Evolución y desigualdades en el estilo de vida relacionado con la salud de la población adulta española durante el periodo 2006-2017

Antecedentes: Entre las principales líneas de actuación de los Objetivos de Desarrollo Sostenible (ODS) establecidos por la Organización de las Naciones Unidas y su proyecto de sensibilización e impacto sobre los 17 ODS, se encuentra el tercer ODS sobre bienestar y salud. En su línea, considerando entre los principales retos de acción política de la Comisión de Determinantes Sociales de la Salud la vigilancia y monitorización de la equidad en salud y sus determinantes sociales, esta tesis doctoral recorre diferentes escenarios de desigualdad durante el periodo 2006-2017, principalmente en los estilos de vida relacionados con la salud de la población adulta. Objetivo: El objetivo general es analizar la evolución y las desigualdades sociales en el estilo de vida y la salud de la población adulta española durante el periodo 2006-2017. Para ello, se consideran tres objetivos específicos: (a) analizar desigualdades socioeconómicas en el estilo de vida y la salud de la población adulta española en el periodo 2006-2017, así como la asociación entre las conductas de estilo de vida y el gradiente socioeconómico en algunos marcadores de salud, incluyendo la calidad de vida relacionada con la salud y la obesidad; (b) examinar factores y circunstancias que ahondan en las desigualdades en el estilo de vida y la salud en el periodo 2006-2017, incluyendo determinantes intermedios como el lugar de residencia y el cuidado informal, y también la influencia de la morbilidad; y (c) determinar plausibles intervenciones (i.e., leyes para el control y regulación de conductas como el tabaquismo y los efectos del nivel educativo) que potencialmente han podido o podrían influir en el estilo de vida relacionado con la salud y reducir sus desigualdades socioeconómicas. Métodos: La muestra estuvo formada por 118.604 personas (52,4% mujeres) de la población española que participaron en la Encuesta Nacional de Salud de España (ediciones de 2006, 2011/12 y 2017) y la Encuesta Europea de Salud de España (ediciones de 2009 y 2014); y por una población afiliada a la Asociación de Deporte para Todos de Madeira en la Región Autónoma de Madeira (Funchal, Portugal) del año 2017, 381 personas (61,2% mujeres). A partir de estas encuestas se midieron variables socioeconómicas y/o sociodemográficas, variables relacionadas con el estilo de vida e indicadores de salud. Se realizaron análisis de regresión logística, mediación, clases latentes, ecuaciones de estimación generalizadas para ajustar modelos de regresión logística y matrices de correlación como principales análisis estadísticos. Resultados: En el periodo analizado, se observó un incremento de la desigualdad socioeconómica en hábitos de vida relacionados con la salud, como la práctica de actividad física, consumo de tabaco e ingesta cotidiana de fruta y verdura. En relación con el gradiente socioeconómico en los indicadores de salud (obesidad y calidad de vida relacionada con la salud), los hábitos de actividad física y alimentación parcialmente explicaron el gradiente socioeconómico en la obesidad. Además, respecto a los dominios de actividad física, la actividad física deportiva fue la modalidad que contribuyó a explicar parcialmente el gradiente socioeconómico en la calidad de vida relacionada con la salud. Se observaron diferencias en el estilo de vida e indicadores de salud entre los entornos urbanos y rurales que persistieron a lo largo del periodo analizado, incluyendo un mayor estatus de peso y consumo de alcohol en los hombres de las zonas rurales y una menor probabilidad de examen citológico en las mujeres de dichas zonas. A su vez, en estos años, los cuidadores informales indicaron un estilo de vida más activo y mayor ingesta diaria de frutas y verduras en comparación con los no cuidadores, aunque también tuvieron un mayor tabaquismo y consumo de alcohol. Además, ciertos grupos de personas con enfermedades crónicas analizadas también tenían una mayor probabilidad de mala salud y peores hábitos de vida en comparación con las personas sin estas enfermedades. Finalmente, a raíz de la introducción de la Ley 42/2010, destinada a reducir el tabaquismo, hubo una disminución paulatina de la población fumadora y, en este periodo analizado, alcanzar un alto nivel educativo (estudios superiores) resultó ser un indicador asociado con un mejor estilo de vida general, independiente de la clase social ocupacional. Conclusión: A pesar de las tendencias más favorables en algunos hábitos de vida, por ejemplo, el tabaquismo, la desigualdad socioeconómica aumenta en algunas de las principales conductas de estilo de vida saludable, lo que demuestra que las políticas de salud pública aplicadas en este periodo no reducen eficazmente el gradiente socioeconómico en las conductas relacionadas con la salud. Ante este problema, la educación podría desempeñar un papel adicional e independiente en la consecución de la equidad sanitaria a través de sus efectos sobre las conductas relacionadas con la salud, independientemente del estatus ocupacional. Sin embargo, los resultados refuerzan la importancia de no considerar únicamente factores conductuales en el gradiente socioeconómico de la salud, ya que estos