Efficacy of two educational interventions about inhalation techniques in patients with chronic obstructive pulmonary disease (COPD). TECEPOC: study protocol for a partially randomized controlled trial (preference trial).

BACKGROUND Drugs for inhalation are the cornerstone of therapy in obstructive lung disease. We have observed that up to 75 % of patients do not perform a correct inhalation technique. The inability of patients to correctly use their inhaler device may be a direct consequence of insufficient or poor inhaler technique instruction. The objective of this study is to test the efficacy of two educational interventions to improve the inhalation techniques in patients with Chronic Obstructive Pulmonary Disease (COPD). METHODS This study uses both a multicenter patients´ preference trial and a comprehensive cohort design with 495 COPD-diagnosed patients selected by a non-probabilistic method of sampling from seven Primary Care Centers. The participants will be divided into two groups and five arms. The two groups are: 1) the patients´ preference group with two arms and 2) the randomized group with three arms. In the preference group, the two arms correspond to the two educational interventions (Intervention A and Intervention B) designed for this study. In the randomized group the three arms comprise: intervention A, intervention B and a control arm. Intervention A is written information (a leaflet describing the correct inhalation techniques). Intervention B is written information about inhalation techniques plus training by an instructor. Every patient in each group will be visited six times during the year of the study at health care center. DISCUSSION Our hypothesis is that the application of two educational interventions in patients with COPD who are treated with inhaled therapy will increase the number of patients who perform a correct inhalation technique by at least 25 %. We will evaluate the effectiveness of these interventions on patient inhalation technique improvement, considering that it will be adequate and feasible within the context of clinical practice.

Nova central elèctrica de transformació de l'aeroport de Girona-Costa Brava

Amb vista a una ampliació de l’aeroport Girona-Costa Brava, per poder donar un servei de qualitat a tots els passatgers, es decideix fer una nova central elèctrica de transformació. L’edifici de la central elèctrica ja està projectat, i l’objecte d’aquest projecte és dissenyar la instal·lació elèctrica de mitja tensió des de l’escomesa de la xarxa general fins les línies de sortida de mitja i baixa tensió

Effectiveness of two interventions based on improving patient-practitioner communication on diabetes self-management in patients with low educational level: study protocol of a clustered randomized trial in primary care.

BACKGROUND In the last decades the presence of social inequalities in diabetes care has been observed in multiple countries, including Spain. These inequalities have been at least partially attributed to differences in diabetes self-management behaviours. Communication problems during medical consultations occur more frequently to patients with a lower educational level. The purpose of this cluster randomized trial is to determine whether an intervention implemented in a General Surgery, based in improving patient-provider communication, results in a better diabetes self-management in patients with lower educational level. A secondary objective is to assess whether telephone reinforcement enhances the effect of such intervention. We report the design and implementation of this on-going study. METHODS/DESIGN The study is being conducted in a General Practice located in a deprived neighbourhood of Granada, Spain. Diabetic patients 18 years old or older with a low educational level and inadequate glycaemic control (HbA1c > 7%) were recruited. General Practitioners (GPs) were randomised to three groups: intervention A, intervention B and control group. GPs allocated to intervention groups A and B received training in communication skills and are providing graphic feedback about glycosylated haemoglobin levels. Patients whose GPs were allocated to group B are additionally receiving telephone reinforcement whereas patients from the control group are receiving usual care. The described interventions are being conducted during 7 consecutive medical visits which are scheduled every three months. The main outcome measure will be HbA1c; blood pressure, lipidemia, body mass index and waist circumference will be considered as secondary outcome measures. Statistical analysis to evaluate the effectiveness of the interventions will include multilevel regression analysis with three hierarchical levels: medical visit level, patient level and GP level. DISCUSSION The results of this study will provide new knowledge about possible strategies to promote a better diabetes self-management in a particularly vulnerable group. If effective, this low cost intervention will have the potential to be easily incorporated into routine clinical practice, contributing to decrease health inequalities in diabetic patients. TRIAL REGISTRATION Clinical Trials U.S. National Institutes of Health, NCT01849731.

Characteristics and effectiveness of diabetes self-management educational programs targeted to racial/ethnic minority groups: a systematic review, meta-analysis and meta-regression.

BACKGROUND It is not clear to what extent educational programs aimed at promoting diabetes self-management in ethnic minority groups are effective. The aim of this work was to systematically review the effectiveness of educational programs to promote the self-management of racial/ethnic minority groups with type 2 diabetes, and to identify programs' characteristics associated with greater success. METHODS We undertook a systematic literature review. Specific searches were designed and implemented for Medline, EMBASE, CINAHL, ISI Web of Knowledge, Scirus, Current Contents and nine additional sources (from inception to October 2012). We included experimental and quasi-experimental studies assessing the impact of educational programs targeted to racial/ethnic minority groups with type 2 diabetes. We only included interventions conducted in countries members of the OECD. Two reviewers independently screened citations. Structured forms were used to extract information on intervention characteristics, effectiveness, and cost-effectiveness. When possible, we conducted random-effects meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals. Two reviewers independently extracted all the information and critically appraised the studies. RESULTS We identified thirty-seven studies reporting on thirty-nine educational programs. Most of them were conducted in the US, with African American or Latino participants. Most programs obtained some benefits over standard care in improving diabetes knowledge, self-management behaviors and clinical outcomes. A meta-analysis of 20 randomized controlled trials (3,094 patients) indicated that the programs produced a reduction in glycated hemoglobin of -0.31% (95% CI -0.48% to -0.14%). Diabetes knowledge and self-management measures were too heterogeneous to pool. Meta-regressions showed larger reduction in glycated hemoglobin in individual and face to face delivered interventions, as well as in those involving peer educators, including cognitive reframing techniques, and a lower number of teaching methods. The long-term effects remain unknown and cost-effectiveness was rarely estimated. CONCLUSIONS Diabetes self-management educational programs targeted to racial/ethnic minority groups can produce a positive effect on diabetes knowledge and on self-management behavior, ultimately improving glycemic control. Future programs should take into account the key characteristics identified in this review.

Història urbana de Girona: el monar reial del Mercadal a Girona

De l'any 1015 consta l'existència del rec comtal, segons escriptura atorgada pel comte Ramon Borrell i per llur esposa, Ermessenda, que varen fer donació a la Seu de Santa Maria, el dia 19 de juny, de quatre mujades de terra situades prop del Mercadal iuxta urbem Gerundensis in ipso plano super ipsum Mercadalem. Les dites terres afrontaven de occiduo in ipso rege comitale i a migdia amb el riu Güell. Aquest fet permet considerar que el rec comtal feia possible, ja al segle XI, la instal·lació del Monar comtal amb llurs molins

Using a Parameterization of a Radiative Transfer Model to Build High-Resolution Maps of Typical Clear-Sky UV Index in Catalonia, Spain

To perform a climatic analysis of the annual UV index (UVI) variations in Catalonia, Spain (northeast of the Iberian Peninsula), a new simple parameterization scheme is presented based on a multilayer radiative transfer model. The parameterization performs fast UVI calculations for a wide range of cloudless and snow-free situations and can be applied anywhere. The following parameters are considered: solar zenith angle, total ozone column, altitude, aerosol optical depth, and single-scattering albedo. A sensitivity analysis is presented to justify this choice with special attention to aerosol information. Comparisons with the base model show good agreement, most of all for the most common cases, giving an absolute error within 0.2 in the UVI for a wide range of cases considered. Two tests are done to show the performance of the parameterization against UVI measurements. One uses data from a high-quality spectroradiometer from Lauder, New Zealand [45.04°S, 169.684°E, 370 m above mean sea level (MSL)], where there is a low presence of aerosols. The other uses data from a Robertson–Berger-type meter from Girona, Spain (41.97°N, 2.82°E, 100 m MSL), where there is more aerosol load and where it has been possible to study the effect of aerosol information on the model versus measurement comparison. The parameterization is applied to a climatic analysis of the annual UVI variation in Catalonia, showing the contributions of solar zenith angle, ozone, and aerosols. High-resolution seasonal maps of typical UV index values in Catalonia are presented

Girona entre l'Islam i Carlemany: una ciutat de frontera (759-801)

Tradicionalment s'ha considerat l'ocupació de Girona pels francs (any 785) com el moment "fundacional" de la ciutat medieval, en paral·lel a la consideració que ha merescut l'època de Carlemany (final del segle VIII i principi del IX) com una època formativa en la història de Catalunya. Però tenim raons per pensar que aquells moments no significaren un gran terrabastall enuna ciutat que, des de començament del segle VIII, jugava un paper polític i militar significatiu en els esdeveniments de l'anomenada Marca Superior, el territori musulmà proper a les terres del regne franc. Més endavant, un cop incorporada a l'imperi carolingi, Girona mantingué la seva condició de ciutat capital de frontera o marca, fins a la conquesta de Barcelona l'any 801. Volem historiar, en la mesura del possible, aquesta etapa d'uns quaranta anys -entre 759 i 801- quan la ciutat visqué en primera línia i, també, protagonitzà les vicissituds de l'enfrontament entre dos dels grans estats d'aquell moment: la monarquia franca dels carolingis i l'emirat omeia A'al-Andalús. Els moviments d'anada i tomada dels seus exèrcits van situar Girona en primera línia de combat en aquells anys, fins a la definitiva consolidació del poder franc a principis del segle IX

El Camí de Sant Jaume en la provincia de Girona

En primer lugar se identifican las distintas rutas del Camí de Sant Jaume en la provincia de Girona con el objetivo de determinar cuáles han sido las principales rutas que los peregrinos han utilizado para su peregrinación hacia Santiago de Compostela dentro de la provincia de Girona. En segundo lugar se establecen los elementos que determinan que un itinerario concreto esté comprendido en el Camino de Santiago para lo cual se analizan las rutas y se buscan los componentes que tienen una relación directa con la peregrinación a Santiago de Compostela, bien por ser elementos descriptivos del Santo, bien por ser elementos que a lo largo de la historia se han atribuido a los peregrinos que peregrina a Santiago de Compostela. En tercer lugar se analiza el recorrido del Camí de Sant Jaume elegido por la Generalitat de Catalunya, se examinan los servicios que ofrece y las carencias o insuficiencias que posee. Finalmente se establece la confección de propuestas de mejora y las acciones pertinentes para corregir las debilidades que en su caso puedan tener estos itinerarios

Les Espècies vegetals introduïdes d’ús ornamental als enjardinaments públics dels sectors de l’esquerra del Ter a la ciutat de Girona

Estudi de les plantes ornamentals conreades al sector esquerra de les ribes del Ter al seu pas per Girona, incidint en les espècies no autòctones i elaboració d’una cartografia digital dels arbres i arbusts de la zona de Sant Ponç (Girona)

Passive smoking in babies: The BIBE Study (Brief Intervention in babies. Effectiveness)

Background: There is evidence that exposure to passive smoking in general, and in babies in particular, is an important cause of morbimortality. Passive smoking is related to an increased risk of pediatric diseases such as sudden death syndrome, acute respiratory diseases, worsening of asthma, acute-chronic middle ear disease and slowing of lung growth.The objective of this article is to describe the BIBE study protocol. The BIBE study aims to determine the effectiveness of a brief intervention within the context of Primary Care, directed to mothers and fathers that smoke, in order to reduce the exposure of babies to passive smoking (ETS).Methods/DesignCluster randomized field trial (control and intervention group), multicentric and open. Subject: Fathers and/or mothers who are smokers and their babies (under 18 months) that attend pediatric services in Primary Care in Catalonia.The measurements will be taken at three points in time, in each of the fathers and/or mothers who respond to a questionnaire regarding their baby's clinical background and characteristics of the baby's exposure, together with variables related to the parents' tobacco consumption. A hair sample of the baby will be taken at the beginning of the study and at six months after the initial visit (biological determination of nicotine). The intervention group will apply a brief intervention in passive smoking after specific training and the control group will apply the habitual care.Discussion: Exposure to ETS is an avoidable factor related to infant morbimortality. Interventions to reduce exposure to ETS in babies are potentially beneficial for their health. The BIBE study evaluates an intervention to reduce exposure to ETS that takes advantage of pediatric visits. Interventions in the form of advice, conducted by pediatric professionals, are an excellent opportunity for prevention and protection of infants against the harmful effects of ETS.

Aportació al coneixement de la dinàmica fluvial en la conca del riu Onyar (Girona)

Two decay rates are distinguished in the discharge hydrograph of the Onyar River, using Maillet's formula. In this way, we can know which Kina of influence is made by geomorphology and rainfall distribution on fluvial processes

Anàlisi geomètrica del Diaclasat de les Guilleries en el sector de la Vall del Ter entre els embassaments del Pasteral i Susqueda (Girona)

The Guilleries are a small and mountainous area located in the north-westem part of the Catalonian Coastal Ranges where metamorphic and igneous Paleozoic rocks are exposed. After the main hercynian folding this area was affected by a brittle deformation that is mainly manifested by the intrusion of a very large number of dykes of granodiorite and the development of a complex joint system. Trends of dykes indicate that their intrusion was related to a SE-NW extension, whose estimated value is 40% on an average. This extension seems to stand, although without any associated igneous event, with the development of NE-SW directed joints which make the main set. Five families more were developed later, onegently-dipping and fou upright; the latter trending roughly SE-NW, ENE-WSW, ESE-WNW and N-S. AU the joint sets appear in the metasedimentary Paleozoic rocks and in the hercynian intrusive bodies. Concerning the ages, joints that belong to the NE-SW and SE-NW directed sets and also those slightly dipping have been attributed to the late-hercynian times and all the other are considered to be later

Característiques geomorfològiques de la Pedralta (Baix Empordà, Girona)

Descripció de les característiques geomorfològiques de La Pedralta, entre els municipis de Santa Cristina d'Aro i de Sant Feliu de Guíxols

Aportaciones al conocimiento de la geología de Bac Grillera (prepirineo, Girona)

The Bac Grillera nappe (Prepirenean of Girona) shows a stratigraphic section composed of two unconformi ty-bounded units. The lower unit is composed by rethian (marly limestones) and liassic (brechoid marly limestones and limestones). The upper unit (sandstones and marly limestones) belongs to the upper Cretaceous (Campanian)

Las formas graníticas de los macizos de les Gavarres i de Begur (Girona)

In the present paper the granite landforms of the Les Gavarres and Begur massifs (Girona) are described. Also the relationship between this landforms and the lithology are analysed