, encontrando algunas diferencias en determinados ��tems relacionados con los beneficios de la inclusi��n en los alumnos sin discapacidad relacionados con los docentes con experiencia previa con discapacidad y en EF antes de la intervenci��n. La otra dimensi��n analizada fue el efecto de la intervenci��n en la autoeficacia del profesor en la ense��anza de la EF en condiciones inclusivas, habiendo utilizado el cuestionario "Self-efficacy in teaching PE under inclusive conditions" (SEIPE; Hutzler, Zach, y Gafni, 2005). Los resultados en este caso muestran diferencias significativas positivas en cuestiones relacionadas como sentirse capaces de mejorar las condiciones ��ptimas de ense��anza con alumnos con discapacidad f��sica como movilidad reducida severa y amputaci��n y discapacidad visual tanto en situaciones deportivas, como juegos o actividades fuera del centro educativo a favor de los docentes. En cuanto al g��nero, los hombres obtuvieron valores superiores a las mujeres en relaci��n a sentirse m��s capaces de incluir a alumnos con discapacidad f��sica tanto en juegos durante el recreo como en la ense��anza de t��cnica deportiva. Los profesores con menos de 10 a��os de docencia mostraron valores m��s positivos en cuanto a sentirse capaces de incluir a un alumno con discapacidad fisica en deportes durante su tiempo libre. El an��lisis del diario del profesor muestra por un lado, las tendencias emergentes como principales elementos facilitadores u obstaculizadores de la inclusi��n en EF, identificando al propio alumno sin discapacidad, el propio profesor, los contenidos, los materiales y la organizaci��n. Por otro lado, el an��lisis de los contenidos propuestos en el programa. En el caso de los alumnos con discapacidad (N=22), se analiz�� el impacto del programa de intervenci��n en el autoconcepto, con el cuestionario "Autoconcepto forma 5" (AF5; F. Garc��a y Musitu, 2001). Se encontraron diferencias significativas a favor de las mujeres antes de la intervenci��n en la dimensi��n familiar, mientras que los hombres obtuvieron valores m��s altos en las dimensiones social y f��sico. En cuanto a la edad, se encontraron diferencias significativas antes de la intervenci��n, con valores superiores en los alumnos m��s j��venes (12-14 a��os) en la dimensi��n f��sico, mientras que los alumnos mayores (15-17 a��os) mostraron valores m��s altos en la dimensi��n social del cuestionario. Respeto al tipo de discapacidad, los alumnos con discapacidad mot��rica mostraron mejores valores que los que tienen discapacidad auditiva para la dimensi��n f��sico antes de la intervenci��n. En cuanto al autoconcepto general, las diferencias significativas positivas se producen en la dimensi��n acad��mica. En cuanto al efecto del programa en la autoestima de los alumnos con discapacidad, se utiliz�� la Escala de "Autoestima de Rosenberg" (Rosenberg, 1989), no obteniendo diferencias significativas en cuanto el g��nero. Apareciendo diferencias significativas antes de la intervenci��n en el caso de la variable edad en los alumnos m��s j��venes, en cuanto a que desear��an valorarse m��s, y en los alumnos con discapacidad auditiva en que no se sienten muy orgullosos de ellos mismos. Se produce una mejora en la autoestima general en cuanto a que se sienten menos in��tiles tras la intervenci��n. En relaci��n al objetivo 3 de este trabajo, tras el an��lisis de los resultados y haber discutido los mismos con los autores de referencia, emergi�� la propuesta de orientaciones tanto para los programa de intervenci��n en EF para la sensibilizaci��n y concienciaci��n del alumnado hacia la inclusi��n como de cara a la formaci��n espec��fica del profesorado, como clave en este tipo de intervenciones. Creemos que el programa ���Deporte Inclusivo Escuela��� se convierte en un elemento transformador de la realidad, ya que responde a las necesidades detectadas a la luz de esta investigaci��n y que vienen a dar respuesta a los distintos agentes implicados en su desarrollo. Por un lado, atiende la demanda del ��mbito educativo en cuanto a las necesidades de formaci��n del profesorado, sensibilizaci��n y concienciaci��n del alumnado sin discapacidad, adem��s de facilitar oportunidades de participaci��n activa al alumno con discapacidad en las sesiones de EF. Por otro lado, satisface la demanda por parte de las instituciones deportivas del ��mbito de la discapacidad en cuanto a la promoci��n y difusi��n de los deportes adaptados y paral��mpicos. Por ��ltimo, desde el ��mbito universitario, se muestra como un recurso en la formaci��n del alumnado del grado en Ciencias de la Actividad F��sica y del Deporte, por su participaci��n directa con la discapacidad. Por estos motivos, este trabajo se muestra como un punto de partida adecuado para seguir avanzando en