Impact of quality management systems in the performance of educational centers: educational policies and management processes.

In this paper, the findings of an I + D + i research are presented. In this study, an analysis was conducted to assess 14 educational centers where in one of two distinct quality systems had been implemented: the EFQM (European Foundation Quality Management) and el Proyecto de Calidad Integrado (PCI)-the Integrated Quality Project-promoted by the Horrêum Foundation (Álvarez and Santos, 2003; Villa and Marauri, 2004). The EFQM was first used by businesses before being recently transferred to the academics. It comprised nine factors that were translated in an educational context: leadership, policy and strategy, people, alliances and resources, processes, impact on people, impact on clients, impact on society, and key impacts of an organization. The first five factors examine the way activities are carried out and improved, and the final four focus on the impact, i.e., the effect of the organization's activities. Improvement is achieved through learning and innovation. The PCI (Muñoz and Sarasúa, 2005) has its educational origins in the Effective School Improvement model. Seven factors are analyzed (Sarasola et al., 2003; Villa et al., 2004): institutional approach, organizational structures, relationships and living together, counseling and tutoring, curriculum, family and the community (Martínez and Galíndez, 2003), and management and services. The study looks at the impact that the two aforementioned quality systems (EFQM and PCI) have had on educational centers. The term "impact" is understood as the changes experienced both inside and outside an educational center. It must be sustainable overtime, considering the changes and effects achieved, as evidence of improvement. The quantitative analysis focuses on two dimensions. The first addresses three key factors of educational policy: educational planning, communication, and support and rewards for teachers. The second comprises three factors linked to management processes in educational institutions: organizational climate, teaching and learning processes, and relationships with the community.

Cognitive and behavioural factors as predictors of abstinence following treatment for alcohol dependence.

AIM: To assess how far causal attributions about abstinence and relapse, drinking self-efficacy, drinking locus of control expectancy and coping behaviour discriminate abstainers from relapsers following treatment for alcohol dependence. DESIGN: A multicentre 6-month follow-up study. SETTING: Mental health centres and self-help groups in Vizcaya (Spain). PARTICIPANTS: The sample was formed by 201 alcoholics who were assessed at their centres and groups on two occasions: while they were in treatment and 6 months later. MEASUREMENTS: During treatment, participants completed several questionnaires related to cognitive and behavioural variables. Drinking problem and background variables were also assessed. Six months later their drinking status and treatment attendance were examined. FINDINGS: Multivariate tests showed that self-efficacy expectancy and long previous time in abstinence independently discriminated alcoholics who maintained abstinence from those who did not. Other cognitive-behavioural variables showed bivariate association with abstinence, but did not add predictive power to these two measures. CONCLUSIONS: The results of this study are consistent with the extensive literature that confirms the predictor power of self-efficacy. Unexpectedly, it did not find independent positive relationships between other psychological variables and abstinence. Given that self-efficacy can predict outcome in the medium term, it is suggested that treatment could target this variable.

A randomized trial of adding fluoxetine to a naltrexone treatment programme for heroin addicts.

AIMS: The purpose of the study was to assess whether fluoxetine would enhance retention in a naltrexone (NTX) treatment programme. DESIGN: Randomized clinical trial. SETTING: The clinical trial was conducted in two Drug Dependence Centres (DCs) of the Basque Country, Spain over a 1-year period. These DCs routinely used naltrexone as part of their treatment. PARTICIPANTS: A total of 112 heroin addicts included in a naltrexone treatment programme were randomly allocated to two groups of 56 patients each. INTERVENTION: One group received 20 mg/24 h of fluoxetine for the first 6 months, while the remaining 56 patients were used as controls. No placebo was used. MEASUREMENTS: Retention rates and hazard functions were estimated. The risk difference and relative risk were also calculated at 6 and 12 months. FINDINGS: The survival functions showed significantly higher retention rates in the fluoxetine group than among the controls. The risk difference at both 6 months (RD6 = 0.23, CI 95% = 0.06-0.42) and 12 months (RD12 = 0.21, CI 95% = 0.09-0.39) favoured the fluoxetine group, with a greater dropout risk at both times among the controls (RR6 = 1.81, CI 95% = 1.11-2.94; RR12 = 1.46, CI 95% = 1.04-2.04). CONCLUSIONS: The study showed that the combination of fluoxetine and naltrexone produced significantly greater retention than in patients given only naltrexone. Placebo-controlled trials are warranted to assess how far this reflects a specific pharmacological effect.

Gypsies and drug addictions. Study of the adherence to treatment.

AIMS: To compare the retention in a Naltrexone Maintenance Programme (NMP) between a gipsy and a 'paya' (non-gypsy) population in the province of Alava (Basque Country, Spain). HYPOTHESIS: The exposure factor 'to be a gypsy' is no different from the factor 'to be "payo" (non-gypsy)' with regard to the response in the continuation of treatment with opiate antagonists. DESIGN AND PARTICIPANTS: Based on a retrospective follow-up study, two cohorts were considered based on the ethnic group to which one belonged. The cohort of gypsies was made up of 52 cases, for whom by means of a matching process 52 'payo' (non-gypsy) subjects were selected to form the other cohort. The matching variables were age, sex, the family support, and HIV+ status. After a period of detoxification, all the subjects participated in a NMP and the retention in this programme was evaluated. FINDINGS: The survival analysis showed a continuation probability that was higher for the non-gypsy group than for the gypsy group, even though the differences were not significant but they did show a tendency (p < 0.06). The post- hoc tests showed differences between the continuations shown by both cohorts between 4 and 8 weeks, with this not being observed at other times. A subsequent proportional risks regression analysis showed a strong influence of the previous treatments variable, the effect of which was greater in the gypsy group, with this finally causing a correction in the continuation curves that reduced the differences. CONCLUSIONS: The results are discussed with regard to the context of the gypsy ethnic group, and suggestions are made with regard to the need for establishing preventive and informative measures that manage to reach the idiosyncrasy of the gypsy culture.

Ecstasy-induced psychotic disorder: six-month follow-up study.

OBJECTIVE: To describe the psychiatric symptoms manifested by persons diagnosed for the first time as having ecstasy-induced psychotic disorder and to explore the evolution of their symptoms over a 6-month period. DESIGN: Observational study with a 6-month follow-up. METHOD: The subjects studied were 32 ecstasy consumers who were treated at two drug-dependency outpatient centers for hallucinatory-delusive manifestations and who were diagnosed as having ecstasy-induced psychotic disorder according to DSM-IV criteria. For the assessment of the intensity of the syndrome and its follow-up, the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI) were used at the outset and after 1, 3 and 6 months. All subjects received treatment with olanzapine. RESULTS: The treatment program was completed by 96.9% of the patients. At the baseline assessment, a high incidence of symptoms of a severe psychiatric disorder was observed. From the first month the psychotic symptoms (BPRS) were considerably reduced with treatment, with the most severe positive symptoms remitting in the first 3 months. The three assessment indicators (BPRS, HDRS and CGI) showed a statistically significant clinical reduction over the 6 months of the assessment period. Furthermore, no relevant side effects were noted. CONCLUSIONS: In its initial manifestations, a drug-induced psychotic syndrome includes marked symptoms meeting the criteria of a severe psychotic disorder, with the presence of considerable positive and negative symptoms. Olanzapine has been shown to be very effective in these situations and its use is suggested as first-choice therapy.