Search

Background Osteoarthritis (OA) is a health condition sensitive to patient’s preferences and values regarding the benefits and risks of the different treatment options. In this sense, patient decision aids (PtDA) can play an important role in helping patients to incorporate their values, needs, and preferences into the decision-making process, thus improving person-centered care. Previous research has focused almost exclusively on knee OA, and therefore, the aim of this study is to develop and evaluate the effectiveness of a PtDA for patients with hip OA. Methods The general design consists of two phases: (1) design a web-based PtDA for patients with hip OA, following the recommended procedures: systematic review of safety/effectiveness of treatments, and an iterative process of development with the help of an Advisory Committee composed of health professionals and patients, and (2) to evaluate the impact of the PtDA on hip OA patients’ decision-making process related with their treatment. For that aim, a multicenter randomized controlled trial will be carried out with 124 patients with hip OA in Tenerife (Spain) comparing intervention or usual care. Discussion PtDAs have been recommended as a useful and effective resource for improving PCC in many health conditions. The intervention is intended to empower patients by fostering their active participation during the decision-making process about their treatment and by ensuring they make informed decisions congruent with their values and preferences. This study will contribute to the scientific knowledge about effectiveness of PtDAs in hip OA, in order to improve the quality of health care offered to these patients. Trial registration ClinicalTrials.gov NCT04241978. Registered on 24 January 2020.

In Spain, there is not a national strategy to promote shared decision making (SDM) in clinical practice, and it is still not a requisite for improving the quality of health services, in either the legal norms or professionals' educational curricula. However, several national strategies in specific health areas increasingly include the principles of person centred care (PCC) and SDM into their objectives, promoting patients' empowerment and activation. Furthermore, several institutions continue to develop Patient Decision Aids (PtDAs) and other resources to facilitate patients' involvement in their own care; training programs for professionals; links between PtDAs and clinical practice guidelines; as well as interventional studies assessing the impact of PCC and SDM interventions in clinical practice. Initiatives to involve patients in health research design and health technology assessment are also being developed. We describe an update of the current state of research, policy and implementation of SDM after five years of substantial advances in Spain. Many challenges remain regarding national and regional policies on PCC and SDM, implementation of SDM in real practice and educational curricula, development of quality indicators and evaluation procedures.

Background: Meditation is defined as a form of cognitive training that aims to improve attentional and emotional self-regulation. This systematic review aims to evaluate the available scientific evidence on the effectiveness and safety of mantra-based meditation techniques (MBM), in comparison to passive or active controls, or other active treatment, for the management of mental health symptoms. Methods: MEDLINE, EMBASE, Cochrane Library, and PsycINFO databases were consulted up to April 2021. Randomised controlled trials regarding meditation techniques mainly based on the repetition of mantras, such as transcendental meditation or others, were included. Results: MBM, compared to control conditions, was found to produce significant small-to-moderate effect sizes in the reduction of anxiety (g = −0.46, IC95%: −0.60, −0.32; I2 = 33%), depression (g = −0.33, 95% CI: −0.48, −0.19; I2 = 12%), stress (g = −0.45, 95% CI: −0.65, −0.24; I2 = 46%), post-traumatic stress (g = −0.59, 95% CI: −0.79, −0.38; I2 = 0%), and mental health-related quality of life (g = 0.32, 95% CI: 0.15, 0.49; I2 = 0%). Conclusions: MBM appears to produce small-to-moderate significant reductions in mental health; however, this evidence is weakened by the risk of study bias and the paucity of studies with psychiatric samples and long-term follow-up.

Background: Digital health literacy (DHL) increases the self-efficacy and empowerment of pregnant and lactating women (PLW) in using the Internet for health issues. The European project IC-Health aimed to improve DHL among PLW, through the co-creation of Massive Open Online Courses (MOOCs). Methods: The co-creation of the MOOCs included focus groups and the creation of communities of practice (CoPs) with PLW and healthcare professionals aimed to co-design the MOOCs. The quantitative measures of MOOCs’ acceptability, experience in the co-creation process and increase in DHL (dimensions of finding, understanding and appraisal) were assessed. Results: 17 PLW participated in focus groups, 113 participants were included in CoPs and 68 participants evaluated the acceptability of MOOCs. A total of 6 MOOCs aimed at improving PLW’s DHL were co-designed. There was a significant improvement in self-perceived DHL after using MOOCs (p-value < 0.001). The acceptability of MOOCs and co-creation experience were positively valued. Conclusions: The preliminary results of the quantitative assessment showed a higher self-perceived DHL after the IC-Health MOOCs. These results suggest that IC-Health MOOCs and the co-creation methodology appear to be a viable process to carry out an intervention aimed to improve DHL levels in European PLW.

Background: Neurological disorders are the leading cause of disability and the second leading cause of death worldwide. Teleneurology (TN) allows neurology to be applied when the doctor and patient are not present in the same place, and sometimes not at the same time. In February 2021, the Spanish Ministry of Health requested a health technology assessment report on the implementation of TN as a complement to face-to-face neurological care. Methods: A scoping review was conducted to answer the question on the ethical, legal, social, organisational, patient (ELSI) and environmental impact of TN. The assessment of these aspects was carried out by adapting the EUnetHTA Core Model 3.0 framework, the criteria established by the Spanish Network of Health Technology Assessment Agencies and the analysis criteria of the European Validate (VALues In Doing Assessments of healthcare TEchnologies) project. Key stakeholders were invited to discuss their concerns about TN in an online meeting. Subsequently, the following electronic databases were consulted from 2016 to 10 June 2021: MEDLINE and EMBASE. Results: 79 studies met the inclusion criteria. This scoping review includes 37 studies related to acceptability and equity, 15 studies developed during COVID and 1 study on environmental aspects. Overall, the reported results reaffirm the necessary complementarity of TN with the usual face-to-face care. Conclusions: This need for complementarity relates to factors such as acceptability, feasibility, risk of dehumanisation and aspects related to privacy and the confidentiality of sensitive data.

El desarrollo de esta parte de la investigación permite la identificación de los beneficios tributarios establecidos en el Código de Rentas del Municipio de Circasia, reglamentado a través de los Acuerdos 024 de 2014 y 001 de 2015, dentro de los cuales se destacan las exenciones, exclusiones, tasas y bases especiales en determinados tributos; la clasificación de las Pymes del Municipio de acuerdo con las actividades económicas y las normas que las regulan, tipificando el sector empresarial al que pertenecen, la personería jurídica mediante la cual se constituyeron y su posicionamiento con respecto a las demás medianas y pequeñas empresas coexistentes en la región; y por último, el análisis de la aplicabilidad de los beneficios tributarios por parte de las Pymes que están localizadas en el municipio de Circasia, Departamento del Quindío, entre los años gravables 2015 y 2020. La investigación se realiza bajo el método descriptivo utilizando un enfoque mixto, considerando una parte cualitativa dado que existe una referenciación conceptual, teórica y documental; y otra parte cuantitativa, por el uso de métodos estadísticos y tabulación de datos para la presentación de los resultados; además se utiliza como instrumento de recolección de la información una encuesta (32 preguntas) estructurada por secciones de acuerdo con el tipo de beneficio tributario, que le fue entregada a la población empresarial objetivo, permitiendo a través de su aplicación obtener datos relevantes, como la limitada acción de la administración en torno a difundir información en cuanto a los beneficios tributarios existentes en el Código de Rentas, el significativo aprovechamiento de parte de las entidades sobre los beneficios que incentivan el pronto pago de algunos impuestos, a la vez que se expusieron cuestiones como los beneficios no aprovechables, dado su restringido público objetivo, así como también la gran utilidad que presentan los beneficios como herramienta del Estado a la hora de incentivar el desarrollo económico, generar empleo, subsanar la carga impositiva y permitirle sobrellevar algunas de las diferentes problemáticas que tienen las empresas en el ejercicio de su actividad, siempre que los incentivos estén diseñados de manera que sean aprovechables y se dé la aplicación de los mismos por parte de las sociedades.

IntroductionAromatherapy is the field of herbal medicine that uses essential oils distilled from flowers, roots, and herbs and other plant compounds to promote physical and psychological well-being. Essential oils are absorbed into the body in different ways, with the inhaled and topical routes being the most widely used. The aim of this review was to critically evaluate and synthesize the available scientific evidence on the efficacy and safety of aromatherapy for the management of any therapeutic indication. This report was requested by the Spanish Ministries of Health and Science and Innovation.MethodsAn overview of systematic reviews (SRs) was performed. The MEDLINE, Embase, CINAHL, and PsycINFO databases were searched for literature published from January 2006 to August 2021. SRs reporting the efficacy and safety of aromatherapy were included. We applied no restrictions in terms of administration route or essential oil used. Two reviewers independently performed screening and selection, data extraction, and quality assessment.ResultsWe included 74 SRs covering a wide variety of populations and settings. The most reported outcome was anxiety, followed by pain, and the most commonly used essential oil was lavender. Fifteen SRs reported mild adverse events with aromatherapy. Only 11 SRs assessed the certainty of evidence using the GRADE approach. Aromatherapy reduced heart rate and likely reduces anxiety and breathing rate in patients with cardiovascular diseases. Aromatherapy probably also reduces pain in women with primary dysmenorrhea. Additionally, it may reduce blood pressure, acute pain, subjective stress, and the need for antiemetic drugs after surgical procedures. However, the evidence was very uncertain regarding the effect of essential oils on anxiety, pain, and quality of life in patients with cancer, anxiety and pain after a caesarean section, and dental anxiety.ConclusionsAromatherapy may be useful for managing psychological and physical symptoms in different settings. However, the conclusions of this review are not definitive because of the moderate to high risk of bias in many of the primary studies included in the SRs.

IntroductionDiabetes mellitus (DM) is one of the most frequent metabolic complications associated with pregnancy, affecting both the prognosis of the pregnant woman and the newborn. Pregestational DM type 1 (T1DM) and type 2 (T2DM) and gestational DM (GDM) are associated with an increased risk of pregnancy complications such as miscarriage, fetal malformations, macrosomia, preeclampsia, and neonatal hypoglycemia, among others. The aim of this review was to evaluate the efficacy and safety of using the Dexcom G6 device (Dexcom, Co., USA) to continuously self-monitor blood glucose levels during pregnancy. This report was requested by the Spanish Ministry of Health.MethodsWe systematically searched for articles published to July 2021 in the MEDLINE, Embase, and Web of Science databases. We included experimental and observational primary studies addressing the safety, efficacy, and cost effectiveness of the Dexcom G6 device for gestational and pregestational diabetes.ResultsTwo non-comparative prospective studies were identified. One study of 25 pregnant women with T1DM, which evaluated glycemic control and complications during pregnancy and postpartum, reported stable hemoglobin A1c levels during gestation in women using the Dexcom G6 device. The percentage of time spent in the therapeutic glucose range (63 to 140 mg/dL) was 59 percent; 38 percent was in the hyperglycemic range and 3 percent was in the hypoglycemic range. Although some patients reported mild erythematous and edematous reactions to the sensor, no moderate or severe reactions or infections occurred at the sensor insertion site. The other study in pregnant women with T1DM (n=20), T2DM (n=3), or GDM (n=9) showed adequate accuracy of the Dexcom G6 device, compared with the reference method, especially when the sensor is placed on the arm.ConclusionsRandomized controlled trials are required to assess the effectiveness and safety of the Dexcom G6 device in maintaining adequate glucose control during pregnancy in women with DM. Studies are also needed to compare the Dexcom G6 device with conventional capillary blood glucose self-monitoring or other monitoring methods. No cost-effectiveness studies have been conducted for the Dexcom G6 device in this patient population.

IntroductionTelemedicine strategies have been broadly introducing in health services during the COVID-19 pandemic, including in care of neurological diseases.MethodsA rapid realist review was conducted using EUnetHTAs Core Model 3.0 and GRADE evidence to decision frameworks were used as frameworks to describe the ethical, legal, organizational, social and patient aspects (ELSI+) related to the use of teleneurology (TN) A scoping multistakeholder meeting helped defined the scope and research questions of the assessment. Patient representatives, clinicians, scientific society representatives with relevant experience in TN were invited and participated. Industry representatives were also present. Systematic searches for ethical, legal, organizational, social and patients related aspects were conducted. Additional manual searches contributed to contextualize these dimensions in the Spanish context. A narrative synthesis was undertaken.ResultsMain results of the assessment of the ELSI+ aspects of TN were described. TN applications are diverse depending on the condition, objective of care and technology used. The implementation of TN lacks specific legal frameworks which implies legal uncertainty. TN may increase geographical accessibility to neurological care in remote areas and by reducing difficult commuting to specialized care centers. Nevertheless, accessibility is challenged by reduced access to technology, the digital divide, lack of health literacy or technologies not adapted to functional diversity. Therefore, equity is not guaranteed if it is offered as a non-voluntary basis or with no support. TN tends to be accepted by patients and carers if it has enough quality, saves travelling time and costs and does not dehumanize care as it is perceived as more flexible and convenient. Quality of TN needs an interdisciplinary team with skills to coordinate organizational aspects of the implementation which include among others, the planification of the support to patients and carers before, during and after the consultation. Health professionals may also need to learn adapted communicational and technological skills.ConclusionsThe implementation of TN poses many ethical, legal, organizational, social or patient-centered challenges.

IntroductionLong-term cocaine use is associated with a wide range of cognitive deficits and neuropsychiatric pathologies. Repetitive transcranial magnetic stimulation (rTMS) is an emerging therapeutic strategy that stimulates the prefrontal cortex and may improve cognitive inhibitory control and decision-making. This systematic review aimed to evaluate and synthesize evidence on the safety, effectiveness, and cost effectiveness of rTMS for the treatment of cocaine addiction.MethodsA systematic review of the literature was carried out. The following electronic databases were searched to identify relevant studies published from inception to October 2020: MEDLINE, Embase, CINAHL, PsycINFO, the Cochrane Central Register of Controlled Trials, and Web of Science. Randomized controlled trials (RCTs), non-randomized controlled trials (nRCTs), case series studies, and full economic evaluations were included.ResultsA total of 12 relevant studies were identified, which included five RCTs, one nRCTs, and six case series studies. None of the studies reported data on cost effectiveness. The results indicated that rTMS reduces cocaine cravings and the number of doses consumed. No serious adverse effects were observed.ConclusionsThe ability to modulate the craving for cocaine in a specific way with non-invasive brain stimulation techniques, such as rTMS, could be a new adjunct to the behavioral treatment of addiction, especially for cocaine use where there is currently no approved pharmacological treatment. Despite the low quality of the included studies, preliminary results indicate that rTMS may reduce cocaine use and cravings. In any case, since this effect is considered moderate, future studies with larger sample sizes and longer follow up are required.

Identificar el efecto de una intervención psicopedagógica relacionada con la potencialización de la inteligencia emocional en estudiantes del programa licenciatura en educación infantil de octavo y décimo semestre de la Corporación Universitaria Minuto de Dios de la regional Buga-Valle. Temáticas como la inteligencia emocional han sido ignoradas en la educación tradicional que ha sido planteada desde objetivos orientados a impartir normas básicas de urbanidad, ortografía y otros requerimientos de la sociedad industrializada, sin embargo, en la actualidad han surgido pedagogías dirigidas a rediseñar el abordaje académico desde la cientificidad, direccionándose hacia contenidos emocionales, trascendiendo de las esperanzas de aprender contenidos y permitiendo a los alumnos vivir en sociedades complejas. Con esta idea en mente, se realizó la presente investigación dirigida al objetivo de identificar el efecto de una intervención psicopedagógica relacionada con la potencialización de la inteligencia emocional en estudiantes del programa licenciatura en educación infantil de octavo y décimo semestre de la Corporación Universitaria Minuto de Dios de la regional Buga-Valle, intentando responder al cuestionamiento de cómo implementar una intervención psicopedagógica para mejorar las habilidades emocionales de los estudiantes anteriormente mencionados.

Background Colorectal cancer (CRC) screening has shown to reduce incidence and mortality rates, and therefore is widely recommended for people above 50 years-old. However, despite the implementation of population-based screening programs in several countries, uptake rates are still low. Decision aids (DAs) may help patients to make informed decisions about CRC screening. Methods We performed a randomized controlled trial to assess the effectiveness of a DA developed to promote CRC screening, with patients from two primary care centers in Spain who never had underwent CRC screening. Contrary to center B (n = 24), Center A (n = 83) attended patients from an area where the population-based screening program was not implemented at that moment. Outcome measures were decisional conflict, knowledge of the disease and available screening options, intention to uptake the test, and concordance between patients’ goals/concerns and intention. Results In center A, there were significant differences favoring the DA in decisional conflict (p

BACKGROUND Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources—that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs). OBJECTIVE We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs. METHODS The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed. RESULTS A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P CONCLUSIONS Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population.

IntroductionAbout 70 percent of metastatic breast, lung, and prostate cancers affect the bones. When this phase of the disease affects the spine, the mobility and quality of life of patients are severely impaired. Radiofrequency ablation (RFA) has become a feasible option in the palliative treatment of vertebral metastases due to its minimal invasiveness and short procedure time. This health technology assessment report aimed to identify, evaluate, and synthesize evidence on the safety, effectiveness, and cost effectiveness of RFA for vertebral metastases.MethodsA systematic search was conducted to identify literature published from December 2016 to July 2019 in the following databases: Medline, Embase, the Cochrane Library, and the Centre for Reviews and Dissemination. Systematic reviews, randomized and non-randomized controlled trials, and case series studies evaluating the efficacy and safety of RFA in patients with vertebral metastases were included.ResultsSixteen studies were included: two systematic reviews, 13 case series studies, and one comparative study. None of the systematic reviews identified any randomized controlled trials. Of the 14 included primary studies, 10 evaluated RFA in combination with vertebroplasty, three evaluated RFA in combination with kyphoplasty, and one study evaluated a combination of RFA and radiation therapy. In all cases, the evaluated patients had different types of cancer (e.g., breast, lung, or liver). The follow-up periods varied between the studies from one day to 12 months. The most commonly used RFA devices were the STAR™ Tumour Ablation System (Merit Medical Systems) and the OsteoCool™ Radiofrequency Ablation System (Medtronic).ConclusionsRFA reduces pain, improves functional capacity, and provides greater local control of disease, potentially giving patients a higher quality of life, even in the context of metastatic disease. Although there is evidence on the safety and efficacy of this technology for the palliative treatment of vertebral metastases, more studies with higher methodological quality are needed. There were no studies available on the cost effectiveness of RFA for this indication.

IntroductionThe PapSEEK test is an emerging minimally invasive technique in which samples are collected from the endocervical or intrauterine cavity with the Papanicolaou (Pap) brush or the Tao brush to detect somatic mutations or aneuploidies indicating the presence of endometrial or ovarian cancer.MethodsWe systematically searched for articles published up to October 2020 in the following electronic databases: Medline, Embase, the Cochrane Library, and the Centre for Reviews and Dissemination. We included experimental studies, observational primary studies, and cost-effectiveness studies evaluating the safety, effectiveness, and cost effectiveness of the PapSEEK test for the early detection of ovarian or endometrial cancer. Relevant outcomes included sensitivity, specificity, the coefficient of variation, re-test rates, the incremental cost-effectiveness ratio, the incremental cost-utility ratio, and the cost of each alternative.ResultsA single relevant retrospective study was identified. In this study, samples from women with endometrial cancer (n = 656) and ovarian cancer (n = 254) were collected with the Pap brush and Tao brush and compared with samples from healthy women (n = 1,002). The diagnostic validity for somatic mutation or aneuploidies obtained with a Pap brush had a sensitivity of 81% for endometrial cancer and 33% for ovarian cancer, and a specificity of 99% for both conditions. When samples were collected from the intrauterine cavity with a Tao brush, the sensitivity increased to 93% for endometrial cancer and to 45% for ovarian cancer. The sensitivity of the PapSEEK test increased only for ovarian cancer when plasma samples to detect circulating tumor DNA were collected in addition to Pap smear samples. This strategy provided a diagnostic validity of 43%, which was higher in late-stage ovarian cancer (56% versus 35%), and a specificity of 100%.ConclusionsProspectively designed studies are required to assess the safety and effectiveness of the PapSEEK test in screening settings, as well as studies comparing the technology with conventional screening methods. No cost-effectiveness studies have been conducted for the PapSEEK test.

Summary Objective To assess the effectiveness of a Patient Decision Aid (PtDA) for knee osteoarthritis. Method Randomized controlled trial, in which 193 patients were allocated to the PtDA or usual care. Outcome measures were the Decisional Conflict Scale (DCS), knowledge of osteoarthritis and arthroplasty, satisfaction with the decision-making process (SDMP) and treatment preference, assessed immediately after the intervention. At 6 months, the same measures were applied in non-operated patients, whereas those who underwent arthroplasty completed the SDMP and the Decisional Regret Scale (DRS). Results The PtDA produced a significant immediate improvement of decisional conflict (MD = −11.65, 95%CI: −14.93, −8.37), objective knowledge (MD = 10.37, 99%IC: 3.15, 17.70) and satisfaction (MD = 6.77, 99%CI: 1.19, 12.34), and a different distribution of preferences (χ 2 = 8.74, p = 0.033). Patients with less than secondary education obtained a stronger effect on decisional conflict (p = 0.015 for the interaction) but weaker for knowledge (p = 0.051). At 6 months, there were no significant differences in any variable, including the rate of total knee replacement. Operated patients showed a low level of regret, which was not affected by the intervention. Conclusion The PtDA is effective immediately after its application, but it shows no effects in the medium-term. Future research should investigate which subgroups of patients could benefit more from this intervention, as well as the longitudinal evolution of decision-related psychological variables.

Desde sus inicios, el programa ha trabajado bajo el objetivo principal de convertirse en uno de los mejores Programas de Formación Docente en Lengua Inglesa de la región; trabajando principalmente en el nivel del idioma, la formación pedagógica y las metodologías de enseñanza de lenguas extranjeras que respondan a las necesidades de nuestros contextos en Colombia y el mundo. Esto es lo que podemos llamar el período "del nacimiento a la madurez". Después de una renovación del programa y a la luz de las experiencias anteriores, las prácticas emergentes y algunos requerimientos del Ministerio de Educación, se inicia un nuevo período, en el que los docentes y directivos se comprometieron a una autorreflexión sobre lo investigado hasta el momento. Por lo tanto, este libro está dedicado únicamente al programa de lengua inglesa donde condensamos los trabajos presentados por los alumnos en colaboración con profesores, mostrando el compromiso que tienen los estudiantes y los profesores con la región, a su desarrollo personal y profesional, así como así como a los objetos de interés en el ámbito de las lenguas extranjeras.

IntroductionPatients with generalised anxiety disorder (GAD) have concerns and needs about their health and the healthcare they receive. Patient decision aids (PtDAs) are tools that assist patients in making health decisions, when there is uncertainty about treatment choice, incorporating their personal preferences and values about the available treatment options. PtDAs can improve shared decision-making and lead to better treatment outcomes. The aim of this study is to evaluate the effectiveness of a web-based PtDA for patients with GAD in primary care (PC).Methods and analysisThe general study design is comprised of two stages: (1) development of a web-based PtDA for patients with GAD, derived from an evidence-based Clinical Practice Guideline and (2) assessment of the effectiveness of the PtDA in a randomised controlled trial (RCT) design, in PC centres in Tenerife (Spain). This RCT will be carried out with 124 patients with GAD, comparing the PtDA to a fact sheet with general information on mental health. Patients will review the PtDA in one session accompanied by a researcher. Post-intervention measures will be administered immediately after the intervention and at 3-month follow-up. The primary outcome will be decisional conflict. Secondary outcomes will include knowledge about GAD and its treatment, treatment preference, concordance between treatment preference and choice, and decision quality (knowledge ≥60% and concordant decision).Ethics and disseminationThe project received ethics approval from the local committee at Nuestra Señora de la Candelaria (HUNSC) University Hospital in Santa Cruz de Tenerife (code: CHUNSC_2019_58). Informed consent will be obtained from each participant before randomisation. Results from the trial will be submitted for publication in international peer-reviewed scientific journals and will be disseminated through workshops and local and international conferences.Trial registration numberNCT04364958.

Objective To identify the information needs and research priorities that women with breast cancer (BC), their families and BC experts perceive on the fertility preservation. Methods We conducted two Delphi-based studies through three online rounds. The first was aimed to identify information and research needs; the second one to assess the importance of those needs and the third one to obtain consensus, defined as an interquartile range ≤2. Results The participation rate was 76.2% in study 1 and 53.7% in study 2. The most important information needs were the referral protocol, pregnancy options for women with BC, side effects of tamoxifen and menopause as a consequence of treatment. The most important research priorities were the participation of different health professionals to provide oncofertility information, referral protocols and efficacy and safety of FP options. Conclusion Information about fertility preservation in the context of BC and different ways to get pregnant, considering risks and benefits, has emerged as an unmet need for patients and careers. The need for a participatory and coordinated approach to the provision of information on oncofertility has been agreed. Other research needs are described in an attempt to focus future research in the most necessary areas.

A partir de la transformación del Covid-19 en una pandemia mundial, se ha hecho evidente que el accionar de los estados ha cobrado una relevancia superior en la determinación de la vida social de la mayoría de las naciones. Ahora bien, lo que no resulta para nada evidente es por qué se está produciendo este incremento de estatalidad social, qué características adopta en la actualidad, qué impacto social está teniendo y como podría evolucionar de aquí en adelante. En este trabajo, sostendré que la renovada centralidad del estado es principalmente el producto de un flujo masivo de delegación de poder coactivo y regulador hacia los estados y líderes protectores, propiciado por un movimiento mundial de auto-conservación social . Sin esa transferencia excepcional de poder social, los estados no tendrían capacidad de maniobra para desplegar las políticas de macro-protección que venimos observando en los últimos meses. publishedVersion Fil: Torres Castaño, Esteban. Universidad Nacional de Córdoba. Facultad de Ciencias Sociales; Argentina. Fil: Torres Castaño, Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; Argentina.

IntroductionVirtual Communities of Practice (VCoP) or knowledge-sharing virtual communities offer ubiquitous access to information and exchange possibilities for people in similar situations, which might be especially valuable for the self-management of patients with chronic diseases. In view of the scarce evidence on the clinical and economic impact of these interventions on chronic conditions, we aim to evaluate the effectiveness and cost-effectiveness of a VCoP in the improvement of the activation and other patient empowerment measures in patients with ischaemic heart disease (IHD).Methods and analysisA pragmatic randomised controlled trial will be performed in Catalonia, Madrid and Canary Islands, Spain. Two hundred and fifty patients with a recent diagnosis of IHD attending the participating centres will be selected and randomised to the intervention or control group. The intervention group will be offered participation for 12 months in a VCoP based on a gamified web 2.0 platform where there is interaction with other patients and a multidisciplinary professional team. Intervention and control groups will receive usual care. The primary outcome will be measured with the Patient Activation Measure questionnaire at baseline, 6, 12 and 18 months. Secondary outcomes will include: clinical variables; knowledge (Questionnaire of Cardiovascular Risk Factors), attitudes (Self-efficacy Managing Chronic Disease Scale), adherence to the Mediterranean diet (Mediterranean Diet Questionnaire), level of physical activity (International Physical Activity Questionnaire), depression (Patient Health Questionnaire), anxiety (Hospital Anxiety Scale-A), medication adherence (Adherence to Refill Medication Scale), quality of life (EQ-5D-5L) and health resources use. Data will be collected from self-reported questionnaires and electronic medical records.Ethics and disseminationThe trial was approved by Clinical Research Ethics Committee of Gregorio Marañón University Hospital in Madrid, Nuestra Señora de Candelaria University Hospital in Santa Cruz de Tenerife and IDIAP Jordi Gol in Barcelona. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, local/international conferences.Trial registration numberClinicalTrials.gov Registry (NCT03959631). Pre-results.

Digital health literacy (DHL) is the ability to search, understand and evaluate information from digital media and apply that knowledge to solve health problems. However, currently many citizens have not developed these skills, and this compromises not only the self-management of their health, but the possibility that health services are socially sustainable. The objective of this article was to present the objectives, activities and results of the IC-Health project whose objective was to develop a series of massive open online courses (MOOCs) to improve the DHL skills of European citizens. An exploratory report on DHL’s current evidence was developed. Furthermore, a survey, focus groups and group interviews were conducted to determine DHL levels and the needs of population cohorts (children, adolescents, pregnant and lactating women, the elderly, and people affected by type 1 and type 2 diabetes). A participation strategy with end users was designed through a community of practice for the creation of MOOCs with the seven European countries that participated in the consortium. Thirty-five MOOCs were developed in eight different languages and a descriptive and exploratory assessment of MOOCs was conducted with new participants. This first evaluation indicated that MOOCs can be an effective educational resource for DHL and a facilitator of shared decision-making processes. The process of co-creation of MOOCs, the components, the challenges and the opportunities identified in this European project could be useful for other developers of MOOCs who want to co-create interventions with beneficiaries in similar settings. Further longer-term actions are still needed to improve citizens’ DHL.

A crise sociossanitária gerada pela proliferação da Covid19 está produzindo uma transformação do estado na sociedade mundial, recriando duas formas inovadoras: a do estado protetor e a do estado agressor. Neste trabalho, sustentarei que essa transformação é principalmente o produto de um fluxo massivo de delegação do poder social provocado por um movimento mundial de autopreservação social. A expansão da função protetora do estado, por sua vez, está coproduzindo em tempo recorde uma nova legitimidade política de exceção, que impacta o campo popular e o campo elitista da sociedade mundial. O artigo identifica os novos aspectos sociopolíticos que trazem com eles a presente conjuntura, bem como as principais continuidades e rupturas relacionadas aos processos sociais envolvidos. The socio-health crisis generated by the proliferation of Covid19 is producing a transformation of the state into world society, recreating two innovative forms: that of the protective state and that of the aggressor state. In this work, I will argue that this transformation is mainly the product of a massive flow of delegation of social power fostered by a worldwide movement of social self-preservation. The expansion of the state's protective function, in turn, is coproducing in record time a new exceptional political legitimacy, which impacts the popular and elitist fields of world society. The article identifies the new socio-political aspects that bring with them the current conjuncture, as well as the main continuities and ruptures related to the social processes involved. Fil: Torres Castaños, Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; Argentina

Additional file 1.

En el sistema tributario Colombiano, el Impuesto al Valor Agregado (IVA), es el impuesto indirecto que representa el rubro más significativo, después del impuesto directo a las rentas de losdiferentes contribuyentes de la Nación. No sólo es necesario el impuesto a las ventas para incrementar los recursos del Estado a nivel Nacional, sino que a través de la historia ha tomado importancia también en los recursos de los entes territoriales en el desarrollo de políticas económicas de capital, de inversión y desarrollo social., Primeria edición

Additional file 1. SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents.

El presente artículo de investigación se enfoca en un diagnóstico sobre el estado actual en la implementación de buenas prácticas de gobierno corporativo en las fundaciones que desarrollan actividades de salud ubicadas en el departamento del Quindío, para lo cual inicialmente se realizó la descripción de los sujetos que cumplían con los parámetros de selección conforme al objeto de estudio. Posteriormente se identificó el marco regulatorio aplicable a las fundaciones y se construyó la encuesta para la recolección de la información, lo anterior sobre la circular externa No. 007 del 30 de junio de 2017 de la Superintendencia Nacional de Salud, la cual regula los temas relacionados con el código de conducta y buen gobierno corporativo. Como resultado general de la investigación se evidencia que las fundaciones no tienen estructuras definidas y sólidas que integren mecanismos y buenas prácticas de buen gobierno corporativo. De modo que el cumplimento de las medidas recomendadas por la circular se está realizando de manera parcial y solo en lo relacionado con los aspectos de obligatorio cumplimento que se estipulan desde otros entes reguladores, como lo son los estatutos y demás lineamientos que integran la conformación de las personerías jurídicas de cualquier tipo de organización.

Background Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources—that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs). Objective We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs. Methods The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed. Results A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P Conclusions Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population.