RESUMEN
In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria.
RESUMEN
OBJECTIVE: To identify under what circumstances a university student should be allowed academic accommodation for ADHD. To frame an evidence-based policy for use in Brazil based on a worldwide experience. METHODS: We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodation for ADHD is made (including malingering detection). We scrutinized the eligibility criteria of the best universities worldwide. Renowned experts in the field and national stakeholders were consulted. RESULTS: We found no international standard for the assessment of students with ADHD who request academic accommodation. Even renowned institutions worldwide differ from one another in their approaches to academic accommodation on the grounds of ADHD. We propose a national unified set of criteria for Brazilian universities, which could generalize internationally. DISCUSSION: Rigorous assessment is paramount for aiding students with disabilities while preventing ineligible students gaining an unfair advantage. Higher education institutions nationwide and beyond may benefit from adopting a unified set of criteria for eligibility to ADHD accommodation programs.
RESUMEN
BACKGROUND: There is no specific recommendation for nutrition therapy for critically ill older adults. However, targeting energy and protein balance and avoiding fasting could improve outcomes in this population with high-risk nutrition outcomes. This study aimed to evaluate the associations between nutrition and mortality/functionality in critically ill older patients. METHODS: A single-center retrospective observational study of critically ill patients aged 65 years or older was conducted. We extracted data from the dietitian evaluations on energy, protein, and the type of diet (fasting, oral, enteral, or parenteral) prescribed in the first week of intensive care unit admission. Primary outcomes were intrahospital mortality and independence and functional capacity evaluated after hospital discharge. RESULTS: Of the 2043 patients screened, 533 were included in the study. Most patients were men (52.1%), with a median age of 73 (68-78) years. Overall, the intrahospital mortality rate was 53.8%. Simplified Acute Physiology Score 3 (SAPS 3), serum albumin and C-reactive protein levels, and surgical patients were independently associated with fasting in a multivariate analysis. The multivariate regression analyses showed that SAPS 3, serum albumin level, and fasting were independently associated with mortality. Each fasting day increases the risk of mortality by 16.7%. Also, independence and functional capacity were not related to nutrition prescription. CONCLUSION: Older adults (65 years or older) constitute a fragile population in whom nutrition breaks were associated with increased hospital mortality. Furthermore, a prospective clinical trial is necessary to establish the best strategy to feed this population.