Evaluación del desempeño cognitivo en escolares y adolescentes con diabetes mellitus tipo 1 / Evaluation of cognitive performance in children and adolescents with type 1 diabetes mellitus

Resumen El objetivo del trabajo fue evaluar el funcionamiento cognitivo de niños y adolescentes con diabetes mellitus tipo 1 (DM1) de la consulta de Endocrinología del IAHULA, y compararlo al de niños no diabéticos, así como investigar la posible influencia de factores relacionados con la enfermedad sobre la cognición. Se realizó un estudio observacional analítico, transversal, que incluyó un grupo de 30 pacientes con DM1 de 8 a 16 años de edad (16 varones) y un grupo control de 30 individuos pareados por edad, género, escolaridad y condición socioeconómica. Se realizó interrogatorio y revisión de historias clínicas para obtener datos sobre las características clínicas y el tratamiento de la DM1. Se les aplicó el test WISC IV para evaluar cognición y cociente intelectual (CI). La edad promedio de los pacientes fue de 13,27 ± 2,31 años, la mitad de ellos masculinos. Se encontraron puntajes menores en los distintos dominios del WISC IV en el grupo con DM1 al compararlos con los del grupo control (p<0,01). El CI fue menor en los niños con DM1 que en los controles (75,47 ± 13,87 frente a 88,57±11,06; p=0,0001); así mismo, se observó con mayor frecuencia un puntaje del CI inferior al percentil 10 en los pacientes con DM1 en comparación con los controles (63,3% frente a 33,3%; p=0,02; Odds ratio: 3,45; IC95%: 1,19-9,99). Se concluyó que la DM1 impacta negativamente el desempeño cognitivo de niños y adolescentes. Se recomienda la evaluación cognitiva de estos pacientes, ya que podría repercutir en su vida diaria.

Abstract The study aimed to evaluate the cognitive functioning of children and adolescents with type 1 diabetes mellitus (T1DM) recruited from the IAHULA Endocrinology Outpatient Unit and to compare it to that of non-diabetics as to investigate the influence on cognition of factors related to the disease. An analytical, cross-sectional observational study was carried out on a group of 30 patients with T1DM between 8 and 16 years of age and on a control group of 30 individuals matched by age, gender, education, and socioeconomic status. Interrogation and review of medical records to obtain data on the clinical characteristics and treatment of T1DM were conducted. The WISC IV test was then applied to evaluate cognition and intellectual coefficient (IQ). The average age of the diabetic patients was 13.27±2.31 years, and half of them were male. Lower scores were found in the different domains of the WISC IV in the group with T1DM (p<0.01). The IQ was found to be lower in children with T1DM than in controls (75.47±13.87 vs. 88.57±11.06; p=0.0001). Likewise, a higher frequency of IQ scores below the 10th percentile was observed in the diabetic children (63.3% vs. 33.3%; p=0.02; Odds ratio: 3.45; 95%CI: 1.19-9.99). It was concluded that T1DM negatively impacts the cognitive performance of children and adolescents. Cognitive evaluation of these patients is recommended, as it could affect their daily life.

La reserva cognitiva como factor modulador del impacto de la cirugía sobre la memoria visual y la denominación en pacientes con epilepsia del lóbulo temporal / Cognitive reserve as a modulating factor in the impact of surgery on visual memory and naming in temporal lobe epilepsy patients

Introducción:La cirugía de la epilepsia del lóbulo temporal (ELT) es un procedimiento eficaz que produce cambios cognitivos. Se han propuesto factores moduladores de dichos cambios, pero permanece sin esclarecer la influencia de la reserva cognitiva. Objetivo: Examinar el efecto del cociente intelectual (CI) sobre los cambios posquirúrgicos en medidas de fluencia verbal, denominación y memoria verbal y visual en una muestra de pacientes con ELT. Pacientes y métodos: Sesenta y cuatro pacientes adultos con ELT farmacorresistente (edad media ± desviación típica: 39,16 ± 11,67) fueron sometidos a una evaluación neuropsicológica antes y un año después de la cirugía. Resultados: Los pacientes con un CI alto presentaron un mejor funcionamiento de la memoria visual inmediata antes de la cirugía que los que tenían un CI medio, así como ausencia de cambios posquirúrgicos. Los pacientes con un CI manipulativo alto presentaron mejor denominación antes de la cirugía que los que tenían un CI manipulativo medio, así como un empeoramiento posquirúrgico significativo. Tanto antes como después de la cirugía, los pacientes con un CI alto presentaron mejor fluencia verbal fonémica y semántica y memoria verbal a corto y largo plazo que los que tenían un CI medio. Conclusiones: El CI es un factor relevante en la evolución de la memoria visual inmediata y de la denominación tras la cirugía en pacientes con ELT. La cirugía no repercute en la ventaja que tienen los pacientes con un CI alto en fluencia verbal y memoria verbal, lo que sugiere que la reserva cognitiva tiene un efecto positivo sobre la función cognitiva, incluso tras la cirugía de la ELT.(AU)

