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.

EZ-IO intraosseous device implementation in a pre-hospital emergency service : a prospective study and review of the literature

Introduction : La prise en charge des patients critiques nécessite dans la majorité des situations l'obtention rapide d'un accès vasculaire, afin d'administrer des médicaments, des solutés de remplissage, ou des produits sanguins. La mise en place d'un accès vasculaire peut s'avérer difficile chez ces patients. En cas d'échec de pose d'une voie veineuse périphérique, des abords vasculaires alternatifs existent. Il s'agit essentiellement de la pose d'une voie veineuse centrale, la réalisation d'une dénudation veineuse, ou la pose d'une voie intra-osseuse. Depuis le développement de dispositifs d'insertion « semi-automatique » à la fin des années 90, la voie intra-osseuse, traditionnellement réservée aux cas pédiatriques, est de plus en plus fréquemment utilisée chez les patients adultes. Le Service des Urgences du CHUV a introduit en 2009 les dispositifs d'insertion d'aiguilles intra-osseuses de type EZ-IO® (perceuse électrique), en salle de réanimation des urgences vitales (déchoquage), ainsi qu'au sein du secteur préhospitalier pour les interventions du SMUR de Lausanne et de l'hélicoptère REGA de la base de Lausanne. Par cette étude, nous voulions mettre en évidence les aspects épidémiologiques des patients ayant dû être perfusés par cet abord dans un contexte préhospitalier, ainsi que les circonstances cliniques ayant justifié un tel usage, le taux de succès, les éventuelles complications, les médicaments perfusés et la mortalité des patients ayant bénéficié de ce dispositif. Méthode: Chaque patient ayant bénéficié de la mise en place d'une voie intra-osseuse par EZ-IO® du 1er janvier 2009 au 31 décembre 2011 a été inclus. Les données récoltées étaient l'âge, le sexe, l'indication à la mise en place de l'intra-osseuse, la localisation, le taux de succès, les médicaments et fluides administrés, les complications, la mortalité à 48 heures et à la sortie de l'hôpital. Tous les articles mentionnant l'utilisation de ΙΈΖ-ΙΟ® dans des situations cliniques ont également été analysés par une revue de littérature structurée exhaustive, afin de comparer nos résultats avec les données de la littérature. Résultats : Cinquante-huit patients, représentant 60 intra-osseuses EZ-IO®, ont été inclus. Leur âge moyen (47 ans), le taux de succès (90%), les indications, la localisation de l'aiguille (98% au niveau du tibia proximal) et le taux de complications (0%) correspondent aux valeurs trouvées dans la littérature. Le taux de survie de nos patients est de 38% à 48 heures et de 29% à la sortie de l'hôpital. De nombreux médicaments ou solutés de perfusion ont été administrés; l'adrénaline restant le médicament le plus fréquemment administré par cette voie. Dans 7 cas, les patients ont bénéficié d'une induction d'anesthésie par voie intra-osseuse. La revue de littérature a permis de compiler 30 études distinctes, représentant un total de 1603 accès vasculaires de type EZ-IO®. Conclusion : La voie intra-osseuse s'avère fiable et rapide pour obtenir un accès vasculaire, avec un taux de complications très faible et permet l'administration d'un grand nombre de substances. D'autres études sont nécessaires pour évaluer l'impact de la voie intra osseuse, notamment en termes de mortalité, de complications tardives, ainsi que d'analyse coût/bénéfice de ce matériel.

From geriatric service to primary care: a retrospective pharmaceutical analysis of the medical prescription

Introduction The population of elderly persons is increasing andnegative outcomes due to polymedication are frequent. Discrepanciesin information about medication are frequent when older persons aretransitioning from hospital to home, increasing the risk of hospitalreadmission. The aims of this study were a) to determine discrepanciesin medical regimen indicated in two official discharge documents(DS = discharge summary, DP=discharge prescription); b) to characterizethe pharmacotherapy prescribed in older patients dischargedfrom a geriatric service.Materials & Methods Elderly patients (N=230) discharged from thegeriatric service (CHUV, Lausanne) over a 6-month period (January toJune 2009) were selected. Community pharmacists compared DS andDP to identify discrepancies including (a) drugs' name; (b) schedule ofadministration, dosage, frequency, prn prescription, treatment durationand galenic formulation. Beers' criteria were applied to identifypotentially inappropriate drugs and a descriptive analysis of drug costs,prescription profiles and generics were also performed.Results On average, patients were 82 ± 7 years old and stayed23.0 ± 11.6 days in the geriatric service. The delay between the datesof patient's discharge with the DP and the sending of the DS to hisgeneral physician averaged 14.0 ± 7.5 days (range 1-55). The DPhad an average of 10.0 ± 3.3 drugs (range 2-19). 77% of patients hadat least one discrepancy. A drug was missing on the DS in 57.8% ofpatients and 19.6% had a missing prn prescription. Among the 2312drugs prescribed, 3% belonged to Beers' list. They were prescribed to61 patients (26.5%), with 6 patients cumulating two Beers' potentiallyinappropriate drugs in their treatment. Analgesics (85% of thepatients), anticoagulants (80%), mineral supplements (77%), laxatives(52%) and antihypertensives (46%) were the drug classes most frequentlyprescribed. Mean costs of treatment as per DP was160.4 ± 179.4 Euros. Generic prescription represented more than 5%of the costs for 3 therapeutic classes (cholesterol-lowering agents(64%), antihypertensives (50%) and antidepressants (47%)).Discussion & Conclusion The high discrepancy rate between medicationlisted in the DP and the DS highlights a need for safetyimprovement. Potential benefits are expected from reinforced pharmacist-physician collaboration in transition from hospital to primarycare. In addition, even though Beers' criteria are questionable, thedrugs prescribed in this already fragile population, and the potentialopportunities of economical optimizations, are advocating thedevelopment and the scientific evaluation of a structured advancedcollaborative pharmacy practice service. This foresees improvedeffectiveness, safety and efficiency in the medication management ofelderly persons.

Safety of Prasugrel Loading Doses in Patients Pre-Loaded With Clopidogrel in the Setting of Primary Percutaneous Coronary Intervention: Results of a Nonrandomized Observational Study.

OBJECTIVES: The aim of this study was to assess the safety of the concurrent administration of a clopidogrel and prasugrel loading dose in patients undergoing primary percutaneous coronary intervention. BACKGROUND: Prasugrel is one of the preferred P2Y12 platelet receptor antagonists for ST-segment elevation myocardial infarction patients. The use of prasugrel was evaluated clinically in clopidogrel-naive patients. METHODS: Between September 2009 and October 2012, a total of 2,023 STEMI patients were enrolled in the COMFORTABLE (Comparison of Biomatrix Versus Gazelle in ST-Elevation Myocardial Infarction [STEMI]) and the SPUM-ACS (Inflammation and Acute Coronary Syndromes) studies. Patients receiving a prasugrel loading dose were divided into 2 groups: 1) clopidogrel and a subsequent prasugrel loading dose; and 2) a prasugrel loading dose. The primary safety endpoint was Bleeding Academic Research Consortium types 3 to 5 bleeding in hospital at 30 days. RESULTS: Of 2,023 patients undergoing primary percutaneous coronary intervention, 427 (21.1%) received clopidogrel and a subsequent prasugrel loading dose, 447 (22.1%) received a prasugrel loading dose alone, and the remaining received clopidogrel only. At 30 days, the primary safety endpoint was observed in 1.9% of those receiving clopidogrel and a subsequent prasugrel loading dose and 3.4% of those receiving a prasugrel loading dose alone (adjusted hazard ratio [HR]: 0.57; 95% confidence interval [CI]: 0.25 to 1.30, p = 0.18). The HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) bleeding score tended to be higher in prasugrel-treated patients (p = 0.076). The primary safety endpoint results, however, remained unchanged after adjustment for these differences (clopidogrel and a subsequent prasugrel loading dose vs. prasugrel only; HR: 0.54 [95% CI: 0.23 to 1.27], p = 0.16). No differences in the composite of cardiac death, myocardial infarction, or stroke were observed at 30 days (adjusted HR: 0.66, 95% CI: 0.27 to 1.62, p = 0.36). CONCLUSIONS: This observational, nonrandomized study of ST-segment elevation myocardial infarction patients suggests that the administration of a loading dose of prasugrel in patients pre-treated with a loading dose of clopidogrel is not associated with an excess of major bleeding events. (Comparison of Biomatrix Versus Gazelle in ST-Elevation Myocardial Infarction [STEMI] [COMFORTABLE]; NCT00962416; and Inflammation and Acute Coronary Syndromes [SPUM-ACS]; NCT01000701).

The construction of infant and primary school teachers’ identity during their initial professional development and first years of work (Identidoc). Summary, main results and contributions

Educators who are currently beginning their professional career at any level of the educationalsystem and who will likely have to work during the next thirty to forty years will be takingpart in the education of individuals who, with the permission of prophets and doomsayers,will live part of their lives in the 22nd century. That long but simple statement causes a bit ofvertigo as well as a good amount of reflection on the part of we educators who were trainedin the 20th century, are working in the 21st century, and are responsible for preparing peopleto build a tomorrow that is already today (Millán and Sancho, 1995). This is the starting pointof our research groups’ interest in exploring how men and women who have graduated fromteacher education programs with specializations in infant and primary education learn to beteachers, and how they establish and position themselves as teachers during their university studies and the first years of their professional life...

The construction of infant and primary school teachers’ identity during their initial professional development and first years of work (Identidoc). Summary, main results and contributions

Educators who are currently beginning their professional career at any level of the educationalsystem and who will likely have to work during the next thirty to forty years will be takingpart in the education of individuals who, with the permission of prophets and doomsayers,will live part of their lives in the 22nd century. That long but simple statement causes a bit ofvertigo as well as a good amount of reflection on the part of we educators who were trainedin the 20th century, are working in the 21st century, and are responsible for preparing peopleto build a tomorrow that is already today (Millán and Sancho, 1995). This is the starting pointof our research groups’ interest in exploring how men and women who have graduated fromteacher education programs with specializations in infant and primary education learn to beteachers, and how they establish and position themselves as teachers during their university studies and the first years of their professional life...

The construction of infant and primary school teachers’ identity during their initial professional development and first years of work (Identidoc). Summary, main results and contributions

Educators who are currently beginning their professional career at any level of the educationalsystem and who will likely have to work during the next thirty to forty years will be takingpart in the education of individuals who, with the permission of prophets and doomsayers,will live part of their lives in the 22nd century. That long but simple statement causes a bit ofvertigo as well as a good amount of reflection on the part of we educators who were trainedin the 20th century, are working in the 21st century, and are responsible for preparing peopleto build a tomorrow that is already today (Millán and Sancho, 1995). This is the starting pointof our research groups’ interest in exploring how men and women who have graduated fromteacher education programs with specializations in infant and primary education learn to beteachers, and how they establish and position themselves as teachers during their university studies and the first years of their professional life...

The construction of infant and primary school teachers’ identity during their initial professional development and first years of work (Identidoc). Summary, main results and contributions

Educators who are currently beginning their professional career at any level of the educationalsystem and who will likely have to work during the next thirty to forty years will be takingpart in the education of individuals who, with the permission of prophets and doomsayers,will live part of their lives in the 22nd century. That long but simple statement causes a bit ofvertigo as well as a good amount of reflection on the part of we educators who were trainedin the 20th century, are working in the 21st century, and are responsible for preparing peopleto build a tomorrow that is already today (Millán and Sancho, 1995). This is the starting pointof our research groups’ interest in exploring how men and women who have graduated fromteacher education programs with specializations in infant and primary education learn to beteachers, and how they establish and position themselves as teachers during their university studies and the first years of their professional life...

Un análisis optimista de la educación matemática en la formación de maestros de educación infantil = An optimistic analysis of mathematics education in training pre-school teachers

This article offers a panorama of mathematics training for future teachers at pre-school level in Spain. With this goal in mind, this article is structured infour sections: where we come from, where we are, where we’re going and where we want to go. It offers, in short, a brief analysis that shows the efforts made to ensure there is sufficient academic and scientific rigour in teachers’ studies at pre-school in general and students’ mathematics education in particular. Together with a description of the progress made in recent years, it also raises some questions for all those involved in training future teachers for this educational stage

Conditions for EFL learning and professional development : Finland-Swedish learner and teacher perspectives

Engelskans dominerande roll som internationellt språk och andra globaliseringstrender påverkar också Svenskfinland. Dessa trender påverkar i sin tur förutsättningarna för lärande och undervisning i engelska som främmande språk, det vill säga undervisningsmålen, de förväntade elev- och lärarroller, materialens ändamålsenlighet, lärares och elevers initiala erfarenheter av engelska och engelskspråkiga länder. Denna studie undersöker förutsättningarna för lärande och professionell utveckling i det svenskspråkiga nybörjarklassrummet i engelska som främmande språk. Utgångsläget för 351 nybörjare i engelska som främmande språk och 19 av deras lärare beskrivs och analyseras. Resultaten tyder på att engelska håller på att bli ett andraspråk snarare än ett traditionellt främmande språk för många unga elever. Dessa elever har också goda förutsättningar att lära sig engelska utanför skolan. Sådan var dock inte situationen för alla elever, vilket tyder på att det finns en anmärkningsvärd heterogenitet och även regional variation i det finlandssvenska klassrummet i engelska som främmande språk. Lärarresultaten tyder på att vissa lärare har klarat av att på ett konstruktivt sätt att tackla de förutsättningar de möter. Andra lärare uttrycker frustration över sin arbetssituation, läroplanen, undervisningsmaterialen och andra aktörer som kommer är av betydelse för skolmiljön. Studien påvisar att förutsättningarna för lärande och undervisning i engelska som främmande språk varierar i Svenskfinland. För att stöda elevers och lärares utveckling föreslås att dialogen mellan aktörer på olika nivå i samhället bör förbättras och systematiseras.

Integrating environmental education in primary school education in Tanzania : teachers’ perceptions and teaching practices

The study focuses on primary school teachers’ perceptions of environmental education, its integration into primary school education and teachers’ teaching practices in Tanzania. The thesis is based on empirical research. The theoretical underpinnings of the study are based on Palmer’s (1998) model of environmental education. According to the model, meaningful environmental education should include education about, in or through and for the environment. The study is supported by national and international literature from research done on environmental education and education for sustainable development and policy statements. The study is qualitative in nature, adopting phenomenography and phenomenology as points of departure. The empirical data was collected from four primary schools in Morogoro region in Tanzania. The study sample consisted of 31 primary school teachers. Data was collected through interviews and lesson observations. According to the results of the study, primary school teachers expressed variations in their perceptions of environmental education and education for sustainable development. Most of the teachers focused on the aspect of knowledge acquisition. According to Tanzanian education and training policy, environmental education has to be integrated into all subjects. Although there is environmental education in the primary school curriculum, it is not integrated on an equal footing in all subjects. Some subjects like science, social studies and geography have more environmental content than other subjects. Teachers claim that the approach used to integrate environmental education into the school curriculum was not favoured because many claimed that what is to be taught as environmental education in the various subjects is not shown clearly. As a result, many teachers suggested that to ensure that it is taught properly it should be included in the curriculum as an independent subject or as specific topics. The study revealed that teachers’ teaching practices in integrating environmental education varied from one subject to another. Although most of the teachers said that they used participatory methods, lesson observations showed that they limited themselves to question and answer and group discussion. However, the teachers faced a number of barriers in the teaching of environmental education, some of which include lack of teaching and learning resources, time and large class size. The role of teachers in the implementation of environmental education in developing an environmentally literate citizenry is of great significance. The responsibility of the government in developing a curriculum with clear goals and content, developing teachers’ capacity in the teaching of environmental education and provision of teaching and learning materials needs to be taken seriously by the government in educational plans and programs.

Mindfulness Practices and Children’s Emotional and Mental Well-Being: Activities to Build and Strengthen Everyday Resilience Adapted for Primary School Teachers

This project reviewed current research on mental health and Canadian children, and then examined the practice of mindfulness as a means of supporting well-being and circumventing the potential detrimental effects of mental health problems. By contextualizing these findings within the recently released educational vision of the Ontario Ministry of Education (2014), which identifies well-being as one of the core principles of education in Ontario, this project investigated how mindfulness-based practices can be brought into the primary grade classroom. The ultimate purpose of this project is the development of a handbook for Ontario teachers of students in grades 1 to 3 (ages 6 to 8). This resource was developed from a comprehensive literature review and provides educators with easy-to-follow activities to use in the classroom to encourage the development of resilience and emotional well-being through mindfulness. The handbook also includes additional information and resources regarding both mindfulness and mental health that may be helpful to teachers, students, and parents.

Pre-Attentive Segmentation in the Primary Visual Cortex

Stimuli outside classical receptive fields have been shown to exert significant influence over the activities of neurons in primary visual cortexWe propose that contextual influences are used for pre-attentive visual segmentation, in a new framework called segmentation without classification. This means that segmentation of an image into regions occurs without classification of features within a region or comparison of features between regions. This segmentation framework is simpler than previous computational approaches, making it implementable by V1 mechanisms, though higher leve l visual mechanisms are needed to refine its output. However, it easily handles a class of segmentation problems that are tricky in conventional methods. The cortex computes global region boundaries by detecting the breakdown of homogeneity or translation invariance in the input, using local intra-cortical interactions mediated by the horizontal connections. The difference between contextual influences near and far from region boundaries makes neural activities near region boundaries higher than elsewhere, making boundaries more salient for perceptual pop-out. This proposal is implemented in a biologically based model of V1, and demonstrated using examples of texture segmentation and figure-ground segregation. The model performs segmentation in exactly the same neural circuit that solves the dual problem of the enhancement of contours, as is suggested by experimental observations. Its behavior is compared with psychophysical and physiological data on segmentation, contour enhancement, and contextual influences. We discuss the implications of segmentation without classification and the predictions of our V1 model, and relate it to other phenomena such as asymmetry in visual search.

All about teaching English : a course for teachers of English : pre-school trough secondary.

Manual para la asignatura de Didáctica de la lengua inglesa I y II que se imparte en la mayoría de facultades de Educación, cuyas unidades se organizan del siguiente modo: objetivos, introducción, contenidos, ejercicios, en algunos casos un glosario y la bibliografía.

Teaching English : a handbook for primary and secondary school teachers.

Ofrece una introducción general a la enseñanza de la lengua inglesa en las escuelas de primaria y secundaria. Sitúa el plan de estudios de esta asignatura en el contexto de la alfabetización de toda la escuela y analiza, entre otras, cuestiones importantes: la planificación y dirección de la clase, el papel del teatro, de los medios de comunicación y de las tecnologías de la información y la comunicación y, también, el desarrollo personal y profesional de los docentes.