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Los centros socioeducativos que trabajan con infancia vulnerable y sus familias, y que cuentan con un elevado índice de población de origen migrado, favorecen una mejora de los recursos personales de los/las niños/as y de las familias que participan en dichos centros, así como de sus redes relacionales, actuando a su vez como promotores de cohesión social. Las familias de 6 centros socioeducativos de la provincia de Barcelona (N=42), mediante un cuestionario diseñado ad hoc, aportan su visión sobre la contribución de estos centros a la mejora de la cohesión social de los territorios.

Oscilómetro automático; Concordancia; Reproducibilidad Automatic oscillometer; Concordance; Reproducibility Oscil·lòmetre automàtic; Concordança; Reproduïbilitat Objetivo La diferencia de presión arterial sistólica entre brazos (dPEB) aumentada (≥ 10 mmHg) se ha relacionado con mayor morbimortalidad cardiovascular. Hay poca evidencia sobre cómo determinar la dPEB y su fiabilidad ha sido poco estudiada. Nuestros objetivos fueron evaluar la concordancia entre 2 oscilómetros automáticos de medición simultánea de la dPEB (2 aparatos OMRON y un aparato Microlife WatchBP® [WBP]) y analizar la reproducibilidad de la dPEB entre visitas en población general atendida en un centro de atención primaria. Diseño Estudio descriptivo transversal de concordancia entre los 2 métodos y de fiabilidad de la dPEB entre 2 visitas separadas una semana. Emplazamiento Centro de Atención Primaria de Parets del Vallès, Barcelona. Participantes Población general de 35-74 años. Intervenciones y mediciones principales Ciento cuarenta y nueve pacientes completaron las 2 visitas. En cada visita se midió la dPEB 3 veces con ambos métodos, y se consideró la media de las 3 determinaciones. Mediante revisión de la historia y entrevista con el paciente se recogieron otras variables como sociodemográficas y antropométricas, antecedentes patológicos y tratamiento farmacológico. Se calculó la concordancia entre los dispositivos y la reproducibilidad entre visitas mediante el coeficiente de concordancia de Lin (CCL) para la dPEB expresada de manera continua y los índices kappa (k) para la dPEB categorizada en normal o patológica. Resultados La concordancia entre métodos para la dPEB expresada de forma continua fue baja: CCL: 0,13 (0,02-0,24). La concordancia fue también baja para la dPEB categorizada en normal o patológica (k = −0,03 [−0,05-0,00]). La reproducibilidad entre visitas fue baja para ambos métodos, y tanto para la dPEB continua como categorizada: con OMRON® CCL: 0,19 (0,03-0,34) y k = −0,02 (−0,16-0,12) y para WBP® CCL: 0,14 (−0,01-0,29) y k = 0,49 (0,33-0,64). Conclusiones La concordancia entre 2 oscilómetros automáticos en la determinación simultánea de la dPEB fue baja. La reproducibilidad entre visitas también fue baja para ambos métodos. Objective An increased interarm blood pressure difference (IAD) (≥10 mmHg) has been associated with increased cardiovascular morbidity and mortality. There are few studies determining how IAD has to be measured and its reliability between visits. The objectives of our study were twofold. First, to evaluate the concordance between two automatic oscillometric devices for IAD measurement (two OMRON devices and one Microlife WatchBP™ device (WBP™)) and to analyse the reproducibility of IAD between visits in the general population attending a primary care centre. Design Descriptive cross-sectional study of concordance between the two methods and reproducibility of IAD between two visits separated by one week. Site Parets del Vallès primary care centre (Barcelona). Participants General population aged 35-74 years. Interventions and main measurements One hundred and forty-nine patients completed the two visits. At each visit, IAD was measured three times with both methods and the mean of the three determinations was considered. Other variables such as sociodemographic and anthropometric variables, pathological antecedents and pharmacological treatment were collected through a review of the medical history and an interview with the patient. Concordance between the two devices and between visits reproducibility were calculated using the Lin concordance coefficient (CCL) for IAD expressed continuously and kappa(k) indices for IAD categorised as normal or pathological. Results Concordance for IAD expressed continuously was low: CCL = 0.13 (0.02-0.24). Concordance was also low for IAD categorised as normal or pathological (k = −0.03 (−0.05-0.00)). Reproducibility between visits was low for both methods and for both continuous and categorised IAD: with OMRON™ CCL = 0.19 (0.03-0.34) and k = −0.02 (−0.16-0.12) and for WBP™ CCL = 0.14 (−0.01-0.29) and k = 0.49 (0.33-0.64). Conclusions Concordance between two automatic oscillometers in the simultaneous IAD measurement was low. Reproducibility between visits was also low for both methods. Este estudio fue financiado con una ayuda a proyectos de investigación en atención primaria del Institut Universitari d’Investigació en Atenció Primària (IDIAP Jordi Gol, número de ayuda 4R18/002-1) y con la beca del GERC 2018 (Grup d́Estudi i Recerca Cardiovascular) de la Filial del Vallès Oriental de la Acadèmia de les Ciències Mèdiques de Catalunya i de Balears.

This article explores the role of after-school programmes (ASPs) in serving underserved families in Barcelona, Spain, during the lockdown phase of the COVID-19 pandemic. Using a mixed-method approach, this exploratory study surveyed 31 directors of ASPs administered by the Pere Tarrés Foundation. These ASPs serve almost 2000 children living under the federal poverty level in Catalonia, Spain. Results showed that the primary needs of children and their families revolved around: a digital divide that prevented them from accessing education remotely, financial difficulties, mental and behavioural problems and difficulty navigating pandemic-related information. The study also explores the ASPs' contributions to address such needs, like engaging families, schools and social and health services to meet the urgent needs of the families, reinforcing school learning, providing support for managing emotions and providing guidance to families to help them better understand health information and gain access to available social and financial resources.

Objectives. There is a growing interest in understanding the association between Guillain-Barré syndrome (GBS) and SARS-CoV-2 infection. The aim of this study was to analyse various characteristics of GBS before and after the pandemic outbreak and thus identify possible distinctive features of GBS associated with SARS-CoV-2 (GBS-S). Material and Methods. In our centre, we retrospectively reviewed the records of patients diagnosed with GBS between January 2018 and March 2022. Epidemiological, clinical, and immunological data were analysed and compared between patients with GBS according to the time of diagnosis and antecedent events. Results. Thirty-nine patients with GBS were included: nine (23.1%) were diagnosed with GBS-S. GBS-S was most frequent in 2020 (6/13, 46.1%). Most of these patients developed a postinfectious classic demyelinating variant (4/9, 44.4%) with frequent bilateral facial paralysis (4/9, 44.4%). Serum antiganglioside antibodies (AGAs) were found in 1/9 patients with GBS-S. Serum anti-SSA/Ro60 antibodies were highly prevalent in GBS-S (7/9 (77.8%) vs. 3/11 (27.3%), p = 0.019 ). Three cases associated with SARS-CoV-2 vaccination (GBS-V) were detected. Of note, two had bilateral facial paralysis and anti-SSA/Ro60 antibodies. Conclusion. Our findings suggest that SARS-CoV-2 has become an important antecedent event associated with GBS in our setting. GBS-S shows a postinfectious demyelinating immune-mediated profile with negative serological testing for AGAs. Serum anti-SSA/Ro60 antibodies were found frequently in these patients. Bilateral facial paralysis stands out as a possible characteristic clinical feature both in GBS-S and GBS-V. Larger, prospective studies are needed for a better understanding of its immunopathogenesis.

Màster en Filosofia Analítica (APhil), Facultat Filosofía, Universitat de Barcelona, Curs: 2021-2022, Director/Tutor: Josep Lluís Prades Celma, While concepts such as intentional action, action done for reasons, or expressive action have been the focus of much contemporary work in the philosophy of action, the concept of voluntary action has not received as much attention in the last century. So much so that the current bibliography about voluntariness is rather scarce. An interesting exception can be found in the recent work of John Hyman (2013, 2015, 2016), whose account of voluntariness is remarkably aimed at rejecting what I will call the Intentional-Voluntary Sufficiency Thesis (IVST henceforth): IVST. For any act-description A and any agent S, if S A-s intentionally then S also A-s voluntarily. Hyman’s main argument against IVST concerns cases of action done under compulsion that falls short of total control over the agent. The argument goes as follows. If S consents to A-ing because she is compelled to do it by a sufficiently grave threat, then S does not A voluntarily although she A-s

To analyse the effects of leisure-based community activities in improving neighbourhood support and social cohesion, data were collected in two neighbourhoods of Barcelona (Spain) through questionnaires and interviews. The results indicate that promoting neighbourhood support requires a different strategy from promoting participation in leisure-based activities aimed at developing social cohesion within a community. The study also suggests various useful strategies to strengthen the effects of leisure-based community activities. The strategies recommended revolve around networking, use of the public space, recognition of diversity and conflict management.

An increased interarm blood pressure difference (IAD) (≥10mmHg) has been associated with increased cardiovascular morbidity and mortality. There are few studies determining how IAD has to be measured and its reliability between visits. The objectives of our study were twofold. First, to evaluate the concordance between two automatic oscillometric devices for IAD measurement (two OMRON devices and one Microlife WatchBP™ device (WBP™)) and to analyse the reproducibility of IAD between visits in the general population attending a primary care centre.Descriptive cross-sectional study of concordance between the two methods and reproducibility of IAD between two visits separated by one week. SITE: Parets del Vallès primary care centre (Barcelona).General population aged 35-74 years.One hundred and forty-nine patients completed the two visits. At each visit, IAD was measured three times with both methods and the mean of the three determinations was considered. Other variables such as sociodemographic and anthropometric variables, pathological antecedents and pharmacological treatment were collected through a review of the medical history and an interview with the patient. Concordance between the two devices and between visits reproducibility were calculated using the Lin concordance coefficient (CCL) for IAD expressed continuously and kappa(k) indices for IAD categorised as normal or pathological.Concordance for IAD expressed continuously was low: CCL=0.13 (0.02-0.24). Concordance was also low for IAD categorised as normal or pathological (k=-0.03 (-0.05-0.00)). Reproducibility between visits was low for both methods and for both continuous and categorised IAD: with OMRON™ CCL=0.19 (0.03-0.34) and k=-0.02 (-0.16-0.12) and for WBP™ CCL=0.14 (-0.01-0.29) and k=0.49 (0.33-0.64).Concordance between two automatic oscillometers in the simultaneous IAD measurement was low. Reproducibility between visits was also low for both methods.

Las tensiones entre ficción y realidad en la escena se producen a partir del desplazamiento de los materiales significantes de los creadores desde su propio deseo. Desde el análisis de estos materiales en movimiento, tanto en el texto dramático como en la escena, en los cuadernos de bitácora y en las entrevistas con los creadores, utilizando como herramienta metodológica los vectores deseantes (Pavis, 2000), observamos que no sólo son procesos autorreferenciales los géneros docudramas, autoperformances, autoficciones y biodramas, sino que todo espectáculo, ficcional o no, tiene una carga autorreferencial relacionada con las segmentaciones de territorialización, des-territorialización y re- territorialización.Estos procedimientos de autorreferencialidad fueron estudiados en las producciones de Palacio, dramaturgo, director y actor de la provincia de San Luis, Argentina.

La dissecció aòrtica (AD) és un dels esdeveniments més catastròfics que pot ocórrer a l’aorta. Quan es produeix una dissecció, apareix un forat a la paret de l’artèria que fa que la sang entri a través de la paret, separant-ne les capes. La dissecció és, amb freqüència, fatal si el nou canal es trenca per la part externa. Tot i que amb menys probabilitat és possible que la paret es trenqui per la part interna, causant danys menys dràstics. La incidència mundial d’aquesta malaltia s’estima entre 3 i 12 casos per cada 100,000 habitants a l’any, amb una mortalitat de fins al 50% depenent del tipus de dissecció i la condició del pacient. Tot i la relativament alta incidència d’aquesta malaltia, les companyies de dispositius mèdics hi han dedicat menys atenció que a d’altres malalties cardiovasculars. És per això que les solucions actuals no han estat dissenyades per tractar la dissecció sinó per a tractar els aneurismes de l’aorta. A més, els tractaments actuals segueixen tenint una taxa de mortalitat i morbiditat altes, i molts pacients necessiten ser re-intervinguts amb el temps. En aquesta tesi es planteja la hipòtesi que un tractament dissenyat específicament per tractar la AD milloraria els resultats dels tractaments actuals en quant a supervivència, qualitat de vida del pacient i reduiria els efectes secundaris d’aquestes operacions. Enlloc d’utilitzar un llarg empelt fet d’un material que és mecànicament molt diferent de l’aorta, es planteja utilitzar un dispositiu petit, amb propietats mecàniques molt similars a les de l’artèria i que només tapi el forat. Per aconseguir-ho, s’ha dissenyat un dispositiu, un pegat, fet d’un polímer bioabsorbible, la policaprolactona, i utilitzant la tècnica d’electrospinning. Aquesta tècnica ha permès crear un pegat amb dues capes per buscar una diferent interacció amb els dos tipus de cèl·lules presents a l’artèria: les cèl·lules endotelials i les musculars. A més, s’ha aconseguit que el pegat tingui les mateixes propietats mecàniques de arteries sanes i dissecades. A continuació, s’ha realitzat un estudi in vitro utilitzant diferents proteïnes i pèptids, i dos tipus de tractaments superficials per avaluar la resposta de les cèl·lules endotelials. La morfologia del pegat ajuda a guiar les cèl·lules cap a les fibres alineades. A més, tot i que l’ús d’algunes proteïnes o pèptids hagi resultat en una millora de la migració i proliferació cel·lular, el pegat per sé ha estat suficient per aconseguir assolir aquest procés. Així doncs, es va decidir procedir amb els experiments in vivo sense l’ús d’additius a la superfície del pegat. Per últim, el pegat va ser testat in vivo demostrant que causa molt poca reacció inflamatòria i que s’adapta perfectament a l’artèria en cada batec. A més, les cèl·lules han estat capaces de colonitzar els pegats, aconseguint re-endotelització i remodelació arterial en tots els assajos prolongats. La disección aórtica (AD) es uno de los acontecimientos más catastróficos que puede ocurrir en la aorta. Cuando se produce una disección, aparece un agujero a la pared de la arteria que hace que la sangre entre a través de la pared, separando las capas. La disección es, con frecuencia, fatal si el nuevo canal se rompe por la parte externa. Aunque con menos probabilidad también es posible que la pared se rompa por la parte interna, causando daños menos drásticos. Su incidencia mundial se estima entre 3 y 12 casos por cada 100,000 habitantes al año, con una mortalidad de hasta el 50% dependiendo del tipo de disección y la condición del paciente. Todo y la relativamente alta incidencia de esta enfermedad, las compañías de dispositivos médicos han dedicado menos atención que a otras enfermedades cardiovasculares. Es por eso por lo que las soluciones actuales no han sido diseñadas para tratar la disección sino para tratar los aneurismas de la aorta. Además, los tratamientos actuales siguen teniendo una tasa de mortalidad y morbilidad altas, y muchos pacientes necesitan ser re-intervenidos con el tiempo. En esta tesis se plantea la hipótesis que un tratamiento diseñado específicamente para tratar la AD mejoraría los resultados de los tratamientos actuales en cuanto a supervivencia y calidad de vida del paciente y reduciría los efectos secundarios de estas operaciones. En lugar de utilizar un largo injerto hecho de un material que es mecánicamente muy diferente de la aorta, se plantea utilizar un dispositivo pequeño, con propiedades mecánicas muy similares a las de la arteria y que solo tape el agujero. Para conseguirlo, se ha diseñado un dispositivo, un parche, hecho de un polímero bioreabsorbible, la policaprolactona, y a través de la técnica de electrospinning. Esta técnica ha permitido crear un parche con dos capas que busca una diferente interacción con los dos tipos de células presentes a la arteria: las células endoteliales y las musculares. Además, se ha conseguido que el parche tenga las mismas propiedades mecánicas tanto de arterias sanas como disecadas. A continuación, se ha realizado un estudio in vitro utilizando diferentes proteínas y péptidos, y dos tipos de tratamientos superficiales para evaluar la respuesta de las células endoteliales. La morfología del parche ayuda a guiar las células hacia las fibras alineadas. Además, a pesar de que el uso de algunas proteínas o péptidos haya resultado en una mejora de la migración y proliferación celular, el parche per se es suficiente para lograr este proceso. Así pues, se decidió proceder con los experimentos in vivo sin el uso de aditivos a la superficie del parche. Por último, el parche fue testado in vivo demostrando que causa muy poca reacción inflamatoria y que se adapta perfectamente a la arteria en cada latido. Además, las células han estado capaces de colonizar los parches, consiguiendo reendotelitzación y remodelación arterial en todos los ensayos prolongados. Aortic dissection (AD) is one of the most catastrophic events that can occur in the aorta. In AD, the inner layer of the aorta tears, causing blood to flow through it. The dissection is often fatal if the blood-filled channel ruptures through the outer aortic wall. Aortic rupture may also happen but is up to 3 less common than AD. The estimated worldwide incidence is between 3 to 12 cases per 100,000 patient per year, with a global mortality of up to 50%, depending on the dissection type and patient conditions. Despite its relatively high incidence, AD has historically received less attention by medical device companies than other cardiovascular diseases. Since current solutions have not been specifically developed for AD but for aortic aneurysm, current treatments present very high mortality, morbidity, and reintervention rates. In this thesis, we hypothesize that a treatment completely focused on AD would improve the outcomes of the surgery, in terms of survival, lifespan, and freedom from secondary effects. Instead of covering a substantial length of the aorta with a stented graft that is biomechanically very different than the aortic tissue, we propose using a small scaffold, with biomechanical properties very similar to the aorta’s, to cover only the entry tear. To do so, we have designed a scaffold in the shape of a patch, made of polycaprolactone, a bioresorbable polymer, manufactured using electrospinning. This technique has allowed to create the patch with two different layers aiming to achieve different migration environments for the two types of cells present in the aortic wall: endothelial and smooth muscle cells. Moreover, the patch has been designed to have very similar mechanical properties to those found in healthy and dissected arteries. Then, an in vitro study using different proteins and peptides and two types of surface treatments have been used to evaluate the endothelial cell response. The morphology helps guiding endothelial cells towards the aligned fibers. Moreover, even though the use of some proteins and peptides resulted in enhancing the migration and proliferation of endothelial cells through the patch, the patch itself was enough to lead this process. Therefore, it was decided to avoid the use of additives for in vivo testing. Finally, the patch was tested in an in vivo environment, demonstrating that it causes very low inflammatory response and that it adapts to the aorta in every heartbeat cycle. Moreover, cells have been able to colonize the patches, with reendothelialization and arterial remodeling in all the chronic tests performed.

Cancer maintenance, metastatic dissemination and drug resistance are sustained by cancer stem cells (CSCs). Triple negative breast cancer (TNBC) is the breast cancer subtype with the highest number of CSCs and the poorest prognosis. Here, we aimed to identify potential drugs targeting CSCs to be further employed in combination with standard chemotherapy in TNBC treatment. The anti-CSC efficacy of up to 17 small drugs was tested in TNBC cell lines using cell viability assays on differentiated cancer cells and CSCs. Then, the effect of 2 selected drugs (8-quinolinol -8Q- and niclosamide -NCS-) in the cancer stemness features were evaluated using mammosphere growth, cell invasion, migration and anchorage-independent growth assays. Changes in the expression of stemness genes after 8Q or NCS treatment were also evaluated. Moreover, the potential synergism of 8Q and NCS with PTX on CSC proliferation and stemness-related signaling pathways was evaluated using TNBC cell lines, CSC-reporter sublines, and CSC-enriched mammospheres. Finally, the efficacy of NCS in combination with PTX was analyzed in vivo using an orthotopic mouse model of MDA-MB-231 cells. Among all tested drug candidates, 8Q and NCS showed remarkable specific anti-CSC activity in terms of CSC viability, migration, invasion and anchorage independent growth reduction in vitro. Moreover, specific 8Q/PTX and NCS/PTX ratios at which both drugs displayed a synergistic effect in different TNBC cell lines were identified. The sole use of PTX increased the relative presence of CSCs in TNBC cells, whereas the combination of 8Q and NCS counteracted this pro-CSC activity of PTX while significantly reducing cell viability. In vivo, the combination of NCS with PTX reduced tumor growth and limited the dissemination of the disease by reducing circulating tumor cells and the incidence of lung metastasis. The combination of 8Q and NCS with PTX at established ratios inhibits both the proliferation of differentiated cancer cells and the viability of CSCs, paving the way for more efficacious TNBC treatments., This work was supported by the Instituto de Salud Carlos III (ISCiii), through Networking Research Center on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN), an initiative that also counts with the assistance from the European Regional Development Fund (ERDF), specifically in the PENTRI-2 Project and by the “Fundació Marató TV3” (337/C/2013) to I.A., M.R. and E.V. Our laboratories were also supported by the Fondo de Investigaciones Sanitarias (FIS, grants PI20/1474 to S.S.J. and PI18/00871 and PI21/00936), co-financed by the ERDF and the 2017-SGR-638 of the Catalan Government to S.S.J. and EvoNano Project (GA800983), funded by European Union’s Horizon 2020 FET Open Programme. N.G.-A. was supported by grants from Pla Estratègic de Recerca i Innovació en Salut (PERIS) of Catalonia (SLT006/17/00270 270).

Weakness is a frequent complication in those critically ill due to COVID-19. This study describes its characteristics and the factors that can condition and predict it.We conducted a prospective, descriptive, observational study of patients admitted to the intensive care unit (ICU) due to COVID-19 between April and May 2020 with muscle weakness. A motor balance equal to or lower than 3/5 according to the modified Medical Research Council muscle strength scale was considered to be severe clinical impairment. Altogether 25 analytical studies, 16 neurophysiological studies and one muscle biopsy were performed, with a telephone follow-up at one month, a comparative analysis between the groups with and without severe compromise, and determination of cut-off points for analytical parameters to predict severe involvement using ROC curves.The sample consisted of 25 patients with a mean age of 58 years (standard deviation ± 9). The median length of stay in the ICU was 27.5 days. All the electromyograms exhibited a myogenic pattern and 75% also showed neuropathy. The group with severe clinical involvement had higher levels of D-dimer (p = 0.08), lactate dehydrogenase (p = 0.03) and interleukin-6 (p = 0.10), and the combination of the alteration of any two of these three parameters predicted severe involvement with a sensitivity of 100% and a specificity of 76.9%. At one month of follow-up, 36% were unable to walk autonomously and 92% continued with muscle weakness.Weakness in severe COVID-19 patients has a major clinical impact. Its early detection and study by means of predictors of its development may allow for better management. The absence in some cases of classical risk factors for ICU-acquired weakness suggests a different pathophysiology.Debilidad como complicación del paciente crítico por COVID-19: características clínicas y factores pronósticos en una serie de casos.Introducción. La debilidad es una complicación frecuente en el enfermo crítico por COVID-19. Se describen sus características, y los factores que pueden condicionarla y predecirla. Pacientes y métodos. Estudio observacional descriptivo prospectivo con pacientes ingresados en la unidad de cuidados intensivos (UCI) por COVID-19 entre abril y mayo de 2020 con debilidad muscular. Se consideró una afectación clínica grave un equilibrio motor igual o inferior a 3/5 según la escala de fuerza muscular modificada del Medical Research Council. Se han realizado 25 estudios analíticos, 16 estudios neurofisiológicos y una biopsia muscular; seguimiento telefónico al mes; análisis comparativo entre los grupos con y sin afectación grave, y determinación de puntos de corte de parámetros analíticos para predecir afectación grave mediante curvas ROC. Resultados. Se incluyó a 25 pacientes con 58 años (desviación estándar ± 9) de edad media. La mediana de estancia en la UCI fue de 27,5 días. Todos los electromiogramas mostraban un patrón miógeno y el 75%, también una neuropatía. El grupo con afectación clínica grave tenía mayores niveles de dímero-D (p = 0,08), lactato deshidrogenasa (p = 0,03) e interleucina 6 (p = 0,10), y la combinación de la alteración de dos cualquiera de estos tres parámetros pronosticaba la afectación grave con una sensibilidad del 100% y una especificidad del 76,9%. Al mes de seguimiento, el 36% no podía deambular autónomamente y el 92% seguía con debilidad muscular. Conclusiones. La debilidad en el enfermo por COVID-19 grave tiene una repercusión clínica importante. Su detección y estudio precoces mediante predictores de su desarrollo pueden permitir un mejor manejo. La ausencia en algunos casos de los factores de riesgo clásicos para la debilidad adquirida en la UCI sugiere una fisiopatología diferente.