solo contribuyen parcialmente a su explicación. Por lo tanto, las políticas públicas deben tener en cuenta otros factores intermedios que pueden mediar en este gradiente de la salud, incluidas las circunstancias materiales, los factores psicosociales y los procesos biológicos que de las propias conductas de estilo de vida derivan.Background: The third Sustainable Development Goal (SDG), on well-being and health, is among the main lines of action of the SDGs established by the United Nations Organization and its project to raise awareness and impact on the 17 SDGs. In line with this, considering the surveillance and monitoring of equity in health and its social determinants among the main challenges of political action of the Commission on Social Determinants of Health, this doctoral thesis covers different scenarios of inequality during the period 2006-2017, mainly in health-related lifestyles of the adult population. Objective: The general objective is to analyze the evolution and social inequalities in health-related lifestyles and health indicators of the Spanish adult population during the period 2006-2017. For this purpose, three specific objectives are considered: (a) to analyze socioeconomic inequalities in health-related lifestyles and health indicators in the Spanish adult population in the period 2006-2017, as well as the association between lifestyle behaviors and socioeconomic gradient in some health indicators, including health-related quality of life and obesity; (b) to examine factors and circumstances that deepen inequalities in health-related lifestyles and health indicators in the period 2006-2017, including intermediate determinants such as place of residence and informal care, and also the influence of morbidity; and (c) to determine plausible interventions (i.e., laws for the control and regulation of behaviors such as smoking and the effects of educational attainment) that potentially have been able or could influence health-related lifestyles and reduce lifestyle-related socioeconomic inequalities. Methods: The sample consisted of 118,604 people (52.4% women) from the Spanish population who participated in the Spanish National Health Survey (2006, 2011/12 and 2017 editions) and the European Health Survey (2009 and 2014 editions) for Spain; and a population affiliated to the Madeira Association of Sport for All in the Autonomous Region of Madeira (Funchal, Portugal) of 2017, 381 people (61.2% women). Socioeconomic and sociodemographic variables, lifestyle-related variables and health indicators were measured from these surveys. Logistic regression analysis, mediation, latent classes, generalized estimating equations to fit logistic regression models and correlation matrices were performed as the main statistical analyses. Results: During the period analyzed, an increase in socioeconomic inequality was observed in health-related lifestyle habits, such as physical activity, smoking, and daily fruit and vegetable intake. Regarding the socioeconomic gradient in certain health indicators (obesity and health-related quality of life), physical activity and eating habits partially explained the socioeconomic gradient in obesity. Furthermore, in terms of physical activity domains, physical activity in sport was the modality that partially explained the socio-economic gradient in health-related quality of life. Differences in lifestyle and health indicators were observed between urban and rural areas that persisted throughout the period analyzed, including a higher weight status and alcohol consumption in rural men and a lower probability of cytological examination in rural women. In turn, in these years, informal caregivers indicated a more active lifestyle and higher daily intake of fruits and vegetables compared to non-caregivers, although they also had higher smoking and alcohol consumption. In addition, certain groups of people with chronic diseases were also more likely to have poorer health and lifestyle habits compared to people without these diseases. Finally, following the introduction of Law 42/2010, aimed at reducing smoking, there was a gradual decrease in the smoking population and, in this period analyzed, attaining a high educational level (university studies or more), proved to be an indicator associated with a better overall lifestyle, independent of occupational social class. Conclusions: Despite more favorable trends in some lifestyle habits, e.g., smoking, socioeconomic inequality increases in some of the main healthy lifestyle behaviors, demonstrating that the public health policies implemented in this period have not effectively reduced the socioeconomic gradient in health-related behaviors. Given this problem, education could play an additional and independent role in achieving health equity through its effects on health-related behaviors, regardless of occupational status. However, the results reinforce the importance of not considering only behavioral factors in the socioeconomic gradient of health, as these only partially contribute to its explanation. Therefore, public policies should consider other intermediate factors that could mediate this health gradient, including material circumstances, psychosocial factors, and biological processes that derive from the lifestyle behaviors themselves

