The Attitudinal Style and Its Potential for Hybridization with Other Pedagogical Models: A Narrative Review.

The 'Attitudinal Style' (AS) enhances the democratic and engaging learning process by improving student motivation and attitudes. Its adaptability, transferability, and applicability make it suitable for hybridization with other pedagogical models (PMs). This study explores the possibilities of blending AS with other PMs for classroom applications, emphasizing the use of formative and shared assessments to maximize efficiency. Adopting a Narrative Review methodology, the research delves into ten academic databases, identifying seven publications that meet the inclusion criteria for a detailed analysis. These publications propose pedagogical approaches for sports, body expression, natural environments, and physical conditioning. They highlight the potential of integrating AS with other PMs to not only enrich physical education (PE) experiences but also introduce innovative teaching methods for various physical activities. The evidence from these sources suggests that combining AS with other PMs serves as a robust strategy to enhance the overall educational experience in PE.

Tratamientos modificadores de la enfermedad en pacientes con esclerosis múltiple en España / Disease-modifying treatments for patients with multiple sclerosis in Spain

La esclerosis múltiple es una enfermedad desmielinizante crónica del sistema nervioso central y discapacitante a largo plazo. Existen diferentes tratamientos modificadores de la enfermedad. Estos pacientes, a pesar de ser generalmente jóvenes, tienen una elevada comorbilidad y riesgo de polimedicación por su compleja sintomatología y discapacidad. Objetivo principal determinar el tipo de tratamiento modificador de la enfermedad en los pacientes atendidos en servicios de farmacia de hospitales españoles. Objetivos secundarios Conocer los tratamientos concomitantes, determinar la prevalencia de la polifarmacia, identificar la prevalencia de interacciones y analizar la complejidad farmacoterapéutica. Método estudio observacional, transversal y multicéntrico. Se incluyeron todos los pacientes con diagnóstico de esclerosis múltiple y tratamiento modificador de la enfermedad activo a los que se atendió en las consultas de pacientes externos o en los hospitales de día durante la segunda semana de febrero 2021. Se recogieron: el tratamiento modificador, las comorbilidades y los tratamientos concomitantes para determinar el patrón de multimorbilidad, polifarmacia, complejidad farmacoterapéutica (Medication Regimen Complexity Index) e interacciones medicamentosas. Resultados se incluyeron 1.407 pacientes de 57 centros de 15 Comunidades Autónomas. La forma de presentación de la enfermedad más frecuente fue la forma remitente recurrente (89,3%). El tratamiento modificador de la enfermedad más prescrito fue dimetilfumarato (19,1%), seguido de teriflunomida (14,0%). De los tratamientos modificadores parenterales, los 2 más prescritos fueron el acetato de glatiramero y el natalizumab con un 11,1 y 10,8% respectivamente. El 24,7% de los pacientes tenían una comorbilidad y el 39,8% al menos 2 comorbilidades. El 13,3% pertenecía al menos a uno de los patrones definidos de multimorbilidad y el 16,5% pertenecían a 2 o más patrones. ... (AU)

Multiple sclerosis is a chronic demyelinating disease of the central nervous system and long-term disabling. Different disease-modifying treatments are available. These patients, despite being generally young, have high comorbidity and risk of polymedication due to their complex symptomatology and disability.Objective primaryTo determine the type of disease-modifying treatment in patients seen in Spanish hospital pharmacy departments.Secondary objectivesTo determine concomitant treatments, determine the prevalence of polypharmacy, identify the prevalence of interactions and analyse pharmacotherapeutic complexity.MethodObservational, cross-sectional, multicentre study. All patients with a diagnosis of multiple sclerosis and active disease-modifying treatment who were seen in outpatient clinics or day hospitals during the second week of February 2021 were included. Modifying treatment, comorbidities and concomitant treatments were collected to determine multimorbidity pattern, polypharmacy, pharmacotherapeutic complexity (Medication Regimen Complexity Index) and drug-drug interactions.Results1,407 patients from 57 centres in 15 autonomous communities were included. The most frequent form of disease presentation was the relapsing remitting form (89.3%). The most prescribed disease-modifying treatment was dimethyl fumarate (19.1%), followed by teriflunomide (14.0%). Of the parenteral disease-modifying treatments, the two most prescribed were glatiramer acetate and natalizumab with 11.1% and 10.8%. 24.7% of the patients had one comorbidity and 39.8% had at least 2 comorbidities. 13.3% belonged to at least one of the defined patterns of multimorbidity and 16.5% belonged to 2 or more patterns. The concomitant treatments prescribed were psychotropic drugs (35.5%); antiepileptic drugs (13.9%) and antihypertensive drugs and drugs for cardiovascular pathologies (12.4%). ... (AU)

[Translated Article] Disease-modifying treatments for patients with multiple sclerosis in Spain.

