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En la actualidad, uno de los mayores retos educativos sigue siendo superar las dificultades que genera el aprendizaje matemático en el alumnado de Educación Primaria y Educación Secundaria. Recientemente, se ha incrementado la investigación sobre el aprendizaje y la cognición matemática debido a las consecuencias personales y sociales del fracaso enel aprendizaje. Una de las líneas de trabajo enfatiza la conveniencia de realizar intervenciones que incorporen los procesos cognitivos implicados en el aprendizaje de las matemáticas, y hagan uso de estrategias innovadoras como el método de cálculo Abierto Basado en Números (ABN). El presente estudio pretende analizar el impacto del programa formativo online para la implantación del método ABN en cursos altos de Educación Primaria y primer ciclo de Educación Secundaria Obligatoria. El proyecto se distribuye en cuatro fases: (1) Selección de escuelas; (2) Programa formativo online para docentes; (3) Estudio empírico para analizar la efectividad del método ABN; y (4) Transferencia de resultados y diseño de materiales y APP educativas matemáticas. Se presentan los resultados obtenidos en la primera etapa, con el objetivo de analizar el impacto del programa formativo y la incorporación de materiales manipulativos para diversos contenidos matemáticos. Los participantes del programa formativo pertenecen a centros educativos de la provincia de Cádiz y fueron seleccionados incidentalmente. La muestra está compuesta por 40 participantes (19 investigadores, 3 docentes expertos en ABN, 18 docentes y 3 estudiantes de máster en Educación Secundaria). Se presentan los resultados extraídos tras la formación del profesorado y las prácticas de aula llevadas a cabo, los cuales muestran la necesidad de formación del profesorado para la incorporación de dinámicas alternativas en los cursos altos de Educación Primaria. Se espera abrir nuevas líneas de investigación basadas en la implementación de programas y talleres para la aplicación de estrategias innovadoras en los centros educativos.

Introduction: In Multiple Sclerosis (MS), withdrawal from employment is a critical problem. This study explores relationships between disease characteristics, work difficulties, health -related quality of life, depression, and stigma and how these factors affect employment status. Methods: A multicenter, non -interventional, cross-sectional study was conducted in adults with relapsing -re- mitting MS (RRMS) and primary progressive MS (PPMS). Patient -reported questionnaires included: 23 -item Multiple Sclerosis Work Difficulties Questionnaire, 29 -item Multiple Sclerosis Impact Scale, Stigma Scale for Chronic Illness, and Beck Depression Inventory -Fast Screen. Results: A total of 199 individuals (mean age = 43.9 ? 10.5 years, 60.8% female, 86.4% with RRMS) parti- cipated in the study. Mean time from diagnosis was 9.6 ? 7.2 years and median Expanded Disability Status Scale score was 2.0 (interquartile range: 1.0 -3.5). Employment rate was 47.2% ( n = 94). Mean physical and psychological MSIS-29 impact sub -scores were 40.38 ? 17.1 and 20.24 ? 7.8, respectively. Forty patients (19.9%) had at least one SSCI-8 item with a score of 4 or 5, suggesting the presence of stigma often or always. Eighty-one patients (40.7%) were depressed and 25 (12.6%) had moderate -to -severe depression . Work diffi- culties were higher in those with worse functional status, a diagnosis of PPMS, and lower educational levels. Employed participants had lower perceptions of stigma and depressive symptoms than those not employed. Higher perceptions of stigma were also strongly linked to higher physical and psychological impact on health - related quality of life and greater work difficulties. Depressive symptoms were also strongly related to work - related problems. Conclusions: Work difficulties, stigma and poor quality of life are common in MS patients, even in a population with low physical disability. Evaluation of these dimensions in clinical practice would allow the development of targeted rehabilitation and specific work plans for MS employers.

Candidemia is a major cause of in-hospital mortality. Antifungal stewardship programme (AFSP) providing infectious diseases consultation (IDC) might improve the outcome. We evaluate the impact on candidemia mortality of IDC as part of AFSP restricting the use of all antifungals with exception of fluconazole. We retrospectively reviewed the charts of patients with documented candidemia in our hospital during the period 2012-2014 evaluating the impact of several variables on 30-days in-hospital mortality. We reviewed data on 276 patients with documented candidemia: 200 (72%) were treated without IDC and 76 (28%) with IDC. In the group without IDC, 52 patients (26%) received no antifungal therapy. Antifungals used for treating candidemia were (no IDC/IDC): azoles (74%/42%); echinocandins (0%/46%); liposomal and lipidic complex amphotericin B (0%/12%). The 30-day in-hospital mortality was respectively (no IDC/IDC) 37% vs. 20% (p = 0.011). The multivariate analysis confirmed IDC as independent factor protecting from death (OR 0.511, 95% CI 0.251-0.994; p = 0.046), together with fungemia due to non-albicans Candida (OR 0.565, 95% CI 0.327-0.977; p = 0.042). Age65 years was associated with a higher risk of death (OR 1.989, 95% CI 1.055-3.895; p = 0.038). The additional cost for the use of echinocandins driven by IDC in the study period was €207,000. IDC, as a part of a restrictive front-end antimicrobial stewardship programme (ASP), providing a timely right choice of antifungal therapy, increases the cost of antifungal drugs but might be a contributing protective factor from mortality due to candidemia. Efforts to increase the number of IDC in patients with candidemia seems to be warranted.

The aim of this paper is to analyse the use of anti-TNF drugs in current Italian practice, evaluate clinical responses to treatment, and identify possible predictors of negative response in patients with rheumatoid arthritis (RA).DOSE is a non-interventional, prospective study of patients with active RA treated for the first time with anti-TNF agents in 21 Italian hospitals. Demographic and clinical characteristics of patients, treatments and outcome measures were assessed. Outcome measures used were EULAR response, DAS28 remission and HAQ remission at 12 months. A stepwise logistic regression model was used to study the predictors of non-response.Of 299 RA patients (mean 53.8 ± 12.8 years, 76.1% female), DAS28 was5.1 in 60.5% of patients and HAQ was1 in 65.9%. Etanercept was the most prescribed anti-TNF. DMARDs were used in 77.6% of patients (methotrexate in 59.2%). Significant improvements in clinical and laboratory parameters were observed at 12 months. The proportion of patients classed as non-responders remained high, and varied according to assessment criteria. The main predictors independently and significantly associated with a high risk of non-response were: age and female gender for all outcome criteria; high DAS28 value for disease remission; and HAQ1 for disability remission.In Italian anti-TNF treatment for RA, age, gender, and high values of both disease activity and disability were predictors of non-response to first-line therapy with anti-TNF drugs. Future studies should consider optimal second-line therapies for RA patients who do not achieve remission to their first anti-TNF treatment.