Introduction: Temporal lobe epilepsy (TLE) surgery is an effective procedure that produces cognitive changes. Factors modulating such changes have been proposed, but the influence of cognitive reserve remains unclear. Objective: To examine the effect of intellectual quotient (IQ) on postsurgical changes in verbal fluency, naming, and verbal and visual memory in a sample of patients with TLE. Patients and methods: 64 adult patients with drug-resistant TLE (mean age ± SD: 39.16 ± 11.67) underwent a neuropsychological evaluation before and one year after surgery. Results: Patients with high IQ showed better immediate visual memory before surgery than those with medium IQ, as well as an absence of postsurgical changes. Patients with high manipulative IQ had better naming before surgery than those with medium manipulative IQ, as well as a significant postsurgical worsening. Both before and after surgery, patients with high IQ showed better phonemic and semantic verbal fluency and short- and long-term verbal memory than those with medium IQ. Conclusions: IQ is a relevant factor in the evolution of immediate visual memory and naming after surgery in patients with TLE. Surgery does not impact on the advantage of high IQ patients in verbal fluency and verbal memory, suggesting that cognitive reserve has a positive effect on cognitive function, even after TLE surgery.(AU)

Forma corta de cuatro subtest de la WAIS-IV para la evaluación de pacientes con diagnóstico de esquizofrenia / Four-subtest short-form of the WAIS-IV for assessment of patients diagnosed with schizophrenia

Introducción: El objetivo de este estudio ha sido obtener una forma corta de la versión española de la WAIS-IV para pacientes con diagnóstico de esquizofrenia que necesite entorno a media hora para ser administrada. Una forma abreviada puede ser muy útil en contextos clínicos y de investigación cuando se necesite una estimación del cociente intelectual de pacientes con diagnóstico de esquizofrenia para su adscripción a programas de intervención o para la descripción de la muestra.Materiales y métodosParticipó en el estudio una muestra de 143 pacientes. Noventa y uno formaron el grupo de test, y los otros 52 se utilizaron en un análisis de validación cruzada. Para aumentar la validez de contenido, se tomó la decisión de crear una forma corta compuesta por un subtest de cada uno de los 4 dominios cognitivos que mide la escala.ResultadosVarios análisis mostraron que la mejor combinación era la compuesta por los subtest: Información, Cubos, Aritmética y Búsqueda de Símbolos. Se calcularon 9 criterios diferentes para evaluar la calidad de esta forma corta.ConclusionesLos datos mostraron muy buenos resultados en los criterios basados en las correlaciones, las diferencias de medias y la validación cruzada, y resultados satisfactorios en los criterios de acuerdos en la categoría, margen de error, precisión clínica y fiabilidad. (AU)

Introduction: The present study aimed to obtain a short form of the Spanish version of the WAIS-IV for patients diagnosed with schizophrenia that requires about half an hour to be administered. The reduced test can be very useful in clinical and research settings when an estimation of the intelligence quotient is required to decide about intervention programmes or to describe the sample.Materials and methodsA sample of 143 patients participated in the study, 91 out of them were the test group, and the other 52 were used for a cross-validation analysis. To increase the content validity, the decision was made to create a short form composed of a subtest of each of the four cognitive domains that the scale measures.ResultsSeveral analyses showed that the best combination was composed of the Information, Block Design, Arithmetic, and Symbol Search subtests. Nine different criteria were calculated to evaluate the quality of the short form.ConclusionsThe data showed very good results for the criteria: correlations, difference of means, and cross-validation. The results were satisfactory for: category agreement, band of error, clinical accuracy, and reliability. (AU)

Four-subtest short-form of the WAIS-IV for assessment of patients diagnosed with schizophrenia.

INTRODUCTION: The present study aimed to obtain a short form of the Spanish version of the WAIS-IV for patients diagnosed with schizophrenia that requires about half an hour to be administered. The reduced test can be very useful in clinical and research settings when an estimation of the intelligence quotient (IQ) is required to decide about intervention programs or to describe the sample. MATERIALS AND METHODS: A sample of 143 patients participated in the study, 91 out of them were the test group, and the other 52 were used for a cross-validation analysis. To increase the content validity, the decision was made to create a short form composed of a subtest of each of the four cognitive domains that the scale measures. RESULTS: Several analyses showed that the best combination was composed of the Information, Block Design, Arithmetic, and Symbol Search subtests. Nine different criteria were calculated to evaluate the quality of the short form. CONCLUSIONS: The data showed very good results for the criteria: correlations, difference of means, and cross-validation. The results were satisfactory for: category agreement, band of error, clinical accuracy, and reliability.

[Neuropsychological performance in neurofibromatosis type 1]. / Rendimiento neuropsicológico en la neurofibromatosis tipo 1.

INTRODUCTION: Neurofibromatosis type 1 (NF1) is a genetic disorder with various clinical manifestations that affect the peripheral and central nervous system, as well as the skin, bones and endocrine and vascular system. There is still insufficient knowledge of neuropsychological effects of NF1 on children, and there is some controversy about the cognitive deficits that defines the cognitive profile of patients affected by this disorder. AIMS: In this study an analysis is made of the neuropsychological performance of a group of patients affected by NF1, compared with a control group of healthy children. SUBJECTS AND METHOD: A comparison was made between the neuropsychological performance of a group of 23 boys and girls with a mean age of 8.7 years (+/-1.39) and diagnosed with NF1, and a control group consisting of 21 healthy children, with mean age of 8.9 years (+/- 1.41) and with similar socio-demographic characteristics. The Wechsler Intelligence Scale for Children (WISC) was applied to evaluate the subjects of both groups. RESULTS: The group of patients affected with NF1 showed a lower performance in every primary index of WISC IV: Verbal Comprehension Index, Fluid Reasoning Index, Working Memory Index, Processing Speed Index, and full Scale IQ. Only in two subscales were no statistically significant differences observed: similarities and coding. CONCLUSION: The results show subtle and generalised neuropsychological alterations in the sample of children affected with NF1, which affect most of cognitive domains that have been evaluated. Proper specific and early neuropsychological treatment should be provided in order to prevent the high risk for these children of presenting learning difficulties and school failure.

Funciones ejecutivas y calidad de vida de pacientes pediátricos trasplantados hepáticos / Executive functions and quality of life in pediatric patients who underwent liver transplantation

Objetivos: caracterización de las Funciones Ejecutivas (FE) y Calidad de Vida (CV) en niños de 8 a 12 años con trasplante hepático (TxHep). Metodología: Se evaluó al primer paciente de la agenda de seguimiento de TxHep (37 niños). Excluidos 7: 6 por discapacidad intelectual: 16,6%, 1 desertó. Instrumentos: escala Graffar, WISC III, NEPSY II, d2, Test de Trazados A y B, y Peds QL. FE: 30 TxHep y 30 controles. (Statistical Package for Social Sciences, versión 11.5). Resultados: 53,3% diagnóstico de Falla Hepática Fulminante (FHF), 70% TxHep con dificultades escolares. CI total: diferencia estadísticamente significativa: p < 0.023; T test de Student (TtS), entre FHF (82 ± 8.2) y el resto TxHep (75.43 ± 6.5). 60% TxHep en el nivel fronterizo. Diferencias estadísticamente significativas FE: Flexibilidad cognitiva; Fijación de Metas; y Procesamiento de la Información. Calidad de Vida: déficit leve en el dominio Escolar (score Z, -0.88 ± 0.87) y en el Psicosocial (score Z, -0.63 ± 1.06), en el reporte de niños TxHep. Conclusiones: una muestra mas amplia podría diferenciar las FE y CV entre FHF y otros diagnósticos. La intervención oportuna del diagnóstico y terapia neurocognitivos favorecen el neurodesarrollo acompañando la sobrevida (AU)

Purpose: To describe executive functions (EF) and quality of life (QOL) in children between 8 and 12 years of age who underwent liver transplantation (LTx). Methods: Patients from the list of LTx patients in follow-up were evaluated (37 children). Excluded 7: 6 because of intellectual disability: 16.6%, 1 dropped out. Tools: Graffar index, WISC III, NEPSY II, d2, Trail Making Tests A and B, and Peds QL. EF: 30 LTx and 30 controls. (Statistical Package for Social Sciences, versión 11.5). Results: 53.3% had a diagnosis of acute liver failure (ALF), 70% of LTx had difficulties in their school performance. Total IQ: a significant statistical difference was found: p < 0.023; Student's t test (StT), between patients with ALF (82 ± 8.2) and the remaining LTx patients (75.43 ± 6.5). Sixty percent had a borderline level. Statistically significant differences in EF: Cognitive flexibility; Goal setting; and Information Processing speed. QOL: A mild deficit in the School (Z-score, -0.88 ± 0.87) and Psychosocial Domain (Z score, -0.63 ± 1.06) in the LTx children's report. Conclusions: A larger study sample will be useful to differentiate EF and QOL in LTx children with ALF and those with other diagnoses. Early intervention after diagnosis and neurocognitive therapy is important to improve patients' quality of survival (AU)

Lactancia materna y su influencia en los procesos cognitivos de escolares españoles (6 años de edad), valorada con la escala de inteligencia Wechsler / Breastfeeding and its influence into the cognitive process of Spanish school-children (6 years old), measured by the Wechsler intelligence scale

Numerosos estudios han intentado demostrar que la duración de la lactancia materna se relaciona con un mejor desarrollo cognitivo en la edad escolar. En el presente estudio se evalúa el potencial efecto beneficioso a largo plazo de la alimentación con leche materna durante los primeros meses de vida, mejorando el desarrollo cognitivo y aquellas funciones relacionadas con la Comprensión Verbal, Razonamiento Perceptivo, Memoria de Trabajo y Velocidad de Procesamiento. Un total de 103 niños, escolarizados en primer curso de Educación Primaria, 6 años de edad, (47 niños y 56 niñas), en diferentes colegios de la provincia de Granada, en áreas urbanas, semiurbanas y rurales. Se evaluó la capacidad cognitiva global y algunos dominios específicos de inteligencia a través de la escala de inteligencia Wechsler para niños -IV. Los resultados demuestran una asociación estadísticamente significativa, entre las mejores puntuaciones en el cociente intelectual (CI) y en los cuatro índices medidos mediante el test WISC-IV, con una mayor duración de la lactancia. Resulta altamente significativas (p=0,000) la asociación entre las mejores puntuaciones en el test y 6 meses de lactancia, lo que valida nuestra hipótesis. Como medio de prevención de diferentes déficit intelectuales se debe reforzar el consejo de lactancia materna exclusiva durante al menos los 6 primeros meses de vida.

Some scientific evidence support that a better cognitive development during the school age is related with breastfeeding. In this study, the potential benefit of breastfeeding duration is evaluated, related to Verbal Comprehension, Perceptual Reasoning, Working Memory and Processing Speed. A total of 103 children, first year of Primary School, six-year-old, (47 boys and 56 girls), were included from different schools in the province of Granada (Spain) at urban, semi-urban and rural areas. The global cognitive capability, as well as some specific intelligence domains which permit a more precise and deeper analysis of the cognitive processes, was evaluated through the Wechsler Intelligence Scale for Children - version IV. The results prove an association, statistically signnificative, between the best values of IQ and the other four WISC-IV indexes and a longer breastfeeding. There is a highly significant (p=0,000) association between the best scores and those children who were breastfed during 6 months, which validates our hypothesis. The advice of breastfeeding during at least the first six months of life should be reinforced to reduce learning difficulties.

Aumento da inteligência ao longo do tempo: efeito Flynn e suas possíveis causas / Increase of intelligence over time: Flynn effect and its possible causes / Aumento de la inteligencia a lo largo del tiempo: efecto flynn y sus causas posibles

O presente trabalho descreve o efeito Flynn, entendido como os ganhos verificados nas medidas de inteligência ao longo do tempo. Para viabilizar a compreensão do efeito, são apresentadas algumas concepções psicométricas sobre a inteligência, sobretudo as que sugerem uma organização hierárquica das capacidades cognitivas, diferenciando fatores mais gerais de fatores mais específicos. O efeito Flynn tende a ser mais consistentemente observado em testes que avaliam a inteligência geral e a inteligência fluida. As possíveis causas explicativas do efeito Flynn são igualmente apresentadas e discutidas, dentre elas: os anos de escolaridade, a nutrição, a complexidade dos ambientes mais atuais, a atitude assertiva para resolver testes e a heterose.

