Oral versus intramuscular administration of vitamin B12 for vitamin B12 deficiency in primary care : a pragmatic, randomised, non-inferiority clinical trial (OB12)

The trial was financed by Ministerio de Sanidad y Consumo Español through their call for independent clinical research, Orden Ministerial SAS/2377, 2010 (EC10-115, EC10-116, EC10-117, EC10-119, EC10-122); CAIBER—Spanish Clinical Research Network, Instituto de Salud Carlos III (ISCIII) (CAI08/010044); and Gerencia Asistencial de Atención Primaria de Madrid. This study is also supported by the Spanish Clinical Research Network (SCReN), funded by ISCIII-Subdirección General de Evaluación y Fomento de la Investigación, project number PT13/0002/0007, within the National Research Program I+D+I 2013-2016 and co-funded with European Union ERDF funds (European Regional Development Fund). This project received a grant for the translation and publication of this article from the Foundation for Biomedical Research and Innovation in Primary Care (FIIBAP) Call 2017 for grants to promote research programs.Objectives To compare the effectiveness of oral versus intramuscular (IM) vitamin B12 (VB12) in patients aged ≥65 years with VB12 deficiency. Design Pragmatic, randomised, non-inferiority, multicentre trial in 22 primary healthcare centres in Madrid (Spain). Participants 283 patients ≥65 years with VB12 deficiency were randomly assigned to oral (n=140) or IM (n=143) treatment arm. Interventions The IM arm received 1 mg VB12 on alternate days in weeks 1–2, 1 mg/week in weeks 3–8 and 1 mg/month in weeks 9–52. The oral arm received 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. Main outcomes Serum VB12 concentration normalisation (≥211 pg/mL) at 8, 26 and 52 weeks. Non-inferiority would be declared if the difference between arms is 10% or less. Secondary outcomes included symptoms, adverse events, adherence to treatment, quality of life, patient preferences and satisfaction. Results The follow-up period (52 weeks) was completed by 229 patients (80.9%). At week 8, the percentage of patients in each arm who achieved normal B12 levels was well above 90%; the differences in this percentage between the oral and IM arm were −0.7% (133 out of 135 vs 129 out of 130; 95% CI: −3.2 to 1.8; p>0.999) by per-protocol (PPT) analysis and 4.8% (133 out of 140 vs 129 out of 143; 95% CI: −1.3 to 10.9; p=0.124) by intention-to-treat (ITT) analysis. At week 52, the percentage of patients who achieved normal B12 levels was 73.6% in the oral arm and 80.4% in the IM arm; these differences were −6.3% (103 out of 112 vs 115 out of 117; 95% CI: −11.9 to −0.1; p=0.025) and −6.8% (103 out of 140 vs 115 out of 143; 95% CI: −16.6 to 2.9; p=0.171), respectively. Factors affecting the success rate at week 52 were age, OR=0.95 (95% CI: 0.91 to 0.99) and having reached VB12 levels ≥281 pg/mL at week 8, OR=8.1 (95% CI: 2.4 to 27.3). Under a Bayesian framework, non-inferiority probabilities (Δ>−10%) at week 52 were 0.036 (PPT) and 0.060 (ITT). Quality of life and adverse effects were comparable across groups. 83.4% of patients preferred the oral route. Conclusions Oral administration was no less effective than IM administration at 8 weeks. Although differences were found between administration routes at week 52, the probability that the differences were below the non-inferiority threshold was very low.Publisher PDFPeer reviewe

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Didáctica de la promoción de la salud comunitaria en los primeros cursos del grado de medicina: teoría y práctica de la identificación de los activos para la salud en la comunidad

El proyecto propicia la formación de los estudiantes de los primeros años de Medicina en tres áreas de conocimiento: en la promoción del derecho a la salud; en la identificación de barreras que limiten el acceso a la salud; y en la metodología de la salud comunitaria, especialmente en la identificación de los activos para la salud. El proyecto se enmarca dentro de la consecución de una Universidad inclusiva, accesible y diversa y contempla de forma prioritaria los Objetivos de Desarrollo Sostenible (ODS) de la Agenda 2030, en especial el ODS 3, que hace referencia a la salud y al bienestar. El proyecto parte de la consideración de que el fomento de la salud es un aspecto fundamental en la formación del médico. En este sentido, considera la salud como un derecho fundamental de las personas en un mundo global e interconectado.El proyecto considera también la salud como una pieza clave del bienestar comunitario. Por ello, parte de que hay que educar al futuro médico en relación con la promoción y generación de salud por parte de la ciudadanía. El proyecto sostiene que la salud y la enfermedad no tiene solo componentes biológicos y psicológicos, sino también sociopolíticos. El proyecto ha contado con la participación, además de los miembros del PDI equipo, de médicos de medicina familiar y comunitaria y del personal de dos ONGD: Farmamundi y Médicos del Mundo, organizaciones que cuentan con una experiencia de más de 15 años en la organización de talleres de sensibilización en colaboración con centros educativos universitarios y de Formación Profesional, especialmente en las ramas socio-sanitarias.Depto. de Salud Pública y Materno - InfantilFac. de MedicinaFALSEsubmitte