Cost Model Developed in European Project LIMA

[EN] In this paper we show the results of the cost model developed in LIMA project (Seventh Framework Programme, CN: 248909). The LIMA project is entitled "Improve photovoltaic efficiency by applying novel effects at the limits of light to matter interaction". The project started in January 2010 and during this year a cost model of the device developed in the project has been developed to assess the industrial viability of this innovative approach to increase the efficiency and reduce the cost of photovoltaic solar cells. During 2011 the cost model has been actualized and a new scenario has been defined. The LIMA project exploits cutting edge photonic technologies to enhance silicon solar cell efficiencies with new concepts in nanostructured materials. It proposes nanostructured surface layers designed to increase the light absorption in the solar cell while decreasing the surface and interface recombination loss. The integration on a back contact solar cell further reduces these interface losses and avoids shading. The project improves light-matter interaction by the use a surface plasmonic nanoparticle layer. This reduces reflection and efficiently couples incident radiation into the solar cell where it is trapped by internal reflection. Surface and interface recombination are minimized by using silicon quantum dot superlattices in a passivating matrix.This work has been carried out in the framework of the LIMA Project. The European Commission is gratefully acknowledged for financial support under Contract number FP7-248909.Vazquez, M.; Mihailetchi, V.; Connolly, JP.; Cubero García, OJ.; Daly, G.; Halm, A.; Kopecek, R.... (2012). Cost Model Developed in European Project LIMA. Energy Procedia. 27:646-651. https://doi.org/10.1016/j.egypro.2012.07.123S6466512

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

Matching microscopic and macroscopic responses in glasses

Primero reproducimos en las computadoras Janus y Janus II un experimento importante que mide la longitud de la coherencia de los hilados de vidrio a través de la reducción de las barreras de energía libre inducidas por el efecto Zeeman. En segundo lugar, determinamos el comportamiento de escala que permite un análisis cuantitativo de un nuevo experimento informado en la Carta complementaria [S. Guchhait y R. Orbach, Phys. Rev. Lett. 118, 157203 (2017)]. El valor de la longitud de coherencia estimada a través del análisis de las funciones de correlación microscópicas resulta ser cuantitativamente consistente con su medición a través de las funciones de respuesta macroscópica. Además, las susceptibilidades no lineales, recientemente medidas en líquidos formadores de vidrio, se escalan como potencias de la misma longitud microscópica.We first reproduce on the Janus and Janus II computers a milestone experiment that measures the spin glass coherence length through the lowering of free-energy barriers induced by the Zeeman effect. Secondly, we determine the scaling behavior that allows a quantitative analysis of a new experiment reported in the companion Letter [S. Guchhait and R. Orbach, Phys. Rev. Lett. 118, 157203 (2017)]. The value of the coherence length estimated through the analysis of microscopic correlation functions turns out to be quantitatively consistent with its measurement through macroscopic response functions. Further, nonlinear susceptibilities, recently measured in glass-forming liquids, scale as powers of the same microscopic length.• European Research Council. Beca No. NPRGGLASS. Ayuda para Marco Baity Jesi • Unión Europea. Marie Skłodowska- Curie. Beca No. 654971 • Consejo Europeo de Investigación (ERC). Subvención 694925 • University of Syracuse. Beca No. NSF-DMR-305184, para David Yllanes Mosquera • Ministerio de Economía y Competitividad. No. FIS2012-35719-C02, No. FIS2013-42840-P (I+D+i), No. FIS2015-65078-C2, No. FIS2016-76359-P (I+D+i), y No. TEC2016-78358-R • Junta de Extremadura y Fondos FEDER. Contrato parcial GRU10158 • Dipùtación General de Aragón y Fondos Social Europeo. AyudapeerReviewe

