Ismael Blanco

Guidelines for the clinical management of familial adenomatous polyposis (FAP)

Background: Familial adenomatous polyposis (FAP) is a well-described inherited syndrome, which is responsible for <1% of all colorectal cancer (CRC) cases. The syndrome is characterised by the development of hundreds to thousands of adenomas in the colorectum. Almost all patients will develop CRC if they are not identified and treated at an early stage. The syndrome is inherited as an autosomal dominant trait and caused by mutations in the APC gene. Recently, a second gene has been identified that also gives rise to colonic adenomatous polyposis, although the phenotype is less severe than typical FAP. The gene is the MUTYH gene and the inheritance is autosomal recessive. In April 2006 and February 2007, a workshop was organised in Mallorca by European experts on hereditary gastrointestinal cancer aiming to establish guidelines for the clinical management of FAP and to initiate collaborative studies. Thirty-one experts from nine European countries participated in these workshops. Prior to the meeting, various participants examined the most important management issues according to the latest publications. A systematic literature search using Pubmed and reference lists of retrieved articles, and manual searches of relevant articles, was performed. During the workshop, all recommendations were discussed in detail. Because most of the studies that form the basis for the recommendations were descriptive and/or retrospective in nature, many of them were based on expert opinion. The guidelines described herein may be helpful in the appropriate management of FAP families. In order to improve the care of these families further, prospective controlled studies should be undertaken.

Peutz–Jeghers syndrome: a systematic review and recommendations for management

Peutz–Jeghers syndrome (PJS, MIM175200) is an autosomal dominant condition defined by the development of characteristic polyps throughout the gastrointestinal tract and mucocutaneous pigmentation. The majority of patients that meet the clinical diagnostic criteria have a causative mutation in the STK11 gene, which is located at 19p13.3. The cancer risks in this condition are substantial, particularly for breast and gastrointestinal cancer, although ascertainment and publication bias may have led to overestimates in some publications. Current surveillance protocols are controversial and not evidence-based, due to the relative rarity of the condition. Initially, endoscopies are more likely to be done to detect polyps that may be a risk for future intussusception or obstruction rather than cancers, but surveillance for the various cancers for which these patients are susceptible is an important part of their later management. This review assesses the current literature on the clinical features and management of the condition, genotype–phenotype studies, and suggested guidelines for surveillance and management of individuals with PJS. The proposed guidelines contained in this article have been produced as a consensus statement on behalf of a group of European experts who met in Mallorca in 2007 and who have produced guidelines on the clinical management of Lynch syndrome and familial adenomatous polyposis.

Situating the local in the neoliberalisation and transformation of urban governance

The local state, and more broadly the logic of the local, remains divorced from accounts of urban governance. Addressing this omission, this article examines how a focus on the local opens up new avenues of enquiry in urban governance. It first discusses the interactions of the ‘urban’ and the ‘local’, analysing the significance of both to an understanding of neoliberalism in action. It then evaluates the opportunities and challenges that emerge from the multiple interplays of the ‘local’ and the ‘urban’, setting out five focal points for the exploration of the local: understandings of ‘crisis’; politics, meaning and affect; agency and regulatory intermediaries; the turn to practice; and place and comparison. The article concludes by calling for the study of local practices, in ways that recognise the multiple logics at play in different conjunctures, and the spaces such ambiguities and ‘messiness’ open up for different forms of situated agency.

Does a ‘Barcelona Model’ Really Exist? Periods, Territories and Actors in the Process of Urban Transformation

Abstract The so-called ‘Barcelona Model’ of urban regeneration is known world-wide as a ‘success story’. Amongst the most frequently mentioned features of this ‘model’ are: the use of major events – such as the Olympic Games – as catalysts for great urban regeneration; the adoption of a relational mode of urban governance based on the collaboration between different tiers of government, public and private bodies; the political and administrative decentralisation and the participation of the citizenship. However, the ‘Barcelona Model’ has also received strong criticism from certain segments of the citys academic elite and several local social movements. This article calls into question the mere existence of one ‘Barcelona Model’. It highlights how the main strategies of urban public policy have changed in different periods. It illustrates that, territorially speaking, the strategies of urban regeneration have also been very varied. Eventually, it shows that the networks of urban actors involved in processes of urban change have been significantly diverse. Some learning elements for the analysis of urban regeneration are highlighted at the end of the article.

Geographies of governance: How place matters in urban regeneration policies

Neoliberal accounts of local governance have paid insufficient attention to variation in the forms of urban governance and urban policies across local regimes. On the basis of a comparison of eight deprived neighbourhoods in Catalonia (Spain) where the same regional programme of urban regeneration has been carried out, this paper explores the significance of place when it comes to understanding the adoption of different models of urban governance. In Spain, the combination of a high autonomy of local government and a very strong tradition of neighbourhood associations has resulted in both local authorities and community organisations playing a very important role in local policy-making. Local structural and agency factors are both essential to understanding why models of urban governance and regeneration change from place to place. The paper concludes that neighbourhood type, size of municipality, social capital and previous conflicts are crucial for the understanding of urban governance geographies.

Austerity Urbanism: Patterns of Neo-liberalisation and Resistance in Six Cities of Spain and the UK

This paper explores neoliberalisation and its counter-currents through a six-case study of austerity urbanism in Spain and the UK. Applying Urban Regime Theory it highlights the role of urban politics in driving, variegating and containing neoliberalism since the 2008 crash. Variegated austerity regimes contribute to strengthening neoliberalism, but with limits. Welfarism survives austerity in felicitous circumstances. And, where contentious politics thrive, as in Spain, it holds out the potential for a broader challenge to neoliberalism. In contrast, austerity regimes in the UK cities are strongly embedded. The legacies of past struggles, and differing local and regional traditions form an important part of the explanation for patterns of neoliberalisation, hybridization and contestation.

Social innovation, reciprocity and contentious politics: Facing the socio-urban crisis in Ciutat Meridiana, Barcelona:

Taking one of the poorest neighbourhoods in Barcelona as a paradigmatic case, the aim of this paper is to explore the ways in which contestation organised by sublocal grassroots movements in the context of the current urban crisis operates, both in terms of content and form of protest. Our thesis is that resident mobilisation in the neighbourhood of Ciutat Meridiana is expressive of a new cycle of (urban) social mobilisations in Spanish cities. In such mobilisations, more or less spontaneous initiatives which emerged to counteract the effects of the crisis at the community level are simultaneously serving as platforms for reciprocity and political contestation. Establishing a dialogue with the literature on social innovation, in this paper we claim that these micro-local urban practices are linked to broader social movements and thus play a fundamental role in the political empowerment of citizens living in highly segregated and vulnerable urban areas.

Urban governance and regeneration policies in historic city centres: Madrid and Barcelona

In this article we seek to analyse and compare the models of regeneration of the city centres of Barcelona and Madrid in the light of the transformation of urban governance in Spain. New ways of network governance are emerging in European cities and Madrid and Barcelona are no exception. Urban policies are evolving towards the creation of more integrated strategies for regeneration that involve not only multiple public stakeholders, but also private actors including social and community organizations. Despite both cities showing some common trends, the analysis reveals significant differences between the two cities, both in terms of the composition and the dynamics of the governance networks, and the priorities and strategies for regeneration. The article concludes by discussing the possible explanatory factors for such differences and their political implications.

Social exclusion, area effects and metropolitan governance: a comparative analysis of five large Spanish cities

As a first step towards the exploration of the particularities urban social exclusion in Spain, the research presented here evaluates the significance of the urban territorial factor at neighbourhood level in order to develop relevant conclusions for the design of urban policies. After comparing the structure and dynamics of socio-spatial inequalities in five large Spanish cities (Madrid, Barcelona, Bilbao, Seville and Murcia), we analyse how different disadvantaged neighbourhoods – inner city districts and peripheral housing estates – affect the life trajectories of different vulnerable social groups: long-term unemployed males, undocumented immigrants, single mothers, old people living alone and young people with a low education level and job problems. We identify the existence of significant differences between inner city districts and peripheral housing estates regarding the way they affect the life chances of their inhabitants. Furthermore, we show how different social groups are unequally affected by the characteristics of the neighbourhood in which they live. This all leads us to stress the importance of urban public policies being sensitive to the diversity of socio-spatial conditions of cities.

Facing the Great Recession in Deprived Urban Areas: How Civic Capacity Contributes to Neighborhood Resilience: FACING THE GREAT RECESSION IN DEPRIVED URBAN AREAS

Research suggests that some communities are more resilient than others in the face of the same external stress. Both the local effects of and local responses to the 2008 financial collapse and economic recession have been geographically variegated. Drawing upon two case studies in the Metropolitan Region of Barcelona (Spain), this paper aims to understand why some historically deprived neighborhoods are proving more resilient than others in facing the effects of the Great Recession. We conclude that neighborhood resilience, strongly influenced by the precrash context and by socially produced conditions of vulnerability, operates in each community according to at least three context–specific and interdependent factors: built environment, social capital, and civic capacity. We focus on civic capacity—understood as neighborhood ability to mobilize different sectors of the community to act in a coordinated fashion around matters of community–wide importance—and demonstrate that it is a significant resource contributing to neighborhood resilience.