From chronic conditions to relevance in multimorbidity: a four-step study in family medicine.

Chronic conditions and multimorbidity (MM) are major concerns in family medicine (FM). Based on the International Classification of Primary Care, Second Edition (ICPC-2), this study aimed to list (i)the chronic conditions and (ii)those most relevant to MM in FM. A panel of FM experts used a four-step process to identify chronic conditions among ICPC-2 items and list chronic conditions most relevant in MM. They also evaluated the importance of eight criteria, previously identified in the literature, for characterizing chronic conditions. Step one involved a focus group of five experts. Steps two, three and four involved 10, 25 and 25 experts, respectively. They rated ICPC-2 items via an online questionnaire using a Likert scale from 1 (never chronic/irrelevant in MM) to 9 (always chronic/always relevant in MM). A median value cut-off was used to evaluate appropriateness of each item and the inter-percentile range adjusted for symmetry to determine the agreement/disagreement between experts. In parallel, in steps two and three, experts rated the importance of eight criteria to characterize chronic conditions, using a Likert scale from 1 (strongly disagree) to 9 (strongly agree). Of the ICPC-2's 686 items, experts identified 139 chronic conditions, of which 75 were deemed most relevant in the context of MM. Four of the eight criteria were retained as important to define chronic conditions: duration, sequelae, recurrence/pattern and the diagnosis itself. Using this list of 75 chronic conditions most relevant in the context of MM should enhance the validity of studies of MM in FM

Oral production and interaction with communicative tasks in the classroom

Aunque a menudo descuidado en las clases de inglés, en especial en los colegios españoles de Educación Primaria, el objetivo principal de aprender una lengua es utilizarla de manera funcional y significativa para comunicarse. Con este objetivo en mente, y basado en los principios del aprendizaje basado en tareas, este trabajo presenta una propuesta pedagógica de cuatro juegos comunicativos diseñados para fomentar la autonomía e interacción oral en el alumnado. Dos de los juegos se pusieron en práctica en una clase de inglés de 27 alumnos/as de 2º de Educación Primaria y los resultados muestran claramente que los/as estudiantes son capaces de interactuar en inglés de manera autónoma, utilizando escasamente el castellano. Además, estas actividades han sido muy motivadoras para ellos/as; lo cual nos lleva a recomendar el uso de estas tareas en Educación Primaria como herramienta para promover la interacción oral y mejorar la adquisición del inglés.Although often neglected in EFL lessons, particularly in Spanish Primary schools, the main objective when learning a language is to use it in meaningful and functional ways in order to communicate effectively. With this aim in mind, and based on the principles of Task Based Language Teaching, this project presents a pedagogical proposal consisting of four communicative games designed to foster learners´ autonomy and oral communicative interaction. Two of the games were used with 27 EFL students in the 2nd year of Primary Education and the results clearly show that children are able to interact in English autonomously and that they use their L1 (Spanish) only scarcely. In addition, the activities have been very motivating for them. All this leads us to recommend the use of this type of tasks in the Primary classroom as a tool to promote oral interaction and to enhance the acquisition of English.Graduado o Graduada en Maestro en Educación Primaria por la Universidad Pública de NavarraLehen Hezkuntzako Irakasletzan Graduatua Nafarroako Unibertsitate Publikoa

ISPE-Endorsed Guidance in Using Electronic Health Records for Comparative Effectiveness Research in COVID-19: Opportunities and Trade-Offs.

As the scientific research community along with healthcare professionals and decision makers around the world fight tirelessly against the coronavirus disease 2019 (COVID-19) pandemic, the need for comparative effectiveness research (CER) on preventive and therapeutic interventions for COVID-19 is immense. Randomized controlled trials markedly under-represent the frail and complex patients seen in routine care, and they do not typically have data on long-term treatment effects. The increasing availability of electronic health records (EHRs) for clinical research offers the opportunity to generate timely real-world evidence reflective of routine care for optimal management of COVID-19. However, there are many potential threats to the validity of CER based on EHR data that are not originally generated for research purposes. To ensure unbiased and robust results, we need high-quality healthcare databases, rigorous study designs, and proper implementation of appropriate statistical methods. We aimed to describe opportunities and challenges in EHR-based CER for COVID-19-related questions and to introduce best practices in pharmacoepidemiology to minimize potential biases. We structured our discussion into the following topics: (1) study population identification based on exposure status; (2) ascertainment of outcomes; (3) common biases and potential solutions; and (iv) data operational challenges specific to COVID-19 CER using EHRs. We provide structured guidance for the proper conduct and appraisal of drug and vaccine effectiveness and safety research using EHR data for the pandemic. This paper is endorsed by the International Society for Pharmacoepidemiology (ISPE)