The present paper describes the Flynn effect, understood as the gains observed in measures of intelligence over time. To facilitate the understanding of the effect some ideas about psychometric intelligence are presented, especially those that suggest a hierarchical organization of cognitive abilities, differing more general factors over specific factors associated with learning. The Flynn effect tends to be more consistently observed in tests of general intelligence and fluid intelligence. Possible causes of the Flynn effect and the abilities in which it is most likely to manifest itself are also presented and discussed.

En este trabajo se describe el efecto Flynn, entendido como las ganancias observadas en las medidas de inteligencia a lo largo del tiempo. Para facilitar la comprensión del efecto, se describen algunas concepciones psicométricas sobre la inteligencia, especialmente aquellas que sugieren una organización jerárquica de las capacidades cognitivas, diferenciando factores más generales de factores más específicos asociados con el aprendizaje. El Efecto Flynn tiende a ser más consistentemente observado en las pruebas de inteligencia general y de inteligencia fluida. Las posibles causas explicativas del efecto Flynn son igualmente presentadas y discutidas.

Aumento da inteligência ao longo do tempo: efeito Flynn e suas possíveis causas / Increase of intelligence over time: Flynn effect and its possible causes / Aumento de la inteligencia a lo largo del tiempo: efecto flynn y sus causas posibles

O presente trabalho descreve o efeito Flynn, entendido como os ganhos verificados nas medidas de inteligência ao longo do tempo. Para viabilizar a compreensão do efeito, são apresentadas algumas concepções psicométricas sobre a inteligência, sobretudo as que sugerem uma organização hierárquica das capacidades cognitivas, diferenciando fatores mais gerais de fatores mais específicos. O efeito Flynn tende a ser mais consistentemente observado em testes que avaliam a inteligência geral e a inteligência fluida. As possíveis causas explicativas do efeito Flynn são igualmente apresentadas e discutidas, dentre elas: os anos de escolaridade, a nutrição, a complexidade dos ambientes mais atuais, a atitude assertiva para resolver testes e a heterose.(AU)

The present paper describes the Flynn effect, understood as the gains observed in measures of intelligence over time. To facilitate the understanding of the effect some ideas about psychometric intelligence are presented, especially those that suggest a hierarchical organization of cognitive abilities, differing more general factors over specific factors associated with learning. The Flynn effect tends to be more consistently observed in tests of general intelligence and fluid intelligence. Possible causes of the Flynn effect and the abilities in which it is most likely to manifest itself are also presented and discussed.(AU)

En este trabajo se describe el efecto Flynn, entendido como las ganancias observadas en las medidas de inteligencia a lo largo del tiempo. Para facilitar la comprensión del efecto, se describen algunas concepciones psicométricas sobre la inteligencia, especialmente aquellas que sugieren una organización jerárquica de las capacidades cognitivas, diferenciando factores más generales de factores más específicos asociados con el aprendizaje. El Efecto Flynn tiende a ser más consistentemente observado en las pruebas de inteligencia general y de inteligencia fluida. Las posibles causas explicativas del efecto Flynn son igualmente presentadas y discutidas.(AU)

Función ejecutiva y cociente intelectual en pacientes con diagnóstico de esquizofrenia / Executive function and intellectual quotient in schizophrenic patients / Função executiva e quociente intelectual nos pacientes com diagnóstico de esquizofrenia

La esquizofrenia ha generado el interés de muchos profesionales de la salud, considerada desde un principio como un síndrome clínico que afecta diferentes procesos como el pensamiento, la emoción, los movimientos, el comportamiento, y aspectos cognitivos como la atención, la memoria, el lenguaje y especialmente las funciones ejecutivas. El objetivo del presente estudio fue evaluar las funciones ejecutivas en pacientes con diagnóstico de esquizofrenia para verificar si existe alguna relación con el Cociente Intelectual. Se tomaron 30 pacientes con un mínimo de escolaridad de tres años, que se encontraban recibiendo tratamiento farmacológico y sin evidencia de un retardo mental previo; se les aplicó el Wisconsin Card Sorting Test (WCST) para evaluar las habilidades implicadas en la función ejecutiva y la escala de Inteligencia de Weschler para adultos (WAIS) para determinar el Cociente Intelectual, CI verbal, manipulativo y global. En la población estudiada, se encontró que los pacientes presentaron un deterioro global en cada una de las habilidades implicadas en la función ejecutiva, y se ubicaron en un rango de deficiencia mental en la escala de inteligencia, confirmándose que aunque existe deterioro de las funciones ejecutivas y un nivel de cociente intelectual bajo en los pacientes, no existe correlación entre estas dos variables.

Schizophrenia, considered from the beginning as a clinical syndrome that affects different processes such as thinking, emotions, movements, and behaviour, as well as cognitive aspects such as attention, memory, language and especially the executive functions, is an entity that has arisen the interest of many health professionals. The objective of the present study was to assess the above mentioned functions in patients who had been diagnosed with schizophrenia and later verify if there was a relation with their intellectual quotient. The sample for this research was composed of 30 patients with no evidence of previous mental retardation, who had studied for at least three years and who were receiving the suitable pharmacological treatment. The Wisconsin Card Sorting Test (WCST) was administered to assess the abilities involved in the executive function, and the Weschler Adult Intelligence Scale (WAIS), to determine the verbal, manipulative and global intellectual quotient (IQ). The research results showed that the patients presented a global deterioration in each one of the abilities involved in the executive function and were located within the rank of mental deficiency in the intelligence scale, thus confirming that although patients showed deterioration of the executive functions and a low level of intellectual quotient, there is no correlation between these two variables.

A esquizofrenia tem despertado o interesse de muitos profissionais da saúde. É considerada uma síndrome clínica que afeta diversos processos, como o pensamento, a emoção, os movimentos, o comportamento; e processos cognitivos como a atenção, a memória, a linguagem e, especialmente, as funções executivas. O objetivo deste estudo foi avaliar as funções executivas nos pacientes com diagnóstico de esquizofrenia, para comprovar si há relação com o quociente intelectual. Intervieram 30 pacientes com escolaridade mínima de três anos, que estavam recebendo tratamento farmacológico, e no tinham evidência de atraso mental prévio. Aplicou-se o Wisconsin Card Sorting Tets (WCST) para avaliar as habilidades envolvidas na função executiva e a Escala de Inteligência de Weschler para adultos (WAIS) para determinar o quociente intelectual, o QI verbal, manipulador e global. Foi achado os pacientes apresentarem um deterioro global em cada uma das habilidades envolvidas na função executiva e situarem em um rango de deficiência mental na escala da inteligência. Isto confirma que mesmo se há deterioro das funções executivas e um nível baixo de quociente intelectual nos pacientes, não existe correlação entre estas duas variáveis.

Inteligencias múltiples: un nuevo paradigma / Multiple intelligences: a new paradigm

A través de la historia los seres humanos se han encargado de descubrir, medir e investigar la inteligencia humana y las emociones. Es así como se logró llegar a un fin común en donde tanto la inteligencia racional como la emocional son determinantes en nuestro desempeño diario. Por lo que resulta primordial el desarrollo de diferentes estrategias de evaluación y de enseñanza en las instituciones, con el fin de promover al máximo todos los tipos de inteligencia, principalmente la inteligencia emocional. Así como el reconocimiento de todos que todo ser humano, independientemente de su edad puede expresar su inteligencia a través de distintas manifestaciones, no solo a través de calificaciones, escalas o evaluaciones, para poder expresar y lograr sus objetivos individuales y sociales.

Through history the human beings have been in charge to discover, to measure and to investigate human Intelligence and the emotions. He is as well as he managed himself to arrive at an aim common in where as much rational intelligence as the emotional one is determining in our daily performance. Reason why the development is fundamental from different strategies from evaluation and education in the institutions, with the purpose of promoting to the maximum all the types of intelligence, mainly emotional intelligence. As well as the recognition of all which all human being, independently of its age can express its intelligence through different manifestations, nonsingle through qualifications, scales or evaluations, to be able to express and to obtain its individual and social objectives.