Atlas OTALEX

Extremadura, in Spain, and Alentejo and Centro, in Portugal, are tree regions belonging to different countries but with several common interests. They are continuous border areas that share similar ecological, socioeconomic and environmental characteristics. The cooperation between these territories which promotes the collaboration and exchange of information between both sides of the Spanish-Portuguese frontier, has important references in several crossborder projects, such as: COORDSIG “Coordination of Geographical Information Systems and Instruments of Territorial Observation in Low Density Rural Areas”, co-financed by EFRD, program Interreg II C, developed between 1997 and 2001; PLANEXAL “Territorial Recognition for the approach of common urban-territorial management and planning strategies in Extremadura and Alentejo”, co-financed by Interreg III A Spain Portugal Program, between 2003 and 2005; GEOALEX “Geographical model for environmental and territorial management of rural low density areas”, co-financed by Interreg III A (Sub-program Alentejo-Extremadura) from 2004 to 2006; OTALEX “Territorial Observatory Alentejo Extremadura”, co-financed by Interreg III A Spain-Portugal Program, developed from 2006 to 2009; and OTALEX II “Territorial and Environmental Observatory Alentejo Extremadura”, co-financed also by Interreg III A Spain-Portugal Program and developed between 2008 and 2011. Starting in 2009 as the ongoing project of OTALEX II, OTALEX C “Territorial and Environmental Observatory Alentejo Extremadura Centro”, co-financed by the Cross Border Cooperation Operational Program of Spain-Portugal 2007-2013 (POCTEP), has as main purpose the creation of a management and environmental monitoring system thought the SDI – IDE OTALEX (Spatial data infrastructure of the Territorial and Environmental Observatory Alentejo-Extremadura-Centro - www.ideotalex.eu) as an information and institutional sharing platform between Alentejo-Extremadura-Centro administrations. The project is integrated by different spanish and portuguese entities that belong to three levels of administration. At national level the spanish Nacional Centro of Geographical Information / Nacional Geographical Institute (CNIG-IGN) and portuguese General Territory Direction (DGT); at the regional level, the General Direction for Transports, Territorial Management and Urbanism (Consejería of Fomento, Vivienda, Territorial Management and Tourism – Government of Extremadura) and Coordination and Regional Development Commission of Alentejo (CCDR-A); at local level, Intermunicipal Community of Central Alentejo (CIMAC), Intermunicipal Community of Alto Alentejo (CIMAA), O. A. Equality and Local Development Area (Diputación of Badajoz) and Diputación of Cáceres; in the high education, the University of Extremadura, the University of Évora and the Polytechnic Institute of Castelo Branco; and as public enterprise, the Enterprise of Development and Infra-structures of Alqueva Dam, S.A. (EDIA). The publication of this crossborder atlas of Alentejo-Extremadura-Centro regions, the ATLAS OTALEX C, integrates the results of an extensive series of crossborder projects overcoming the fruitful cohesion of territories in the defence of their common interests. The present publication collects and synthetizes the harmonization effort made in bringing in common the information of the distinct partners of OTALEX C project, and aims to contribute in an effective way to the sustainable development of these crossborder regions through the definition of common strategies and of the implementation of crossborder of territorial and environmental observation instruments.Programa Operacional de Cooperação Transfronteiriça Espanha-Portugal 2007-2013 (POCTEP

ATLAS OTALEX C

Extremadura, in Spain, and Alentejo and Centro, in Portugal, are tree regions belonging to different countries but with several common interests. They are continuous border areas that share similar ecological, socioeconomic and environmental characteristics. The cooperation between these territories which promotes the collaboration and exchange of information between both sides of the Spanish-Portuguese frontier, has important references in several crossborder projects, such as: COORDSIG “Coordination of Geographical Information Systems and Instruments of Territorial Observation in Low Density Rural Areas”, co-financed by EFRD, program Interreg II C, developed between 1997 and 2001; PLANEXAL “Territorial Recognition for the approach of common urban-territorial management and planning strategies in Extremadura and Alentejo”, co-financed by Interreg III A Spain Portugal Program, between 2003 and 2005; GEOALEX “Geographical model for environmental and territorial management of rural low density areas”, co-financed by Interreg III A (Sub-program Alentejo-Extremadura) from 2004 to 2006; OTALEX “Territorial Observatory Alentejo Extremadura”, co-financed by Interreg III A Spain-Portugal Program, developed from 2006 to 2009; and OTALEX II “Territorial and Environmental Observatory Alentejo Extremadura”, co-financed also by Interreg III A Spain-Portugal Program and developed between 2008 and 2011. Starting in 2009 as the ongoing project of OTALEX II, OTALEX C “Territorial and Environmental Observatory Alentejo Extremadura Centro”, co-financed by the Cross Border Cooperation Operational Program of Spain-Portugal 2007-2013 (POCTEP), has as main purpose the creation of a management and environmental monitoring system thought the SDI – IDE OTALEX (Spatial data infrastructure of the Territorial and Environmental Observatory Alentejo-Extremadura-Centro - www.ideotalex.eu) as an information and institutional sharing platform between Alentejo-Extremadura-Centro administrations. The project is integrated by different spanish and portuguese entities that belong to three levels of administration. At national level the spanish Nacional Centro of Geographical Information / Nacional Geographical Institute (CNIG-IGN) and portuguese General Territory Direction (DGT); at the regional level, the General Direction for Transports, Territorial Management and Urbanism (Consejería of Fomento, Vivienda, Territorial Management and Tourism – Government of Extremadura) and Coordination and Regional Development Commission of Alentejo (CCDR-A); at local level, Intermunicipal Community of Central Alentejo (CIMAC), Intermunicipal Community of Alto Alentejo (CIMAA), O. A. Equality and Local Development Area (Diputación of Badajoz) and Diputación of Cáceres; in the high education, the University of Extremadura, the University of Évora and the Polytechnic Institute of Castelo Branco; and as public enterprise, the Enterprise of Development and Infra-structures of Alqueva Dam, S.A. (EDIA). The publication of this crossborder atlas of Alentejo-Extremadura-Centro regions, the ATLAS OTALEX C, integrates the results of an extensive series of crossborder projects overcoming the fruitful cohesion of territories in the defence of their common interests. The present publication collects and synthetizes the harmonization effort made in bringing in common the information of the distinct partners of OTALEX C project, and aims to contribute in an effective way to the sustainable development of these crossborder regions through the definition of common strategies and of the implementation of crossborder of territorial and environmental observation instruments

­Tenemos correo!

Se usa el correo para animar a la lectura a los alumnos de Primaria. Es una forma de variar la presentación de las lecturas haciendo que resulten más atractivas para el alumnado. Estos reciben unas cartas muy especiales, se trata de unas lecturas secuenciadas que se presentan de diferentes formas y que inducen a los alumnos a participar en juegos de lectura, ya que en cada carta se les presenta una incógnita que tienen que resolver. Con esta actividad se mejora su actitud hacia la lectura, mejoran la entonación, el ritmo de la lectura en voz alta, la comprensión lectora y la expresión escrita. Además, esta actividad también repercute en un aumento del número de visitas de la biblioteca para buscar información. Se realizan actividades como escribir las respuestas a las cartas, elaborar cuestionarios, realizar dibujos y actividades de expresión plástica como murales, convertirse en espías y tener que buscar información en la biblioteca, en internet para resolver los jeroglíficos, juegos de palabras o adivinanzas. Adjunta ejemplos del material elaborado para el desarrollo de las actividades.Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Ordenación AcadémicaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

El periódico escolar como recurso para la comunicación, la participación y la animación a la lectura

Con este proyecto se pone en marcha una publicación cuatrimestral elaborada con aportaciones de todos los alumnos del centro. En esta revista escolar tienen cabida todos los sectores de la comunidad educativa para informar a las familias y para anunciar las actividades que se realizan en el centro. Entre los objetivos está el que los alumnos se sientan motivados en su trabajo diario por la posibilidad de que alguno de sus trabajos sea publicado en el periódico escolar. Además, con la publicación se pretende fomentar la observación y la creatividad entre los alumnos, que estos desarrollen el hábito lector, que valoren los trabajos de los compañeros y dar a conocer a toda la comunidad educativa las actividades que se desarrollan en el centro. Esta actividad también es muy positiva para fomentar la colaboración de los padres a través de la asociación de madres y padres de alumnos. El periódico está compuesto de secciones como creación literaria que recoge escritos de alumnos; un libro, un amigo, que contiene reseñas de libros que los alumnos recomiendan a sus compañeros; nuestro mundo; galería de arte; aprender con el periódico, donde se recogen trabajos de investigación de los alumnos; actividades dentro del centro; pasatiempos; entrevistas; una sección en inglés y otra de música. La publicación es maquetada y diseñada por los profesores. Adjunta un ejemplar del periódico.Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Ordenación AcadémicaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES