Referral from primary care to a physical activity programme : establishing long-term adherence? A randomized controlled trial. Rationale and study design

Background: Declining physical activity is associated with a rising burden of global disease. There is little evidence about effective ways to increase adherence to physical activity. Therefore, interventions are needed that produce sustained increases in adherence to physical activity and are cost-effective. The purpose is to assess the effectiveness of a primary care physical activity intervention in increasing adherence to physical activity in the general population seen in primary care. Method and design: Randomized controlled trial with systematic random sampling. A total of 424 subjects of both sexes will participate; all will be over the age of 18 with a low level of physical activity (according to the International Physical Activity Questionnaire, IPAQ), self-employed and from 9 Primary Healthcare Centres (PHC). They will volunteer to participate in a physical activity programme during 3 months (24 sessions; 2 sessions a week, 60 minutes per session). Participants from each PHC will be randomly allocated to an intervention (IG) and control group (CG). The following parameters will be assessed pre and post intervention in both groups: (1) health-related quality of life (SF-12), (2) physical activity stage of change (Prochaska's stages of change), (3) level of physical activity (IPAQ-short version), (4) change in perception of health (vignettes from the Cooperative World Organization of National Colleges, Academies, and Academic Associations of Family Physicians, COOP/WONCA), (5) level of social support for the physical activity practice (Social Support for Physical Activity Scale, SSPAS), and (6) control based on analysis (HDL, LDL and glycated haemoglobin). Participants' frequency of visits to the PHC will be registered over the six months before and after the programme. There will be a follow up in a face to face interview three, six and twelve months after the programme, with the reduced version of IPAQ, SF-12, SSPAS, and Prochaska's stages. Discussion: The pilot study showed the effectiveness of an enhanced low-cost, evidence-based intervention in increased physical activity and improved social support. If successful in demonstrating long-term improvements, this randomised controlled trial will be the first sustainable physical activity intervention based in primary care in our country to demonstrate long-term adherence to physical activity

Patient preferences for treatment of multiple sclerosis with disease-modifying therapies: a discrete choice experiment

José Manuel Garcia-Dominguez,1 Delicias Muñoz,2 Marta Comellas,3 Irmina Gonzalbo,3 Luis Lizán,3 Carlos Polanco Sánchez4 1Multiple Sclerosis Unit, Hospital General Universitario Gregorio Marañon, Madrid, 2Neurology Department, Hospital Universitario Alvaro Cunqueiro, Vigo, 3Outcomes’10, Jaime I University, Castellón, 4Health Economics & Outcomes Research, Merck, Madrid, Spain Objectives: To assess disease-modifying therapy (DMT) preferences in a population of patients with multiple sclerosis (MS) and to estimate the association between sociodemographic and clinical factors and these preferences. Methods: Preferences for DMTs attributes were measured using a discrete choice experiment. Analysis of preferences was assessed using mixed-logit hierarchical Bayes regression. A multilinear regression was used to evaluate the association between the preferences for each attribute and patients’ demographic and clinical characteristics. A Student’s t-test or Welch’s t-test was used for subgroup comparisons. Results: A total of 125 patients were included in the final analysis (62.9% female, mean age 44.5 years, 71.5% with relapsing-remitting MS diagnosis). The most important factor for patients was the possibility of suffering from the side effects of the treatment (relative importance [RI] =50%), followed by a delay in disease progression (RI =19.4%), and route and frequency of administration (RI =14.3%). According to maximum acceptable risk, patients were willing to accept an increase of 3.8% in severity of side effects, for a delay of 1 year in disease progression. Treatment duration was the most prevalent factor affecting preferences, followed by the age of patients, type of MS, level of education, and the type of current treatment. Patients treated orally were significantly more concerned about the route and frequency of administration (P=0.026) than patients on injectable therapy. Naïve patients stated significantly less importance to prevention of relapses (P=0.021) and deterioration of the capacity for performing usual daily life activities (P=0.015). Finally, patients with >5 years since diagnosis were significantly less concerned about preventing disease progression (P=0.021), and more concerned about treatment side effects (P=0.052) than compared with patients with <5 years of MS history. Conclusion: The most important attribute for MS patients was side effects of DMTs, followed by delay in disability progression. Experience with DMTs and time since MS diagnosis changed patients’ preferences. These results give information to adjust new DMT treatment in order to satisfy patients’ preferences and therefore, improve adherence to treatment. Keywords: multiple sclerosis, preferences, conjoint analysis, discrete choice experimen

Circuitos de atención médica de la paciente con osteoporosis postmenopáusica en España

Objetivos: Alcanzar un consenso sobre los circuitos de atención médica de la paciente con osteoporosis postmenopáusica (OPM), incluyendo los circuitos de derivación y manejo (herramientas de evaluación y pruebas médicas), identificando perfiles de acuerdo con la opinión de expertos en metabolismo óseo pertenecientes al Sistema de Salud Español. Material y métodos: Se empleó la técnica Delphi con dos rondas de consulta sucesivas. Participaron 38 expertos en el manejo de OPM pertenecientes a 14 sociedades científicas. La revisión de la literatura y la opinión del comité científico nutrieron el cuestionario. Los expertos expresaron su “deseo” (1=rechazo total; 9=deseo más fuerte) y “pronóstico” (1=no ocurrirá en absoluto; 9=ocurrirá con máxima probabilidad) acerca de las cuestiones planteadas. Se alcanzó consenso cuando el 75% o más de los participantes puntuaron 1-3 (desacuerdo) o 7-9 (acuerdo). Adicionalmente, los expertos se dividieron en 3 grupos de discusión para complementar la información según los perfiles de pacientes previamente hallados en el método Delphi. Resultados: Se alcanzó consenso en el 75% de las preguntas. Los expertos establecieron tres perfiles de pacientes con OPM: sin fractura, con fractura vertebral y con fractura no vertebral, así como los recursos diagnósticos y terapéuticos que conviene emplear en estas pacientes. La paciente sin fractura debería ser manejada por Atención Primaria o Reumatología y se utilizarán escalas para valorar el riesgo de fractura en fases tempranas de la enfermedad. La paciente con fractura vertebral crónica debería referirse a Reumatología y Rehabilitación, y se derivará a Reumatología; mientras que la paciente con fractura vertebral aguda debería ser tratada por Cirugía Ortopédica, y así es como posiblemente ocurrirá. El diagnóstico de la paciente con fractura vertebral estará basado principalmente en la radiografía. Para la evaluación de la progresión se deberían utilizar cuestionarios sobre la capacidad funcional y escalas del dolor. Sin embargo, no se utilizarán en la práctica habitual debido a la falta de tiempo. La paciente con fractura no vertebral debería ser y será referida a Cirugía Ortopédica, recomendando realizar 3-4 radiografías anuales para asegurar la consolidación de la fractura. Conclusiones: Los resultados del método Delphi muestran los circuitos de derivación de la paciente con OPM, que se concentran en Atención Primaria y Reumatología, cuando no existe fractura, y Cirugía Ortopédica, en caso de fractura

Circuitos de atención médica de la paciente con osteoporosis postmenopáusica en España

Objectives: To reach a consensus on the medical care circuits of patients with postmenopausal osteoporosis (PMO), including derivation and management (assessment tools and medical tests), identifying profiles according to the opinion of bone metabolism experts, from Spain’s Health Service. Material and methods: The Delphi technique was used with two successive consultation rounds, with 38 experts in PMO management belonging to 14 scientific societies taking part in the study. Review of literature and the opinion of the scientific committee rounded out the questionnaire. The experts expressed their "desire" (1=total rejection, 9=stronger desire) and "forecast" (1=will absolutely not occur; 9=will occur with maximum probability) about the issues raised. A consensus was reached when 75% or more of the participants scored 1-3 (disagreement) or 7-9 (agreement). In addition, experts were divided up into 3 discussion groups to complement the information according to patient profiles found previously in the Delphi method. Results: Consensus was reached on 75% of the questions. The experts established three profiles of PMO patients: no fracture, vertebral fracture and non-vertebral fracture, as well as the diagnostic and therapeutic resources recommended for these patients. The patient without a fracture should be managed in Primary Care or Rheumatology and scales will be used to evaluate fracture risk in early stages of the disease. The patient with chronic vertebral fracture should refer to Rheumatology and Rehabilitation, and will be Rheumatology, whereas the patient with acute vertebral fracture should be treated in Orthopedic Surgery, and this is how it will possibly happen. Diagnosis of vertebral fracture patients will be based mainly on x-rays. To assess progress, questionnaires on the functional capacity and pain scales are recommended. However, these will not be used due to the lack of time involved. The patient with non-vertebral fracture should be and will be referred to Orthopedic Surgery, with 3-4 radiographs recommended to ensure fracture consolidation. Conclusions: Delphi method results indicate that referral of PMO patients are concentrated in Primary Rheumatology, when there is no fracture, and Orthopedic Surgery, in the case of fracture.Objetivos: Alcanzar un consenso sobre los circuitos de atención médica de la paciente con osteoporosis postmenopáusica (OPM), incluyendo los circuitos de derivación y manejo (herramientas de evaluación y pruebas médicas), identificando perfiles de acuerdo con la opinión de expertos en metabolismo óseo pertenecientes al Sistema de Salud Español. Material y métodos: Se empleó la técnica Delphi con dos rondas de consulta sucesivas. Participaron 38 expertos en el manejo de OPM pertenecientes a 14 sociedades científicas. La revisión de la literatura y la opinión del comité científico nutrieron el cuestionario. Los expertos expresaron su "deseo" (1=rechazo total; 9=deseo más fuerte) y "pronóstico" (1=no ocurrirá en absoluto; 9=ocurrirá con máxima probabilidad) acerca de las cuestiones planteadas. Se alcanzó consenso cuando el 75% o más de los participantes puntuaron 1-3 (desacuerdo) o 7-9 (acuerdo). Adicionalmente, los expertos se dividieron en 3 grupos de discusión para complementar la información según los perfiles de pacientes previamente hallados en el método Delphi. Resultados: Se alcanzó consenso en el 75% de las preguntas. Los expertos establecieron tres perfiles de pacientes con OPM: sin fractura, con fractura vertebral y con fractura no vertebral, así como los recursos diagnósticos y terapéuticos que conviene emplear en estas pacientes. La paciente sin fractura debería ser manejada por Atención Primaria o Reumatología y se utilizarán escalas para valorar el riesgo de fractura en fases tempranas de la enfermedad. La paciente con fractura vertebral crónica debería referirse a Reumatología y Rehabilitación, y se derivará a Reumatología; mientras que la paciente con fractura vertebral aguda debería ser tratada por Cirugía Ortopédica, y así es como posiblemente ocurrirá. El diagnóstico de la paciente con fractura vertebral estará basado principalmente en la radiografía. Para la evaluación de la progresión se deberían utilizar cuestionarios sobre la capacidad funcional y escalas del dolor. Sin embargo, no se utilizarán en la práctica habitual debido a la falta de tiempo. La paciente con fractura no vertebral debería ser y será referida a Cirugía Ortopédica, recomendando realizar 3-4 radiografías anuales para asegurar la consolidación de la fractura. Conclusiones: Los resultados del método Delphi muestran los circuitos de derivación de la paciente con OPM, que se concentran en Atención Primaria y Reumatología, cuando no existe fractura, y Cirugía Ortopédica, en caso de fractura

Euclid Near Infrared Spectrometer and Photometer instrument concept and first test results obtained for different breadboards models at the end of phase C

10 pagesInternational audienc

Euclid near infrared spectrometer and photometer instrument flight model presentation, performance, and ground calibration results summary

International audienceThe NISP (Near Infrared Spectrometer and Photometer) is one of the two Euclid instruments (see ref [1]). It operates in the near-IR spectral region (950-2020nm) as a photometer and spectrometer. The instrument is composed of: - a cold (135K) optomechanical subsystem consisting of a Silicon carbide structure, an optical assembly, a filter wheel mechanism, a grism wheel mechanism, a calibration unit and a thermal control system - a detection system based on a mosaic of 16 H2RG with their front-end readout electronic. - a warm electronic system (290K) composed of a data processing / detector control unit and of an instrument control unit that interfaces with the spacecraft via a 1553 bus for command and control and via Spacewire links for science data This paper presents: - the final architecture of the flight model instrument and subsystems - the performances and the ground calibration measurement done at NISP level and at Euclid Payload Module level at operational cold temperature. © COPYRIGHT Society of Photo-Optical Instrumentation Engineers (SPIE