Implementation of a virtual community of practice to promote the empowerment of middle-aged people with multimorbidity: study protocol of a randomised controlled trial.

INTRODUCTION: Empowering people living with multimorbidity (multiple chronic conditions) to gain greater confidence in managing their health can enhance their quality of life. Education focused on self-management is a key tool for fostering patient empowerment and is mostly provided on an individual basis. Virtual communities of practice (VCoP) present a unique opportunity for online education in chronic condition self-management within a social context. This research aims to evaluate the effectiveness/cost-effectiveness of individualised, online self-management education compared with VCoP among middle-aged individuals living with multiple chronic conditions. METHODS AND ANALYSIS: People aged 30-60, living with ≥2 chronic conditions and receiving care in primary care (PC) centres and outpatient hospital-based clinics in Madrid and Canary Islands will enrol in an 18-month parallel-design, blinded (intervention assessment and data analysts), pragmatic (adhering to the intention-to-treat principle), individually randomised trial. The trial will compare two 12-month web-based educational offers of identical content; one delivered individually (control) and the other with online social interaction (VCoP, intervention). Using repeated measures mixed linear models, with the patient as random effect and allocation groups and time per group as fixed effects, we will estimate between-arm differences in the change in Patient Activation Measure from baseline to 12 months (primary endpoint), including measurements at 6-month and 18-month follow-up. Other outcomes will include measures of depression and anxiety, treatment burden, quality of life. In addition to a process evaluation of the VCoP, we will conduct an economic evaluation estimating the relative cost-effectiveness of the VCoP from the perspectives of both the National Health System and the Community. ETHICS AND DISSEMINATION: The trial was approved by Clinical Research Ethics Committees of Gregorio Marañón University Hospital in Madrid/Nuestra Señora Candelaria University Hospital in Santa Cruz de Tenerife. The results will be disseminated through workshops, policy briefs, peer-reviewed publications and local/international conferences. TRIAL REGISTRATION NUMBER: NCT06046326.

Relación entre hormona paratiroidea y riesgo cardiovascular en pacientes con insuficiencia de vitamina D / Relation between parathyroid hormone and cardiovascular risk in patients with vitamin D deficiency

Fundamento y objetivo: El déficit de vitamina D y la hormona paratiroidea (PTH) están asociados a un incremento del riesgo cardiovascular y de rigidez arterial. El objetivo de nuestro estudio es comparar el riesgo cardiovascular en sujetos con insuficiencia de vitamina D, según su concentración de PTH, así como evaluar la respuesta tras la administración de vitamina D. Pacientes y método: Estudio prospectivo de pacientes con concentración de 25(OH)-vitamina D menor de 30 nmol/l. Se evaluaron parámetros de riesgo vascular como presión arterial, rigidez arterial, perfil lipídico y metabolismo de la glucosa. Los pacientes recibieron suplementos de vitamina D durante 3 meses, tras lo cual se reevaluaron los parámetros previos. Resultados: Se incluyeron un total de 32 pacientes. Aquellos con PTH mayor de 65 pg/ml tenían mayor edad, peor función renal, mayor presión arterial sistólica, mayor presión de pulso y mayor rigidez arterial. El tratamiento con vitamina D mostró una tendencia no estadísticamente significativa a reducir la presión arterial y la rigidez arterial. Conclusiones: El incremento de PTH en pacientes con insuficiencia de vitamina D implica un peor control de la presión arterial y una mayor rigidez vascular. La reposición con vitamina D muestra una tendencia a reducir estos parámetros (AU)

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[Relation between parathyroid hormone and cardiovascular risk in patients with vitamin D deficiency]. / Relación entre hormona paratiroidea y riesgo cardiovascular en pacientes con insuficiencia de vitamina D.

BACKGROUND AND OBJECTIVES: Vitamin D deficiency and parathyroid hormone (PTH) are associated with an increased cardiovascular risk and arterial stiffness. The aim of our study is to compare the cardiovascular risk in subjects with low vitamin D, attending to the PTH concentration, as well as evaluating the response after administration of vitamin D. PATIENTS AND METHODS: Prospective study of patients with a concentration of 25(OH)-vitamin D below 30nmol/l. We evaluated vascular risk parameters as blood pressure, arterial stiffness, lipid profile and glucose metabolism. Patients received vitamin D supplements for 3 months, after which the previous parameters were reassessed. RESULTS: A total of 32 patients were included. Those with PTH over 65pg/ml were older, had worse renal function, higher systolic blood pressure, pulse pressure and arterial stiffness. Treatment with vitamin D showed a statistically significant trend to lower blood pressure and pulse wave velocity. CONCLUSIONS: The increase in PTH in patients with low vitamin D involves poor control of blood pressure and increased vascular stiffness. Vitamin D replacement shows a tendency to reduce these parameters.