la investigaci��n en esta ��rea. ABSTRACT Physical Education (PE) seems a priori, as a suitable area to work educational interventions to facilitate the inclusion of students with disabilities. However, little is known about the potential that have adapted and Paralympic sports as content to raise awareness of students without disabilities, especially in inclusive practice context. On the other hand, teachers��� attitude and their training are presented as key in this context because it is who selects the content to work. We understand that PE have a unique opportunity in the curriculum to encourage active and effective participation of students with disabilities in class (especially at motor competence development, etc.), although this depends on factors related to the two agents. For these reasons that the PE, as actors and as content is displayed as a context for investigating the processes of inclusion of students with disabilities in education. This research aims to shed light on the questions that condition and limit this context, from a multidisciplinary perspective, with different methodologies on the three agents mentioned. The lack of accord in the literature regarding the characteristics and type of effective facilitators of awareness of students, and that is a new area as a research topic, has prompted us to work in this topic research. The first aim of this research was to design and implement a program of awareness towards disability based on adapted sports in the area of physical education for middle and high school students. Initially, a literature search was performed both nationally and internationally, in order to define the main features that brings the scientific literature in this area. On the one hand, we supported in the Paralympic School Day (IPC, 2004) educative program and on the other hand, in that review, we developed an initial approach to structure and phases. The project was presented to the Spanish Paralympic Committee and the Spanish Sports Federations for people with disabilities, in order to obtain institutional support in the form of guarantees and resources not only in economic terms but also as logistical support and dissemination. Thanks to the support of Fundaci��n Sanitas, Liberty Seguros and Politechnical University of Madrid, we proceeded to design the program. For the development of teaching resources it was contacted experts in the field of Adapted Physical Activity and physical education and both the field of education (high school teachers and university professors) as the adapted sport national. In turn, it began to spread among the teachers of the schools in order to identify their interest in participating in the academic year (2012-2013) in the "Inclusive Sport in School" program. With the completion of the development of educational materials to schools he was visited to present the briefing where the program, as well as features and steps for its implementation are explained. The program is based on the Contact Theory (Allport, 1954) and based on adapted and Paralympic sports, raised with an inclusive approach, selecting strategies for promoting awareness and awareness to inclusion like information, contact and simulation of disability. At the meeting held at the Faculty of Sciences of Physical Activity and Sport (INEF-UPM) in February 2013, it was coordinated with the teachers implementing the program in each of the 13 schools with concrete actions such as adequacy of methodological approach in the annual planning of the teacher, the loan or the presentation of materials Paralympian among other issues. To achieve the objective 2 of this paper, to analyze the effect of the program on the various actions involved it, students without disabilities, PE teachers and students with disabilities, the date for management of the different methodological tools for before (pretest) and after the intervention (posttets). For students without disabilities (N= 1068), the effect of the intervention on the attitude towards inclusion was analyzed, using the quantitative questionnaire "Integrated Physical Education Attitude Children-Revised" (CAIPE-R; Block, 1995), after validation and adaptation to the Spanish context. The results showed significant positive changes in the attitude of the group with no structured contact with students with disabilities. This shows the beliefs towards the cooperative play was with peers with disabilities in PE classes also measured, using the questionnaire "Children's Beliefs Toward Cooperative Playing With Peers With Disabilities in Physical Education" (CBIPPD-MPE; Obrusnikova, Block, and Dillon, 2010). The development of a system of categories based on the Theory of Planned Behavior (Azjen, 1991) served as the basis for analysis of