Car d'hom cert era: Pràctiques de canibalisme en el Mesolític de les Coves de Santa Maira (Castell de Castells, la Marina Alta, Alacant)

Es presenten evidències de pràctiques antropofàgiques en un grup del Mesolític mediterrani. S'han documentat trenta restes humanes en el nivell mesolític de les coves de Santa Maira. A més de la descripció de les marques antropogèniques identificades, també se situa la troballa en el seu context regional dins les pautes de subsistència dels grups mesolítics de la zona, i es plantegen hipòtesis sobre la seua intencionalitat. Se presentan evidencias de prácticas antropofágicas en un grupo del Mesolítico mediterráneo. Se han documentado treinta restos humanos en el nivel mesolítico de Coves de Santa Maira. Además de la descripción de las marcas antropogénicas identificadas, también se sitúa el hallazgo en su contexto regional dentro de las pautas de subsistencia de los grupos mesolíticos, y se plantean hipótesis sobre su intencionalidad. In this paper we present evidence of anthropophagic behaviour amongst hunter-gatherer groups of the Mediterranean Mesolithic. Thirty human remains have been found in the Mesolithic levels of the Santa Maira Caves. As well as describing the anthropogenic marks identified, this paper contextualizes them within the archaeological context and subsistence patterns described for Mesolithic groups in the region, and hypothesizes about their intentionality

Car d’hom cert era: Cannibalism in the Mesolithic at Santa Maira Caves (Castell de Castells, La Marina Alta, Alicante)

Es presenten evidències de pràctiques antropofàgiques en un grup del Mesolític mediterrani. S’han documentat trenta restes humanes en el nivell mesolític de les coves de Santa Maira. A més de la descripció de les marques antropogèniques identificades, també se situa la troballa en el seu context regional dins les pautes de subsistència dels grups mesolítics de la zona, i es plantegen hipòtesis sobre la seua intencionalitat.Se presentan evidencias de prácticas antropofágicas en un grupo del Mesolítico mediterráneo. Se han documentado treinta restos humanos en el nivel mesolítico de Coves de Santa Maira. Además de la descripción de las marcas antropogénicas identificadas, también se sitúa el hallazgo en su contexto regional dentro de las pautas de subsistencia de los grupos mesolíticos, y se plantean hipótesis sobre su intencionalidad.In this paper we present evidence of anthropophagic behaviour amongst hunter-gatherer groups of the Mediterranean Mesolithic. Thirty human remains have been found in the Mesolithic levels of the Santa Maira Caves. As well as describing the anthropogenic marks identified, this paper contextualizes them within the archaeological context and subsistence patterns described for Mesolithic groups in the region, and hypothesizes about their intentionality

A primary healthcare information intervention for communicating cardiovascular risk to patients with poorly controlled hypertension: The Education and Coronary Risk Evaluation (Educore) study-A pragmatic, cluster-randomized trial