Multiple sclerosis is a chronic demyelinating disease of the central nervous system and long-term disabling. Different disease-modifying treatments are available. These patients, despite being generally young, have high comorbidity and risk of polymedication due to their complex symptomatology and disability. OBJECTIVE PRIMARY: To determine the type of disease-modifying treatment in patients seen in Spanish hospital pharmacy departments. SECONDARY OBJECTIVES: to determine concomitant treatments, determine the prevalence of polypharmacy, identify the prevalence of interactions and analyze pharmacotherapeutic complexity. METHOD: Observational, cross-sectional, multicentre study. All patients with a diagnosis of multiple sclerosis and active disease-modifying treatment who were seen in outpatient clinics or day hospitals during the second week of February 2021 were included. Modifying treatment, comorbidities and concomitant treatments were collected to determine multimorbidity pattern, polypharmacy, pharmacotherapeutic complexity (Medication Regimen Complexity Index) and drug-drug interactions. RESULTS: 1407 patients from 57 centres in 15 autonomous communities were included. The most frequent form of disease presentation was the relapsing remitting form (89.3%). The most prescribed disease-modifying treatment was dimethyl fumarate (19.1%), followed by teriflunomide (14.0%). Of the parenteral disease-modifying treatments, the two most prescribed were glatiramer acetate and natalizumab with 11.1% and 10.8%. 24.7% of the patients had 1 comorbidity and 39.8% had at least 2 comorbidities. 13.3% belonged to at least one of the defined patterns of multimorbidity and 16.5% belonged to 2 or more patterns. The concomitant treatments prescribed were psychotropic drugs (35.5%); antiepileptic drugs (13.9%) and antihypertensive drugs and drugs for cardiovascular pathologies (12.4%). The presence of polypharmacy was 32.7% and extreme polypharmacy 8.1%. The prevalence of interactions was 14.8%. Median pharmacotherapeutic complexity was 8.0 (IQR: 3.3-15.0). CONCLUSIONS: We have described the disease-modifying treatment of patients with multiple sclerosis seen in Spanish pharmacy services and characterized concomitant treatments, the prevalence of polypharmacy, interactions, and their complexity.

Disease-modifying treatments for patients with multiple sclerosis in Spain. / Tratamientos modificadores de la enfermedad en pacientes con esclerosis múltiple en España.

Multiple sclerosis is a chronic demyelinating disease of the central nervous system and long-term disabling. Different disease-modifying treatments are available. These patients, despite being generally young, have high comorbidity and risk of polymedication due to their complex symptomatology and disability. OBJECTIVE PRIMARY: To determine the type of disease-modifying treatment in patients seen in Spanish hospital pharmacy departments. SECONDARY OBJECTIVES: To determine concomitant treatments, determine the prevalence of polypharmacy, identify the prevalence of interactions and analyse pharmacotherapeutic complexity. METHOD: Observational, cross-sectional, multicentre study. All patients with a diagnosis of multiple sclerosis and active disease-modifying treatment who were seen in outpatient clinics or day hospitals during the second week of February 2021 were included. Modifying treatment, comorbidities and concomitant treatments were collected to determine multimorbidity pattern, polypharmacy, pharmacotherapeutic complexity (Medication Regimen Complexity Index) and drug-drug interactions. RESULTS: 1,407 patients from 57 centres in 15 autonomous communities were included. The most frequent form of disease presentation was the relapsing remitting form (89.3%). The most prescribed disease-modifying treatment was dimethyl fumarate (19.1%), followed by teriflunomide (14.0%). Of the parenteral disease-modifying treatments, the two most prescribed were glatiramer acetate and natalizumab with 11.1% and 10.8%. 24.7% of the patients had one comorbidity and 39.8% had at least 2 comorbidities. 13.3% belonged to at least one of the defined patterns of multimorbidity and 16.5% belonged to 2 or more patterns. The concomitant treatments prescribed were psychotropic drugs (35.5%); antiepileptic drugs (13.9%) and antihypertensive drugs and drugs for cardiovascular pathologies (12.4%). The presence of polypharmacy was 32.7% and extreme polypharmacy 8.1%. The prevalence of interactions was 14.8%. Median pharmacotherapeutic complexity was 8.0 (IQR: 3.3 -- 15.0). CONCLUSIONS: We have described the disease-modifying treatment of patients with multiple sclerosis seen in Spanish pharmacy services and characterised concomitant treatments, the prevalence of polypharmacy, interactions, and their complexity.

Impact of the COVID-19 Pandemic on Cancer Diagnosis in Madrid (Spain) Based on the RTMAD Tumor Registry (2019-2021).

The coronavirus disease 2019 (COVID-19) pandemic has caused a significant disruption to cancer diagnosis, treatment and prevention worldwide that could have serious consequences in the near future. We intend to evaluate the weight of this backlog on a community-wide scale in Madrid during the period 2020-2021, and whether a stage shift towards the advanced stage has occurred. Cancer diagnoses in the Madrid tumor registry (RTMAD) from 2019-2021 were evaluated. Absolute and percentage differences in annual volume and observed-to-expected (O/E) volume ratios were calculated. Standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated using the O/E ratio. The SIR for 2020-2021 compared to 2019 was 94.5% (95% CI 93.8-95.3), with unequal gender-specific cancer diagnosis recovery (88.5% for males and 102.1% for females). Most cancer types were underdiagnosed in 2020. The tendency worsened in 2021 for colorectal and prostate cancers (87.8%), but lung cancer recovered (102.1%) and breast cancer was over-diagnosed (114.4%) compared with reference pre-COVID-19 data. These changes have modified the ranking of the most frequent malignancies diagnosed in Madrid. Breast cancer has overtaken colorectal and prostate cancers, displaced to second and third position, respectively. Not only was colorectal cancer diagnosis affected more as a consequence of the COVID-19 pandemic but diagnosis of this malignancy at the advance stage also increased by 3.6% in 2020 and 4.2% in 2021 compared to the reference period of 2019. In summary, there is a large volume of undetected cancer in Madrid caused by the reduced access to care secondary to the COVID-19 pandemic, especially regarding colorectal and prostate cancer. Strategies are needed to recover the backlog of diagnoses and effectively treat these cases in the future and solve the negative impact that will be caused by the diagnostic delay. Analyzing the impact of new diagnoses suffered by each different malignancy and their recovery will help to understand how the future allocation of resources should look.

Assessment of the effectiveness of tocilizumab on mortality and progression to mechanical ventilation or intensive care in patients with COVID-19 admitted to a tertiary hospital.

OBJECTIVES: The evidence for tocilizumab in the treatment of COVID-19 is contradictory, with some clinical trials showing benefits in regard to progression to mechanical ventilation (MV) and/or mortality. The aim of this study is to evaluate in real clinical practice the effectiveness of tocilizumab in treating COVID-19 and to identify prognostic factors for patient outcomes. METHODS: This was an observational, retrospective study of COVID-19 patients treated with tocilizumab between March 2020 and February 2021 in a tertiary hospital. Variables were demographics, comorbidities, vital signs, analytical parameters, COVID-19 treatment, progression to MV, intensive care unit (ICU) admission, hospital stay, and mortality. RESULTS: A total of 685 patients (64.7% men, median 68 years) were included. Overall mortality was 23.4% (14.2% in the first 14 days post-tocilizumab) and 93.3% in patients with MV and/or in the ICU at 14 days post-tocilizumab. In addition, 61.5% of discharges occurred during the same period. In patients who died, statistically significant differences were observed in the baseline analytical parameters of C-reactive protein (CRP), D-dimer and higher lactate dehydrogenase (LDH) (p<0.05). CONCLUSIONS: In most patients the clinical results of tocilizumab were observed at 14 days post-administration and could benefit from earlier administration of treatment. Baseline levels of CRP, D-dimer and LDH could be prognostic factors for the evolution of the COVID-19 patient.

En búsqueda de acuerdos sobre los fines pedagógicos que han de regir en la Educación Física / In search of agreement on the pedagogical aims to be pursued in Physical Education

Actualmente son numerosos los desacuerdos en torno a la enseñanza de la Educación Física (EF), incluso hacia sus intenciones, finalidades y funciones. Esta variedad de enfoques, en muchos casos opuestos, se agudiza notoriamente por la influencia de las redes sociales. La búsqueda del “like” y el halago inmediato deriva en un reduccionismo de la materia, más mediatizado por la ocurrencia de la actividad concreta que por la evidencia científica. Esto, junto a otros factores, limita que la asignatura goce del prestigio social y curricular que merece. El objetivo del presente artículo es intentar arrojar luz sobre los principios fundamentales que han de estructurar la enseñanza de la EF. A través de la revisión de la literatura, se presentan diez elementos clave: 1.- Plantear propuestas con coherencia pedagógica; 2. - Crear una identidad corporal dentro de la cultura de la actividad física y el deporte; 3.- Generar un clima social positivo en el aula; 4.- Trabajar la inclusión y romper estereotipos; 5.- Utilizar los modelos pedagógicos; 6.- Aplicar la evaluación formativa y compartida; 7.- Evidenciar el aprendizaje generado; 8.- Fomentar la autorregulación; 9.- Promover la transferibilidad del aprendizaje; 10.- Conocer/transformar el entorno y el servicio a la comunidad. El texto, sin ninguna pretensión de sentar cátedra, busca la reflexión pausada y profunda del profesorado de EF, un colectivo de gran dinamismo, potente y con infinidad de posibilidades para conseguir que la asignatura siga creciendo y evolucionando. (AU)

There are currently numerous disagreements about the teaching of Physical Education (PE), including its intentions, aims and functions. This variety of approaches, in many cases opposed to each other, is made more acute by the influence of social networks. The search for "likes" and immediate praise leads to a reductionism of the subject, more influenced by the occurrence of the specific activity than by scientific evidence. This, together with other factors, limits the subject from enjoying the social and curricular prestige it deserves. The aim of this article is to try to shed light on the fundamental principles that should structure the teaching of PE. Through a review of the literature, ten key elements are presented: 1.- Proposing proposals with pedagogical coherence; 2. - Creating a corporal identity within the culture of physical activity and sport; 3.- Generating a positive social climate in the classroom; 4.- Working on inclusion and breaking stereotypes; 5. - To use pedagogical models; 6.- To apply formative and shared evaluation; 7.- To demonstrate the learning generated; 8.- To encourage self-regulation; 9.- To promote the transferability of learning; 10.- The text, without any pretensions of setting up a chair, seeks the slow and deep reflection of PE teachers, a highly dynamic and powerful group with infinite possibilities to ensure that the subject continues to grow and evolve. (AU)

Formulación magistral en la atención farmacéutica del paciente oncopediátrico / Drug Compounding in Pharmaceutical Care of Oncopediatric Patients

Introducción: El tratamiento farmacológico del paciente oncopediátrico supone una dificultad para el equipo asistencial ya que muchos medicamen-tos registrados por la administración sanitaria no están indicados en población pediátrica, creándo-se un vacío terapéutico en el tratamiento que es cubierto a través de la formulación magistral (FM). El objetivo del estudio es analizar la elaboración de medicamentos individualizados para oncopediatría en los últimos tres años en el Servicio de Farmacia de un hospital de tercer nivel.Métodos: Estudio descriptivo, observacional, retrospectivo de las FM que se elaboraron para el Servicio de Oncopediatría en el periodo 2019-2021. Para cada FM se detalló su indicación y aplicación clínica. En la descripción cuantitativa se especificó número de fórmulas elaboradas y porcentaje. En la descripción cualitativa se detalló principio activo y concentración, procedimiento para elaborar la for-mulación, dosis de principio activo y de excipientes; condiciones de conservación y fecha de caducidad.Resultados: En el periodo de estudio, se elaboraron 3730 FM para el Servicio de Oncopediatría. Las 4 fórmulas magistrales con mayor peso en la prepa-ración son las de los principios activos: etopósido, fenofibrato, ondansetrón y mercaptopurina. El 57,4% de las FM fueron soluciones orales y el 26,5% suspensiones. La aplicación clínica del 71% de las FM preparadas fue el tratamiento de las patologías onco-hematológicas.Conclusiones: En el paciente oncopediátrico, se acentúa la necesidad de una farmacoterapia más individualizada para asegurar una correcta dosifi-cación y adherencia al tratamiento, siendo la FM la herramienta que solventaría sus necesidades terapéuticas (AU)

Introduction: The pharmacological treatment of the oncopediatric patient represents a difficulty for the health care team, since many drugs registered by the health administration are not indicated in the pediatric population, creating a therapeutic gap in the treatment that is covered through the drug compounding (DC). The aim of this study is to analyze the preparation of individualized drugs for oncopediatrics in the last three years in the Phar-macy Service of a tertiary hospital.Methods: It was carried out a descriptive, observa-tional and retrospective study of the DCs that were prepared for the Oncopediatric Service in the period 2019-2021. For each DC, its indication and clinical application were detailed. In the quantitative de-scription, the number of DC elaborated and percent-age were specified. In the qualitative description, active ingredient and concentration, procedure to prepare the formulation, dose of active ingredient, excipients, storage conditions and expiration date were detailed.Results: During the study period, 3730 DC were prepared for the Oncopediatric Service. It is import-ant to note that the 4 formulations with the greatest weight in the preparation were those of the active ingredients: etoposide, fenofibrate, ondansetron and mercaptopurine. Oral solutions and suspen-sions accounted for 57.4% and 26.5% of the DC. The clinical application of 71% of the DC prepared was the treatment of onco-hematological patholo-gies.Conclusions: In the oncopediatric patient, the need for a more individualized pharmacotherapy is accentuated to ensure a correct dosage and adher-ence to treatment, being the DC the tool that would solve its therapeutic needs (AU)

Analysis of first-line treatment in older patients with metastasic colorectal cancer.

OBJECTIVE: The purpose of this study was to analyse the effectiveness and safety of first-line treatment of metastatic colorectal cancer (CRCm) in older patients treated in a tertiary hospital. MATERIAL AND METHODS: This was an observational and retrospective study, including patients aged 75 years or older, with CRCm, who received chemotherapy treatment in 2017. The main variables studied were type of treatment, Progression-Free Survival (PFS), Overall Survival (OS), dose reductions, and treatment delays due to adverse events. RESULTS: A total of 59 patients (71.2% men) with a median age of 76 years were enrolled in this study. About 70% presented colon cancer, with the left colon being the most frequent location. They were treated with 9 different schemes, in most cases using polychemotherapy and biological agents. The median PFS and OS was 12 and 30 months, respectively. A total of 23/59 of patients started treatment at doses lower than recommended in the clinical practice guidelines. In terms of safety, 34/59 of patients had at least one dose reduction, and 30/59 suffered one treatment delay. The most frequent adverse reactions were asthenia, peripheral neuropathy, diarrhoea, and palmoplantar erythrodysesthesia. CONCLUSION: Our patients presented baseline clinical characteristics similar to the general adult population, with no tumour characteristics associated with advanced age. The efficacy and toxicity were similar to those in the clinical trials, although our patients had more dose reductions. Considering the heterogeneity of patients and in the absence of clinical trials in the older population, real-life studies can be very useful.

(Pro)renin Receptor Is a Novel Independent Prognostic Marker in Invasive Urothelial Carcinoma of the Bladder.

(Pro)renin receptor (PRR) is being investigated in several malignancies as it activates pathogenic pathways that contribute to cell proliferation, immunosuppressive microenvironments, and acquisition of aggressive neoplastic phenotypes. Its implication in urothelial cancer (UC) has not been evaluated so far. We retrospectively evaluate the prognostic role of PRR expression in a series of patients with invasive UC treated with radical cystectomy and other clinical and histopathological parameters including p53, markers of immune-checkpoint inhibition, and basal and luminal phenotypes evaluated by tissue microarray. Cox regression analyses using stepwise selection evaluated candidate prognostic factors and disease-specific survival. PRR was expressed in 77.3% of the primary tumors and in 70% of positive lymph nodes. PRR expression correlated with age (p = 0.006) and was associated with lower preoperatively hemoglobin levels. No other statistical association was evidenced with clinical and pathological variables (gender, ASA score, Charlson comorbidity index, grade, pT, pN) or immunohistochemical expressions evaluated (CK20, GA-TA3, CK5/6, CD44, PD-L1, PD-1, B7-H3, VISTA, and p53). PRR expression in primary tumors was associated with worse survival (log-rank, p = 0.008). Cox regression revealed that PRR expression (HR 1.85, 95% CI 1.22-2.8), pT (HR 7.02, 95% CI 2.68-18.39), pN (HR 2.3, 95% CI 1.27-4.19), and p53 expression (HR 1.95, 95% CI 1.1-3.45) were independent prognostic factors in this series. In conclusion, we describe PRR protein and its prognostic role in invasive UC for the first time. Likely mechanisms involved are MAPK/ERK activation, Wnt/ß-catenin signaling, and v-ATPAse function.

Detection of active hepatitis C in a single visit and linkage to care among marginalized people using a mobile unit in Madrid, Spain.

BACKGROUND: The burden of hepatitis C virus (HCV) infection among marginalized people in Spain is high, despite the fact that HCV prevalence has decreased in recent years. We aimed to assess the effectiveness of a simplified point-of-care (PoC) model for screening for active HCV infection via a mobile unit and subsequent linkage to care with the assistance of navigators. METHODS: We carried out a prospective study on 2001 participants from Madrid, Spain. A nurse and a navigator/educator screened for hepatitis C in a mobile unit, using the OraQuick HCV Rapid Antibody Test and Xpert HCV VL Fingerstick assay. Participants with active HCV were referred to the hospital the same day with a navigator for evaluation and treatment of HCV. RESULTS: Overall, 1621 (81%) participants had not been exposed to HCV, 380 (18.9%) were positive for HCV antibodies, and 136 (6.8%) had active hepatitis C. Among the latter, 134 (98.5%) received the HCV screening results, 133 (97.8%) had an appointment at the hospital, 126 (92.8%) were seen by a physician once they were at the hospital, and 105 (77.2%) started HCV treatment. Being over 50 years old and a person who uses drugs, particularly people who inject drugs (PWID), was directly associated with active hepatitis C (p<0.05). PWID were the only patients with HCV reinfection (4.3% in people without recent injecting drug use and 5.9% in people with recent injecting drug use). Among PWID, no income and daily alcohol intake were also directly associated with active hepatitis C. People with recent injecting drug use showed the lowest rates of attendance at the hospital (91.8%) and starting HCV treatment (70.4%). CONCLUSION: HCV screening using a two-step PoC-based strategy and its linkage to care was extremely efficient for identifying and treating marginalized people with active hepatitis C, thanks to the use of a mobile unit with personnel and technical equipment, an interdisciplinary team, and collaboration between institutions.

The Role of Epigenetics in the Progression of Clear Cell Renal Cell Carcinoma and the Basis for Future Epigenetic Treatments.

Clear cell renal cell carcinoma (ccRCC) is curable when diagnosed at an early stage, but when disease is non-confined it is the urologic cancer with worst prognosis. Antiangiogenic treatment and immune checkpoint inhibition therapy constitute a very promising combined therapy for advanced and metastatic disease. Many exploratory studies have identified epigenetic markers based on DNA methylation, histone modification, and ncRNA expression that epigenetically regulate gene expression in ccRCC. Additionally, epigenetic modifiers genes have been proposed as promising biomarkers for ccRCC. We review and discuss the current understanding of how epigenetic changes determine the main molecular pathways of ccRCC initiation and progression, and also its clinical implications. Despite the extensive research performed, candidate epigenetic biomarkers are not used in clinical practice for several reasons. However, the accumulated body of evidence of developing epigenetically-based biomarkers will likely allow the identification of ccRCC at a higher risk of progression. That will facilitate the establishment of firmer therapeutic decisions in a changing landscape and also monitor active surveillance in the aging population. What is more, a better knowledge of the activities of chromatin modifiers may serve to develop new therapeutic opportunities. Interesting clinical trials on epigenetic treatments for ccRCC associated with well established antiangiogenic treatments and immune checkpoint inhibitors are revisited.

The Attitudinal Style as Pedagogical Model in Physical Education.

The continuous changes in the different legislative systems have led to the application of different ways of understanding students and generating learning in them. In this sense, an area such as physical education is not alien to the continuous changes in teaching learning and its teaching has been modified from a behavioural approach to more cognitive perspectives. In this line, the Attitudinal Style concept arises with the intention of responding to this need for evolution, a global approach to teaching, as well as the generation of materials that allow the participation and learning of all types of students, greatly favoring their involvement and/or adaptation. The objective of this study is to present the Attitudinal Style as a pedagogical model within school physical education, analyzing its characteristics, elements and main purposes. A systematic review of narrative character is used, showing the origins and fundamental elements to justify the Attitudinal Style as a pedagogical model. Thus, aspects such as the generation of positive experiences in the students; the rigorous explanation of what is being learned, adaptation to the content, context and students; the work of collaboration and/or cooperation as a means to achieve a group achievement; the transfer of learning; and the application of formative evaluation, make this model of teaching applicable, relevant and necessary in the different educational levels.

The Attitudinal Style as a Pedagogical Model in Physical Education: Analysis of Its Effects on Initial Teacher Training.

The implementation of the pedagogical model has meant an increase in rigour and coherence in Physical Education (PE) classes. The objectives of the study were twofold; (a) to delimit the characteristics and elements that make up Attitudinal Style as a pedagogical model; (b) to analyze the perception of future teachers on the usefulness and transferability of the model in their classes. Twelve future PE teachers (seven women and five men) with an age of 20.14 ± 1.48 participated. All of them were part of the University of Burgos (Spain). A qualitative approach was used with two data collection instruments (reflective group journals and discussion group) and two categories of analysis were established: (a) usefulness in the construction of professional identity; (b) transferability of the Attitudinal Style in the school. The results showed how future PE teachers consider the model as a transcendental methodological tool in understanding and addressing PE at school. Interpersonal relationships in the classroom, student autonomy and group responsibility are highlighted as necessary aspects with high transferability to the school.

Evaluar en Educación Física: análisis de la tensiones existentes y justificación del empleo de la evaluación formativa y compartida / To evaluate in physical education: analysis of the existing tensions and justification of the employment of the formative and shared assessment / Avaliar na educação física: análise das tensões existentes e justificação do uso da avaliação formativa e compartilhada

Siempre ha existido un amplio debate en torno a la evaluación en Educación Física, tratando de comprender cuál es el modelo más adecuado para desarrollar todo el potencial de esta asignatura. En este artículo pretendemos contribuir al debate, para lo cual tratamos de aclarar algunas ideas preconcebidas a través del análisis de las principales tensiones que surgen en torno a su uso, y la justificación de por qué utilizar procesos de evaluación formativa y compartida en esta asignatura. Nuestra intención es generar reflexión en torno a la evaluación, con el fin de romper con barreras de corte más tradicional y dotar de una nueva visión a la temática, pretendiendo que sea de utilidad para que el profesorado la pueda aplicar en su aula.

There has always been a wide debate around the assessment in Physical Education, trying to understand what is the most appropriate model to develop the full potential of this subject. In this article, we intend to contribute to the debate, for this, we try to clarify some preconceived ideas through the analysis of the main tensions that arise around its use, and the justification of why it is important to use formative and shared assessment processes in this subject. Our intention is to generate reflection on the assessment, in order to break with traditional barriers and provide a new vision to the subject, pretending that it is useful for teachers and so they can apply it in their classroom.

Sempre houve um amplo debate em torno da avaliação em Educação Física, tentando entender qual é o modelo mais adequado para desenvolver todo o potencial dessa disciplina. Neste artigo, pretendemos contribuir para o debate e, para isso, tentamos esclarecer algumas idéias preconcebidas por meio da análise das principais tensões que surgem em torno de seu uso e a justificativa de por que usar processos de avaliação formativa e compartilhada nesta disciplina. Nossa intenção é gerar reflexão sobre a avaliação, a fim de romper as barreiras mais tradicionais e proporcionar uma nova visão do assunto, ao considerar que é útil para os professores aplicá-la em sala de aula.

¿por qué quiero ser profesor de educación física? análisis del cambio de percepción durante la formación universitaria y los primeros años de la carrera docente / Por que é que eu quero ser professor de educação física? análise da mudança na percepção durante a formação universitária e anos iniciais da carreira docente / Why do i want to be a physical education teacher? analysis of the change in perception during university education and early years of teaching career

Resumen: El presente estudio tiene dos objetivos: a) analizar la evolución de la percepción de futuros maestros EF de primer, cuarto curso de carrera y egresados; b) contrastar la realidad profesional del maestro de EF con la valoración de profesores universitarios de EF. Participaron 10 estudiantes en un diseño longitudinal de seis años, dividido en tres fases (2012, 2015 y 2017). También participaron ocho docentes universitarios. Se utilizó un enfoque cualitativo con dos instrumentos de recogida de datos y se establecieron tres categorías de análisis. Los resultados mostraron cómo, en primer curso, los estudiantes dudan sobre qué es ser docente en EF, mientras que en cuarto curso muestran desmotivación respecto a la posibilidad de serlo. Por su parte, los egresados reflejan la incoherencia existente entre la formación universitaria recibida y la exigencia del sistema de acceso a la función pública, cuestión sobre la que los profesores universitarios no muestran concordancia.

Resumo: O presente estudo tem dois objetivos: a) analisar a evolução da percepção dos futuros professores de EF do primeiro, quarto ano de carreira e graduados; b) contrastar a realidade profissional do professor de EF com a avaliação dos professores universitários de EF. Dez alunos participaram de um projeto longitudinal de seis anos, dividido em três fases (2012, 2015 e 2017). Oito professores universitários também participaram. Foi utilizada uma abordagem qualitativa com dois instrumentos de recolha de dados e foram estabelecidas três categorias de análise. Os resultados mostraram como, no primeiro ano, os alunos duvidam do que é ser professor na EF, enquanto no quarto ano mostram falta de motivação em relação à possibilidade de se tornar um. Por outro lado, os graduados refletem a incoerência existente entre a formação universitária recebida e a exigência do sistema de acesso ao serviço público, uma questão sobre a qual os professores universitários não concordam.

Abstract: The present study has two objectives: a) to analyse the evolution of the perception of future EF teachers of first, fourth year of career and graduates; b) to contrast the professional reality of the EF teacher with the assessment of EF university professors. Ten students participated in a six-year longitudinal design, divided into three phases (2012, 2015 and 2017). Eight university professors also participated. A qualitative approach was used with two data collection instruments. The results showed how, in the first year, students doubt what it is like to be a teacher in EF, while in the fourth year they show a lack of motivation regarding the possibility of becoming one. On the other hand, the graduates reflect the incoherence existing between the university training received and the requirement of the system of access to the public service, an issue on which the university professors do not agree.

Entender y enseñar la educación física en la formación inicial del profesorado: estudio de caso en España y Costa Rica / Compreensão e ensino de educação física na formação inicial de professores: estudo de caso na Espanha e Costa Rica / Understanding and teaching physical education in teacher's initial training: a case study in Spain and Costa Rica

Resumen: El estudio contrasta cómo se aborda la Educación Física (EF) en la formación inicial del profesorado (FIP) en España y Costa Rica. Participaron 81 estudiantes, 43 de España y 37 de Costa Rica, y dos de sus profesores. Se utilizó un enfoque cualitativo con tres instrumentos: análisis de guías docentes, grupos de discusión y entrevistas. Se analizaron tres categorías: a) concepción de la EF, b) contribución a las demandas socioeducativas de la EF y c) vinculación con el contexto profesional de la actividad física. Los resultados muestran que en España se orienta la asignatura hacia la EF escolar, mientras que en Costa Rica se abordan contenidos vinculados al ámbito físico. Los alumnos españoles valoran positivamente desarrollar aspectos docentes, mientras que en Costa Rica lo consideran inconexo. El estudio concluye que los modelos sociales y culturales de los países inciden directamente en la forma de enseñar la EF en la FIP. (AU)

Resumo: Este estudo compara o modo como a Educação Física (EF) é abordada na formação inicial de professores (FIP) na Espanha e na Costa Rica. Participaram do estudo 81 alunos (43 e 37 respectivamente) e dois professores. Utilizaram-se três instrumentos: análise de guias de ensino, grupos de discussão e entrevistas. Foram analisadas três categorias: a) o projeto da EF, b) a contribuição para as demandas socioeducativas da Educação Física e c) as ligações com o contexto profissional na área da atividade física. Os resultados mostram que na Espanha a disciplina é mais orientada para a Educação Física Escolar, enquanto na Costa Rica são abordados conteúdos relacionados com a preparação física. Os estudantes espanhóis apreciam desenvolver aspectos educacionais, enquanto na Costa Rica consideram esse aspecto pouco coerente. O estudo conclui que os modelos sociais dos países afetam a forma de ensinar a Educação Física na formação inicial dos professores. (AU)

Abstract: The study compares how Physical Education (PE) is addressed during initial teacher training (ITT) in Spain and Costa Rica. Participants included 81 students from both countries ­ 43 and 37 respectively ­ and two of their teachers. A qualitative approach was used, including analysis of teaching guides, discussion groups, and interviews. Three categories were analyzed; A) PE views, b) contribution to the social-educational demands of PE; and c) links with the professional context in the field of physical activity. The results show that the discipline is oriented towards school PE in Spain, while content related to the physical area is addressed in Costa Rica. Spanish students greatly appreciate developing teaching aspects while in Costa Rica they consider these as unrelated. The study concludes that social and cultural models in both countries directly affect how PE is taught during ITT. (AU)

Trastuzumab, non-pegylated liposomal-encapsulated doxorubicin and paclitaxel in the neoadjuvant setting of HER-2 positive breast cancer.

BACKGROUD: Neoadjuvant treatment based on the combination of trastuzumab plus chemotherapy is the standard of care in patients with HER2-positive early or locally advanced breast cancer. The concurrent use of trastuzumab, anthracyclines and taxanes is frequently used in this setting despite the potential cardiotoxicity of both anthracyclines and trastuzumab. However, not much information is available about this chemotherapy scheme. OBJECTIVE: We wanted to evaluate the efficacy and safety profile of the combination of trastuzumab, liposome-encapsulated doxorubicin and paclitaxel as neoadjuvant scheme. We also tried to establish predictive factors of pathologic complete response. SETTING: The study was carried out in a tertiary University Hospital of Spain. METHOD: This is a descriptive study of the clinical practice performed in our hospital. MAIN OUTCOME MEASURE: Efficacy was measured in terms of pathologic complete response, which was defined as the absence of invasive cancer cells in the breast and the axilla after neoadjuvant treatment. RESULTS: Thirty patients were included, the median age was 48. Seventeen (56.7 %) were hormonal receptor (HR) positive, 14 (46.6 %) had IIIa-b clinical stage and one of them had inflammatory breast cancer. 12 patients (40 %) achieved pCR. Patients with HR-negative BC achieved a higher pCR rate than those ones with HR-positive BC (61.5 % and 23.5 %, respectively; p value = 0.035). 21 patients (70 %) underwent breast conservative surgery. The treatment was in general well tolerated, most frequent grade 3-4 adverse events were neutropenia (20 %), asthenia and liver enzyme alteration (10 %) and febrile neutropenia (6.7 %). No patient developed heart failure, but one (3.3 %) presented a 10 % asymptomatic absolute reduction in left ventricular fraction ejection. CONCLUSIONS: The studied treatment for the neoadjuvant setting of HER2 positive breast cancer seems to be an effective therapeutic option. Despite the expected high rate of cardiotoxicity of this regimen, the study results shows that this treatment regimen appears to be safe. The combination of trastuzumab, non-pegylated liposomal-encapsulated doxorubicin and paclitaxel should be considered for the treatment of HER2-overexpressing breast cancer.

Efectos del planteamiento docente en la enseñanza del futbol sobre el clima de aula. Percepciones de alumnado y profesorado / Efeitos de professores planejam futebol ensino em sala de aula climáticas. Percepções de estudantes e profesores / Effects of the methodological approach teaching soccer on the class climate. Perceptions of students and teachers

El objetivo del presente estudio fue analizar los efectos de dos planteamientos metodológicos diferentes sobre la percepción de los estudiantes y los docentes del clima de aula. Un total de 240 alumnos (56.3% mujeres, 53.7% varones) de los cuatro cursos de Educación Secundaria y sus docentes accedieron a participar (13.34 ± 1.29 años). 112 estudiantes experimentaron un planteamiento de enseñanza Técnico-Tradicional y 128 un planteamiento basado en el Estilo Actitudinal, en ambos casos para la enseñanza del fútbol. El Cuestionario de Medida de las Estrategias Motivacionales en las clases de Educación Física fue utilizado antes y después de la intervención para medir la percepción del clima de aula en los estudiantes. Entrevistas semi-estructuradas fueron usadas para extraer información de los docentes. Los resultados obtenidos de los estudiantes mostraron cómo los grupos que experimentaron el planteamiento Técnico-Tradicional incrementaron de manera significativa la percepción de un clima de aula orientado al ego. Por el contrario, los grupos que vivenciaron el Estilo Actitudinal desarrollaron una percepción de clima de aula significativamente diferente y más orientado a la tarea. Por otro lado, la práctica de fútbol en horario extraescolar se ha mostrado como influyente en la motivación del alumnado solo en el grupo Técnico-Tradicional, mientras que el curso influyó solo en el grupo del Estilo Actitudinal. Finalmente, las ideas expresadas por los docentes se reflejan en el clima de aula generado por ellos en sus clases (AU)

O objetivo deste estudo foi analisar os efeitos de duas abordagens metodológicas para a percepção de alunos e professores em sala de aula a atmosfera. Um total de 240 alunos (56,3% do sexo feminino, 53,7% do sexo masculino) dos quatro cursos do ensino secundário e os professores concordaram em participar (13,34 ± 1,29 anos). 112 estudantes experimentaram abordagem técnica tradicional de ensino e de base 128 do Comportamento Estilo, tanto para o ensino de abordagem de futebol. Questionário de Medida da estratégias de motivação nas aulas de EF foi usada antes e após a cirurgia para medir a percepção do ambiente de sala de aula para os alunos. Entrevistas semi-estruturadas foram usadas para extrair informações de professores. Os resultados dos alunos mostraram como os grupos que experimentaram a abordagem técnico-tradicional aumentou significativamente a percepção de um ego orientada atmosfera de sala de aula. Pelo contrário, os grupos que apresentaram Estilo Comportamento desenvolvido uma sala de aula percepção do clima significativamente diferente e mais orientado para a tarefa. Por outro lado, a prática de futebol depois do horário escolar provou ser influente em motivar os alunos sozinhos no grupo técnico-tradicional, enquanto apenas influenciou o curso de grupo Comportamento Style. Por fim, as ideias expressas pelos professores são refletidas na atmosfera da sala de aula por eles gerados em suas aulas (AU)

The goal of the present study was to assess the effects of two different methodological approaches on students and teachers’ perceptions of the class climate. A total of 240 students (56.3% females, 53.7% males) of the 4 grades of Secondary Education and their teachers agreed to participate (13.34 ± 1.29 years). 112 experienced a Technical-Traditional teaching approach, and 128 an approach based on the Actitudinal Style, in both cases to teach football. The Questionnaire to Measure the Motivational Strategies used in Physical Education Classes was used prior and after the intervention to assess students’ perceptions of the class climate. Semistructured interviews were used to assess teachers’ views. Results showed that the groups who had experienced the Technical-Traditional approach significantly increased their perception of an ego class climate. The groups that experienced the Actitudinal Style approach developed a significantly different task oriented class climate. Extra-curricular Football practice significantly influenced students’ motivation only in the Technical-Traditional group. Grade level significantly influenced students’ motivation only in the Actitudinal Style group. Finally, teachers’ ideas reflect the class climate generated by them (AU)

Natural History of Parkinson's Disease in the Province of Segovia: Disability in a 20 Years Longitudinal Study.

BACKGROUND: Parkinson's disease mainly affects the elderly population causing a progressive functional disability with motor, psychic, and cognitive deterioration. OBJECTIVE: This study was carried out to evaluate disability caused by Parkinson's disease by analyzing the median time to reach Hoehn and Yahr stage III and to investigate predictor variables based on a 20-year longitudinal follow-up study. METHODS: We examined 273 patients with Parkinson's disease recruited between 1978 and 1998. We performed a survival analysis using the Kaplan-Meier method to determine the time to disability and we used a Cox regression model to adjust prognosis factors. RESULTS: The median time to reach Hoehn and Yahr stage III was 7.73 years (95% CI: 5.95-8.05). Independent predictors of disability were: age at onset, the hazard ratio (HR) = 1.10, 95% CI: 1.08-1.12; UPDRS II (activities of daily living) HR = 1.08, 95% CI: 1.03-1.14; and akinesia and rigidity at onset HR = 1.55, 95% CI: 1.07-2.24. CONCLUSIONS: Patients with Parkinson's disease evolve gradually toward disability, and prognostic factors of this evolution were identified.