Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines

El desarrollo profesional de los profesores de ciencias naturales

Se sopesa en este sondeo las percepciones de 236 profesores de CC. NN. de todas las comunidades sobre la formación permanente recibida. Los autores han reflexionado sobre la formación permanente ontológicamente constituida por nueve ocho organizadores lógico-formativos y 40 temas educativos que se ha especificado en un Cuestionario de Heteroformación de 293 cuestiones. Se ha especulado sobre 166 subhipótesis, que se redujeron a 14 verificadas. Al final se hacen recomendaciones sobre las perspectivas de la formación permanente en el área de CC. NN

Formación inicial y permanente en E.G.B

El capítulo primero de la investigación «Formación inicial y permanente en E.G.B.» se ha centrado en el análisis de las actitudes hacia la enseñanza de alumnos de E.U.M. El conocimiento de las actitudes hacia la enseñanza es relevante ya que nos proporciona una imagen de la disposición que tienen los profesores en formación o en ejercicio hacia la actividad docente

A reflexão sobre a prática na pesquisa e formação do professor de música The reflective practice in research and training of teachers of music

O objetivo deste artigo é apresentar e discutir a metodologia da pesquisa O conhecimento prático do professor de música, refletindo sobre suas contribuições para o campo de investigação do pensamento do professor. O desenho metodológico da coleta de dados consistiu em observação, entrevista semiestruturada e entrevista de estimulação de recordação. Segundo a perspectiva das professoras participantes, a pesquisa valorizou suas práticas docentes, reconhecendo seus conhecimentos e incentivando-as a assumirem todo seu potencial como profissionais ativas e reflexivas. Em relação à pesquisa sobre a formação de professores, é destacada a importância de serem ouvidas as vozes dos professores, por meio de relatos em que eles reflitam sobre suas práticas. Por fim, é analisado o potencial da reflexão sobre a prática, na formação de educadores musicais crítico-reflexivos.<br>The objective of this article is to present and discuss the methodology of the research: The music teacher's practical knowledge, considering its contributions to the research field of the teacher's thought. The data collection methodological design consisted of observation, semi-structured interview and recall stimulation interview. According to the perception of the participant teachers, the research has valued their teaching practices by recognizing their knowledge and stimulating them to take upon themselves all of their potential as an active and reflective professional. In relation to the research on teachers' formation, we highlight the importance of making the teachers' voices heard, through reports where they think upon their practices. Finally, we analyze the potential of reflection on practice for the formation of critical reflexive music educators

Metabolomic Identification of Subtypes of Nonalcoholic Steatohepatitis

BACKGROUND & AIMS: Nonalcoholic fatty liver disease (NAFLD) is a consequence of defects in diverse metabolic pathways that involve hepatic accumulation of triglycerides. Features of these aberrations might determine whether NAFLD progresses to nonalcoholic steatohepatitis (NASH). We investigated whether the diverse defects observed in patients with NAFLD are caused by different NAFLD subtypes with specific serum metabolomic profiles, and whether these can distinguish patients with NASH from patients with simple steatosis. METHODS: We collected liver and serum from methionine adenosyltransferase 1a knockout (MAT1A-KO) mice, which have chronically low levels of hepatic S-adenosylmethionine (SAMe) and spontaneously develop steatohepatitis, as well as C57Bl/6 mice (controls); the metabolomes of all samples were determined. We also analyzed serum metabolomes of 535 patients with biopsy-proven NAFLD (353 with simple steatosis and 182 with NASH) and compared them with serum metabolomes of mice. MAT1A-KO mice were also given SAMe (30 mg/kg/day for 8 weeks); liver samples were collected and analyzed histologically for steatohepatitis. RESULTS: Livers of MAT1A-KO mice were characterized by high levels of triglycerides, diglycerides, fatty acids, ceramides, and oxidized fatty acids, as well as low levels of SAMe and downstream metabolites. There was a correlation between liver and serum metabolomes. We identified a serum metabolomic signature associated with MAT1A-KO mice that also was present in 49% of the patients; based on this signature, we identified 2 NAFLD subtypes. We identified specific panels of markers that could distinguish patients with NASH from patients with simple steatosis for each subtype of NAFLD. Administration of SAMe reduced features of steatohepatitis in MAT1A-KO mice. CONCLUSIONS: In an analysis of serum metabolomes of patients with NAFLD and MAT1A-KO mice with steatohepatitis, we identified 2 major subtypes of NAFLD and markers that differentiate steatosis from NASH in each subtype. These might be used to monitor disease progression and identify therapeutic targets for patients