PURPOSE: Uncertainty exists regarding the best way to communicate cardiovascular risk (CVR) to patients, and it is unclear whether the comprehension and perception of CVR varies according to the format used. The aim of the present work was to determine whether a strategy designed for communicating CVR information to patients with poorly controlled high blood pressure (HBP), but with no background of cardiovascular disease, was more effective than usual care in the control of blood pressure (BP) over the course of a year. METHODS: A pragmatic, two-arm, cluster-randomized controlled trial was performed. Consecutive patients aged 40-65 years, all diagnosed with HBP in the last 12 months, and all of whom showed poor control of their condition (systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg), were recruited at 22 primary healthcare centres. Eleven centres were randomly assigned to the usual care arm, and 11 to the informative intervention arm (Educore arm). At the start of the study, the Educore arm subjects were shown the "low risk SCORE table", along with impacting images and information pamphlets encouraging the maintenance of good cardiovascular health. The main outcome variable measured was the control of HBP; the secondary outcome variables were SCORE table score, total plasma cholesterol concentration, use of tobacco, adherence to prescribed treatment, and quality of life. RESULTS: The study participants were 411 patients (185 in the Educore arm and 226 in the usual care arm). Multilevel logistic regression showed that, at 12 months, the Educore intervention achieved better control of HBP (OR = 1.57; 1.02 to 2.41). No statistically significant differences were seen between the two arms at 12 months with respect to the secondary outcomes. CONCLUSIONS: Compared to usual care, the Educore intervention was associated with better control of HBP after adjusting for age, baseline SBP and plasma cholesterol, at 12 months.This study was funded by the Spanish Ministry of Science and Innovation via the Instituto de Salud Carlos III, Subprograma de Proyectos de Investigación en Evaluación de Tecnologías Sanitarias y Servicios de Salud (PI 09/90354), and the Fundación de Investigación e Innovación Biomédica en Atención Primaria (FIIBAP). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscriptS

Exploring Health Science Students’ Notions on Organ Donation and Transplantation: A Multicenter Study

The knowledge acquired during university education about organ donation and transplantation (ODT) decisively influences the information future health professionals transmit. This is important in ODT where the participation of the general public is essential to obtain organs. Objective: To determine notions of Spanish medicine and nursing students on ODT and its relationship with attitude toward ODT. Methods and Design: and design. We conducted a sociologic, multicenter, and observational study. The population for our study consisted of medical and nursing students in Spanish universities. Our database was the Collaborative International Donor Project, stratified by geographic area and academic course. A validated questionnaire (PCID-DTO-RIOS) was self-administered and completed anonymously. Our sample consisted of 9598 medical and 10, 566 nursing students (99% confidence interval; precision of ±1%), stratified by geographic area and year of study. Results: The completion rate for our study was 90%. Only 20% (n=3640) of students thought their notions on ODT were good; 41% (n=7531) thought their notions were normal; 36% (n=6550) thought their notions were scarce. Comparing groups, there were differences between those who believed that their notions on ODT were good (44% nursing vs 56% medical students; P < .000), and those who believed it scarce (54% nursing vs 46% medical students; P < .000). Notions on ODT were related with attitude toward the donation of one''s own organs: those who considered their notions were good were more in favor then those who considered it scarce (88% vs 72%; P < .000). Conclusion: Only 20% of Spanish medical and nursing students thought their notions on ODT were good. Having good knowledge is related to a favorable attitude towards ODT. Receiving specific information on the subject could improve their knowledge about ODT during their training

Ciencia en Sociedad. Reflexiones en el marco de su relación bidireccional

Con autorización de la editorial para este libro. La edición de este libro estuvo a cargo de Jesús Rey Rocha y Víctor Ladero.Este libro surge como una iniciativa para compilar una serie de artículos alumbrados a partir de la génesis del Grupo CURIE (Científic@s Unid@s por la Reactivación de la Investigación en España), semilla de la Asociación Española para el Avance de la Ciencia (AEAC). Durante meses sus miembros estuvieron intercambiando reflexiones y debatiendo sobre la distancia entre la ciencia y la sociedad, y la necesidad de crear una asociación que llenase ese vacío entre los científicos y los ciudadanos, que apostase por llevar la ciencia y los conocimientos generados por la misma a toda la sociedad, tal y como establecen la Declaración de Derechos Humanos y la Constitución Española, en su artículo 44.Peer reviewe

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe