Study protocol of cost-effectiveness and cost-utility of a biopsychosocial multidisciplinary intervention in the evolution of non-specific sub-acute low back pain in the working population: cluster randomised trial.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Background: Low back pain (LBP), with high incidence and prevalence rate, is one of the most common reasons to consult the health system and is responsible for a significant amount of sick leave, leading to high health and social costs. The objective of the study is to assess the cost-effectiveness and cost-utility analysis of a multidisciplinary biopsychosocial educational group intervention (MBEGI) of non-specific sub-acute LBP in comparison with the usual care in the working population recruited in primary healthcare centres. Methods/design: The study design is a cost-effectiveness and cost-utility analysis of a MBEGI in comparison with the usual care of non-specific sub-acute LBP.Measures on effectiveness and costs of both interventions will be obtained from a cluster randomised controlled clinical trial carried out in 38 Catalan primary health care centres, enrolling 932 patients between 18 and 65 years old with a diagnosis of non-specific sub-acute LBP. Effectiveness measures are: pharmaceutical treatments, work sick leave (% and duration in days), Roland Morris disability, McGill pain intensity, Fear Avoidance Beliefs (FAB) and Golberg Questionnaires. Utility measures will be calculated from the SF-12. The analysis will be performed from a social perspective. The temporal horizon is at 3 months (change to chronic LBP) and 12 months (evaluate the outcomes at long term. Assessment of outcomes will be blinded and will follow the intention-to-treat principle. Discussion: We hope to demonstrate the cost-effectiveness and cost-utility of MBEGI, see an improvement in the patients' quality of life, achieve a reduction in the duration of episodes and the chronicity of non-specific low back pain, and be able to report a decrease in the social costs. If the intervention is cost-effectiveness and cost-utility, it could be applied to Primary Health Care Centres. Trial registration: ISRCTN: ISRCTN5871969

Cumplimiento, conocimiento y automedicación como factores asociados a los resultados clínicos negativos de la farmacoterapia

The patient plays a fundamental role in the attainment of good results in pharmacotherapy. Noncompliance,self-medication, or insufficient knowledge of the therapy being employed may provide asource for the causes of these negative clinical outcomes, otherwise known as medicine related problems(MRP). he Dader method was used in the evaluation, identification and classification of MRP. Theassociation of variables was established through the statistical Chi square test. Patient knowledge of themedicine, degree of compliance to therapy and self-medication were studied as causes of the negativeoutcomes encountered. 2556 patients were interviewed throughout the year that the study took place,giving a total of 2261 of valid cases. 33% presented an MRP as the cause of his/her visit to the hospitalemergency ward. Knowledge of the medicine, compliance and self-medication were only studied in thepopulation that presented an MRP and in this work it is demonstrated that these are aspects that areassociated with different dimensions of MRP. It is not possible to establish an association between theexistence or not of negative clinical outcomes in patients with the factors of knowledge of medication,compliance and self-medication. This is due to the fact that these variables are not attributable to thepatient himself, but rather are associated with the characteristics of each medicine.El paciente juega un papel primordial en la consecución de los resultados terapéuticos. El incumplimiento,la automedicación, o la falta de conocimiento del la farmacoterapia pueden ser causas de esosresultados clínicos negativos, denominados en ocasiones problemas relacionados con medicamentos(PRM). El método Dáder se utilizó para la evaluación, identificación y clasificación de PRM. Laasociación de variables se estableció mediante el estadístico chi cuadrado. El conocimiento de la medicación,el cumplimiento y la automedicación fueron estudiados como causa de estos resultados negativosde la medicación. Fueron entrevistados 2556 pacientes durante el año de estudio, resultando 2261 casosválidos. El 33 % presentaron un PRM como causa de visita a urgencias. El conocimiento de la medicación,el cumplimiento y la automedicación fueron estudiados solo en la población que presentó unPRM y se demuestra que son aspectos asociados a las distintas dimensiones de PRM. No es posibleestablecer asociación entre la existencia o no de resultados clínicos negativos en los pacientes con elconocimiento de la medicación, el cumplimiento y la automedicación, debido a que estas variables noson atributos del paciente sino que están asociadas a cada medicamento

Preparation methods of chitosan nanoparticles: a review

El quitosano es un polisacárido natural que ha sido utilizado frecuentemente en el desarrollo de distintos materiales, debido a sus excepcionales propiedades fisicoquímicas y biológicas. Las nanopartículas de quitosano son generalmente producidas por estrategias denominadas de construcción (del inglés “bottom up”), donde el ensamblado polimérico es promovido por distintas interacciones moleculares. Sin embargo, un grupo de estrategias llamadas de deconstrucción (del inglés “top-down”) basadas en la fragmentación de estructuras macroscópicas, han generado un gran interés recientemente como alternativa para la obtención de nanomateriales. El presente trabajo hace una revisión bibliográfica de los resultados obtenidos por distintas investigaciones sobre la producción de sistemas de nanopartículas basadas en quitosano durante las últimas décadas. Las evidencias demostraron que las nanopartículas de quitosano juegan un papel preponderante en la investigación de los nanomateriales poliméricos con aplicaciones biomédicas y farmacéuticas, debido a la gran diversidad de métodos de obtención existentes que determinan las propiedades de los materiales, tales como tamaño de partícula, capacidad de incorporación y liberación de compuestos bioactivos, carga superficial, mucoadhesividad, entre otras

Enhancing the use of Asthma and COPD Assessment Tools in Balearic Primary Care (ACATIB):a region-wide cluster-controlled implementation trial

Asthma and chronic obstructive pulmonary disease (COPD) health status assessment tools have demonstrated their value in guiding clinical management. Their use in primary care is still suboptimal. The objective of this study was to assess the effect of an educational intervention programme on the use of the Asthma Control Test (ACT), modified Medical Research Council (mMRC) and COPD Assessment Test (CAT) among primary care settings of the Balearic Islands, Spain. In this region-wide cluster-controlled implementation study, an educational intervention on the use of respiratory health status tools was provided to primary care practices in Mallorca (intervention group). Practices in Ibiza and Menorca functioned as control practices. Written and multimedia materials were provided to all participants to educate their colleagues. Primary outcome was the difference between intervention and control practices in the percentage of practices that increased the use-and recording-of ACT, CAT and mMRC tests between the 6-month period before intervention and the 6-month period after intervention. In the intervention group, 32 out of 45 (71%) centres enhanced the total number of tests, compared with 4 out of 12 (33%) in the non-intervention group (χ(2); P=0.02). Before intervention, 399 test scores were recorded in 88,194 patients (asthma: 57,339; COPD: 30,855). After intervention, 1,576 test scores were recorded in 92,714 patients (asthma: 61,841; COPD: 30,873). An educational intervention programme targeted on primary care physicians enhances the use of respiratory health status tools and promotes behavioural changes. However, the effect is very low and difficult to measure in clinical terms

Study protocol of effectiveness of a biopsychosocial multidisciplinary intervention in the evolution of non-speficic sub-acute low back pain in the working population : cluster randomised trial

Background: Non-specific low back pain is a common cause for consultation with the general practitioner, generating increased health and social costs. This study will analyse the effectiveness of a multidisciplinary intervention to reduce disability, severity of pain, anxiety and depression, to improve quality of life and to reduce the incidence of chronic low back pain in the working population with non-specific low back pain, compared to usual clinical care. Methods/Design: A Cluster randomised clinical trial will be conducted in 38 Primary Health Care Centres located in Barcelona, Spain and its surrounding areas. The centres are randomly allocated to the multidisciplinary intervention or to usual clinical care. Patients between 18 and 65 years old (n = 932; 466 per arm) and with a diagnostic of a non-specific sub-acute low back pain are included. Patients in the intervention group are receiving the recommendations of clinical practice guidelines, in addition to a biopsychosocial multidisciplinary intervention consisting of group educational sessions lasting a total of 10 hours. The main outcome is change in the score in the Roland Morris disability questionnaire at three months after onset of pain. Other outcomes are severity of pain, quality of life, duration of current non-specific low back pain episode, work sick leave and duration, Fear Avoidance Beliefs and Goldberg Questionnaires. Outcomes will be assessed at baseline, 3, 6 and 12 months. Analysis will be by intention to treat. The intervention effect will be assessed through the standard error of measurement and the effect-size. Responsiveness of each scale will be evaluated by standardised response mean and receiver-operating characteristic method. Recovery according to the patient will be used as an external criterion. A multilevel regression will be performed on repeated measures. The time until the current episode of low back pain takes to subside will be analysed by Cox regression. Discussion: We hope to provide evidence of the effectiveness of the proposed biopsychosocial multidisciplinary intervention in avoiding the chronification of low back pain, and to reduce the duration of non-specific low back pain episodes. If the intervention is effective, it could be applied to Primary Health Care Centres

Novel insights into host-fungal pathogen interactions derived from live-cell imaging

Acknowledgments The authors acknowledge funding from the Wellcome Trust (080088, 086827, 075470 and 099215) including a Wellcome Trust Strategic Award for Medical Mycology and Fungal Immunology 097377 and FP7-2007–2013 grant agreement HEALTH-F2-2010-260338–ALLFUN to NARG.Peer reviewedPublisher PD

Automatic business process model extension to repair constraint violations

Consider an artifact-centric business process model, containing both a data model and a process model. When executing the process, it may happen that some of the data constraints from the data model are violated. Bearing this in mind, we propose an approach to automatically generate an extension to the original business process model that, when executed after a constraint violation, repairs the contents of the data leaving it in a new consistent state.Peer ReviewedPostprint (author's final draft

Phenotypic characterization and 16S rDNA identification of culturable non-obligate halophilic bacterial communities from a hypersaline lake, La Sal del Rey, in extreme South Texas (USA)

Background: La Sal del Rey ( the King’s Salt”) is one of several naturally-occurring salt lakes in Hidalgo County, Texas and is part of the Lower Rio Grande Valley National Wildlife Refuge. The research objective was to isolate and characterize halophilic microorganisms from La Sal del Rey. Water samples were collected from the lake and a small creek that feeds into the lake. Soil samples were collected from land adjacent to the water sample locations. Sample salinity was determined using a refractometer. Samples were diluted and cultured on a synthetic saline medium to grow halophilic bacteria. The density of halophiles was estimated by viable plate counts. A collection of isolates was selected, gram-stained, tested for catalase, and characterized using API 20E® test strips. Isolates were putatively identified by sequencing the 16S rDNA. Carbon source utilization by the microbial community from each sample site was examined using EcoPlate™ assays and the carbon utilization total activity of the community was determined. Results: Results showed that salinity ranged from 4 parts per thousand (ppt) at the lake water source to 420 ppt in water samples taken just along the lake shore. The density of halophilic bacteria in water samples ranged from 1.2 × 102 - 5.2 × 103 colony forming units per ml (cfu ml-1) whereas the density in soil samples ranged from 4.0 × 105 - 2.5 × 106 colony forming units per gram (cfu g-1). In general, as salinity increased the density of the bacterial community decreased. Microbial communities from water and soil samples were able to utilize 12 - 31 carbon substrates. The greatest number of substrates utilized was by water-borne communities compared to soil-based communities, especially at lower salinities. The majority of bacteria isolated were gram-negative, catalase-positive, rods. Biochemical profiles constructed from API 20E® test strips showed that bacterial isolates from low-salinity water samples (4 ppt) showed the greatest phenotypic diversity with regards to the types and number of positive tests from the strip. Isolates taken from water samples at the highest salinity (420 ppt) tended to be less diverse and have only a limited number of positive tests. Sequencing of 16S DNA displayed the presence of members of bacterial genera Bacillus, Halomonas, Pseudomonas, Exiguobacterium and others. The genus Bacillus was most commonly identified. None of the isolates were members of the Archaea probably due to dilution of salts in the samples. Conclusions: The La Sal del Rey ecosystem supports a robust and diverse bacterial community despite the high salinity of the lake and soil. However, salinity does appear to a limiting factor with