the beliefs of students without disabilities. After surgery, emerging behavioral beliefs remained, except in the case of the factors identified as barriers to inclusion. In the case of normative beliefs also they remained after surgery and regarding control beliefs, students identified the teacher as the main facilitator of inclusion. Regarding PE teachers participating in the program (N = 18), the effect of the program was analyzed their attitude toward inclusion of students with disability in PE with the questionnaire "Toward Attitude inclusion of Individual with in Physical Education "(ATISDPE-R; Kudl����ek, V��lkov��, Sherrill, Myers, and French, 2002). The results showed no significant difference occurred after surgery in the general attitude, finding some differences in certain related benefits of inclusion in students without disability relating to teachers with previous experience with disability in PE before intervention. The other dimension was analyzed the effect of the intervention on self-efficacy of teachers in the teaching of PE in inclusive terms, having used the questionnaire "Self-efficacy in PE teaching even under conditions" (SEIPE; Hutzler, Zach, and Gafni, 2005). The results showed significant differences positive in issues like being able to enhance the optimal conditions for teaching students with physical disabilities as amputation and severe visual impairment in both sports situations, such as games or activities outside the school to for teachers. Regard to gender, men earned higher values regarding women about feel more able to include students with physical disabilities in both games during recess and teaching sports technique. Teachers with less than 10 years of teaching showed more positive values as you feel able to include a student with physical disabilities in sports during their leisure time. The analysis of daily teacher shows on the one hand, emerging trends as key facilitators or barrier of the inclusion elements in PE, identifying the students without disabilities themselves, the professor, contents, materials and organization. Furthermore, the analysis of daily teacher about the contents proposed in the program. In the case of students with disabilities (N=22), the impact of the intervention program on self-concept was analyzed, with the questionnaire "Self-concept form 5" (AF5, F. Garcia and Musitu, 2001). The women showed significant differences before the intervention in family dimension, while men scored higher values in the social and physical dimensions were found. In terms of age, significant differences were found before the intervention, with higher values in younger students (12-14 years) in the physical dimension, while older children (15-17 years) showed higher values the social dimension of the questionnaire. Respect disabilities, students with motor disabilities showed better values than those with hearing impairment to the physical dimension before surgery. As for the general self-concept, positive significant differences occur in the academic dimension. As for the effect of the program on self-esteem of students with disabilities Scale "Rosenberg Self-Esteem" (Rosenberg, 1989) was used, not getting significant differences in gender. Only appear significant difference before the intervention in the case of younger students as they wish to be valued more, and students with hearing disabilities who do not feel very proud of themselves. Improved self-esteem generally occurs in that they feel less useless after surgery. With regard to the aim 3 of this research, after analyzing the results and have discussed them with the authors, it emerged the proposal of guidelines for both intervention program EF for sensitization and awareness of students towards inclusion as in the face of specific training for teachers, as key in such interventions. We believe that "Inclusive Sport Schools" program becomes a transforming element of reality, as it responds to the needs identified in the light of this research and come to respond to the various elements involved in its development. On the one hand, it meets the demand of the education sector in terms of the needs of teacher training, awareness of students without disability, and facilitates opportunities for students with disabilities for active participation in PE class. On the other hand, it meets the demand of sports institutions in the field of disability regarding the promotion and dissemination of adapted and Paralympic sports. Finally, it is shown as a resource from the university level for the training of degree in Physical Activity and Sport Science students, by its direct involvement with disability. For these reasons, this work is shown as a good starting point to further advance research in this area.

El recorrido: evaluaci��n de las cualidades sensoriales y formales del medio urbano como parte de los criterios de caminabilidad. La ciudad de Taipei como caso de estudio

La presente investigaci��n aborda el an��lisis de las cualidades del entorno urbano que inciden en la experiencia perceptiva de su recorrido. Los intereses que la motivan tienen que ver con la recuperaci��n de la ciudad para el viandante y se sit��a dentro de un marco de intereses m��s amplio como es el de la ciudad sostenible. En primer lugar, se contextualiza el tema de la experiencia del recorrido a trav��s de disciplinas diferentes como son el cine, la literatura, la arquitectura, el urbanismo, la arquitectura del paisaje, la psicolog��a y la est��tica ambiental. De este modo, se refuerza el argumento en torno al papel que desempe��an la forma y otros est��mulos sensoriales en la experiencia del espacio, ya sea ��ste urbano, arquitect��nico o natural. La experiencia que las personas viven al desplazarse por un entorno viene definida por infinitos factores que van desde la configuraci��n f��sica del entorno recorrido, hasta el aprendizaje cultural de la persona que camina; desde los est��mulos sensoriales que se reciben, hasta las condiciones f��sicas que posibilitan la funcionalidad del recorrido; desde las sutilezas de ��ndole secuencial que se desvelan a medida que avanzamos, hasta las condiciones higrot��rmicas en el momento en que se lleva a cabo el desplazamiento. Sin embargo, factores como las motivaciones y atenciones personales del que anda, as�� como sus recuerdos de experiencias anteriores, deseos, imaginaci��n y estado de ��nimo, tambi��n definen nuestra experiencia al caminar que, indudablemente, se encuentra ligada a nuestra personalidad y, por lo tanto, no puede ser exacta a la de otra persona. Conscientes de que todos estos factores se funden en un fen��meno global, y que no se dan en la vida por separado, nos hemos esforzado por independizar las cualidades sensoriales y formales, ��nicamente a efectos de investigaci��n. La importancia del tema a investigar reside en las conexiones que existen entre las cualidades del medio construido y la experiencia cotidiana de su recorrido, en la medida en que dicha vinculaci��n establece relaciones con la calidad de vida, la salud de los ciudadanos y sus sentimientos de identidad. En este sentido, el problema clave encontrado es que si la definici��n de la experiencia del recorrido urbano es demasiado amplia, se vuelve nebulosa e inoperativa, pero si se precisa demasiado, se pueden excluir variables importantes. Hemos concentrado nuestros esfuerzos en buscar un medio que permita hacer operativo el estudio de aspectos que, por su propia naturaleza, son dif��ciles de controlar y aplicar en la pr��ctica. En este sentido, el campo de estudio que a��na inter��s en el tema, producci��n cient��fica y vocaci��n pr��ctica, es el de la caminabilidad de las ciudades. Por esta raz��n, hemos situado nuestro trabajo dentro del marco de criterios que este campo establece para valorar un entorno caminable. Sin embargo, hemos detectado que los trabajos sobre caminabilidad tienden a desarrollarse dentro de la disciplina del planeamiento de transporte y, con frecuencia, siguiendo las mismas pautas que la investigaci��n sobre el transporte motorizado. Adem��s, la tendencia a proporcionar datos num��ricos producto de la medici��n controlada de variables, para respaldar iniciativas dentro de los ��mbitos de toma de decisiones, lleva consigo un progresivo alejamiento de los aspectos m��s sutiles y pr��ximos de la experiencia de las personas y la especificidad de los lugares. Por estas razones, hemos estimado necesario profundizar en la experiencia peatonal explorando otras l��neas de trabajo como son la habitabilidad de las ciudades, pol��ticas llevadas a cabo para mejorar la calidad del espacio p��blico o las certificaciones de sostenibilidad en el ��mbito del urbanismo. Tambi��n se han estudiado las aproximaciones gr��ficas a la representaci��n y simulaci��n de recorridos urbanos por su importancia en la comunicaci��n y promoci��n de caminar. Para detectar las problem��ticas implicadas en la definici��n de una herramienta que permita valorar, de manera operativa, la calidad de la experiencia del recorrido urbano, la metodolog��a de valoraci��n propuesta se ha basado en la combinaci��n de distintos m��todos y en la conjugaci��n de tres aproximaciones: valoraci��n por parte del investigador en calidad de experto, valoraci��n realizada por el investigador en el papel de usuario y valoraci��n por el ciudadano. El desarrollo de esta investigaci��n se ha visto condicionado por la intenci��n de aplicar lo estudiado en un caso pr��ctico. El marco de criterios que los trabajos sobre caminabilidad de las ciudades establecen para que se d�� un entorno caminable, se puede resumir en que concurran los siguientes factores: mezcla de usos, densidad de poblaci��n y edificaci��n relativamente altas, destinos p��blicos accesibles a pie, un alto grado de seguridad con respecto al tr��fico y actos delictivos, alta funcionalidad (dimensiones, pendientes, etc.) y atractivo. Una vez definido el modelo de ciudad en que es pertinente realizar una investigaci��n sobre las cualidades del entorno urbano responsables de que ��ste se perciba como atractivo, se escogi�� la ciudad de Taipei, entre otras razones, por cumplir con los requisitos restantes. Con respecto al caso pr��ctico, el objetivo es detectar