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 longterm adherence to physical activity. Trial Registration: A service of the U.S. National Institutes of Health. Developed by the National Library of Medicine. ClinicalTrials.gov ID: NCT00714831.

Preventive health care and payment systems to providers

Prevention has been a main issue of recent policy orientations in health care. This renews the interest on how different organizational designs and the definition of payment schemes to providers may affect the incentives to provide preventive health care. We present, both the normative and the positive analyses of the change from independent providers to integrated services. We show the evaluation of that change to depend on the particular way payment to providers is done. We focus on the externality resulting from referral decisions from primary to acute care providers. This makes our analysis complementary to most works in the literature allowing to address in a more direct way the issue of preventive health care.

Approaches to OER Development

OER development is becoming more sophisticated as instructors and course specialists become more familiar with the environment. Most OER development approaches for online courses have been developed from those that were appropriate in the face-to-face context. However, the OER online environment opens up new possibilities for learning as well as holding particular limitations. This paper presents some approaches that OER implementers should bear in mind when initiating and supporting OER course development projects.1. Beg, borrow, or steal courseware. Don't reinvent the wheel.2. Take what exists and build the course around it.3. Mix and match. Assemble. Don't create.4. Avoid the "not invented here" syndrome. 5. Know the content -garbage in and garbage out.6. Establish deadlines. Work to deadlines, but don't be unrealistic. 7. Estimate your costs and then double them. Double them again. 8. Be realistic in scheduling and scoping.9. The project plan must be flexible. Be prepared for major shifts.10. Build flexibly for reuse and repurposing -generalizability reduces costs 11. Provide different routes to learning. 12. Build to international standards.There are necessary features in every OER, including introduction, schedule etc. but it is most important to keep the course as simple as possible. Extreme Programming (XP) methodology can be adapted from software engineering to aid in the course development process.

Preliminary report of the first season work of the International Pluridisciplinary Archaeological Expedition to Bactria 2006

The International Pluridisciplinary Archaeological Expedition in Bactria (IPAEB) was created in 2006.The name underlines the international character of the team (which includes Uzbeks, Spanish, French, British and Greek members), the presence of specialists from various fields apart from archaeology and the fame of Bactria1.

An introduction to Mediterranean deep-sea biology

This chapter presents the state of the art concerning the deep-sea Mediterranean environment: geology, hydrology, biology and fisheries. These are the fields of study dealt with in the scientific papers of this volume. The authors are specialists who have addressed their research to the Mediterranean deep-sea environment during the last years. This introduction is an overview but not an exhaustive review.

Preliminary report of the first season work of the International Pluridisciplinary Archaeological Expedition to Bactria 2006

The International Pluridisciplinary Archaeological Expedition in Bactria (IPAEB) was created in 2006.The name underlines the international character of the team (which includes Uzbeks, Spanish, French, British and Greek members), the presence of specialists from various fields apart from archaeology and the fame of Bactria1.