fortalezas y debilidades del ��rea central de la ciudad de Taipei en cuanto a la experiencia perceptiva que proporciona a los viandantes. ABSTRACT This research addresses the analysis of the qualities of the urban environment that affect the perceptual experience of walking. The interests lying behind it are related to the recovery of the city for pedestrians, and is framed within the sustainable city framework of interests. Firstly, the issue of the experience of walking is contextualized through different disciplines such as film, literature, architecture, urban planning, landscape architecture, environmental psychology and aesthetics. This way, the argument about the role that form and other sensory stimuli play in the experience of space, whether it is urban, architectural or natural, is strengthened. The walking experience of people is defined by factors ranging from the physical configuration of the environment to the cultural background of the person who walks, from the sensory stimuli that are perceived to the physical conditions that enable the functionality of the walk, from the subtleties of sequential nature that are revealed as we move around to hygrothermal conditions at the specific time of walking. Nevertheless, factors such as personal motivations and attentions of the walker, as well as memories of past experiences, desires, imagination and mood, also define our walking experience that is undoubtedly linked to our personality and, therefore, it cannot be exactly the same as other people's experience. Being aware that all these factors come together in a total phenomenon and that, in real life, they do not exist separately, we focused on separating sensory and formal qualities only for research purposes. The importance of the research topic lies in the connections between the qualities of the built environment and the quotidian experience of walking through it, to the extent that such link establishes relationships with the quality of life, health and feelings of identity of citizens. In this sense, the key problem encountered is that, if the definition of urban walking experience is too broad, it becomes nebulous and non���operational, but if it is too precise, important variables can be excluded. We concentrated our efforts on finding a way to operationalize the study of questions that, by their very nature, are difficult to control and apply in practice. In this regard, the field of study that combines interest in the topic, scientific production and practical purpose, is the walkability of cities. For this reason, we placed our work within the framework of the set of criteria that this field establishes for assessing an environment as walkable. However, we found that works on walkability tend to be developed within the discipline of transportation planning and often following the same guidelines that research on motorized transport. Furthermore, the tendency to provide numerical data as a result of the controlled measurement of variables in order to support initiatives in decision making areas, involves a progressive distancing from the proximity and the most subtle aspects of the experience of people, and from the specificity of places. For these reasons, we considered it was necessary to deepen into the study of pedestrians experience, by exploring other lines of work such as the livability of cities, implemented policies to improve the quality of the public space or sustainability certifications in urbanism. Graphic representation and simulation of urban walks are also studied due to their important role in communication and promotion of walking. In order to find the issues involved in defining a tool to assess, in an operational way, the quality of urban walking experience, the proposed assessment methodology is based on the combination of different methods and the synthesis of three approaches: assessment by the researcher as expert, assessment by the researcher playing the role of user and assessment by the citizens. The development of this research has been conditioned by our intention of applying it in a case study. The framework of criteria that works on walkability of cities set to define a walkable environment, can be summarized in the following factors: mix of uses, population and building density rather high, public destinations accessible on foot, high levels of safety in terms of traffic and crime, high functionality (dimensions, slopes, etc.) and attractiveness. After defining the model of city in which it is relevant to conduct an investigation on the qualities that are responsible of the attractiveness of the environment; Taipei City was selected because it meets the remaining requirements, among other reasons. Regarding the case study, the goal is to identify strengths and weaknesses in the central area of Taipei City in terms of the perceptual experience of pedestrians.

Postmarketing surveillance study of a non-chlorofluorocarbon inhaler according to the safety assessment of marketed medicines guidelines

Objective To evaluate the safety of a non-chlorofluorocarbon metered dose salbutamol inhaler.

Implications of applying widely accepted cholesterol screening and management guidelines to a British adult population: cross sectional study of cardiovascular disease and risk factors

Objective: To compare the implications of four widely used cholesterol screening and treatment guidelines by applying them to a population in the United Kingdom.