A cluster-randomised clinical trial comparing two cardiovascular health education strategies in a child population: the Savinghearts project.

BACKGROUND: This paper describes a methodology for comparing the effects of an eduentertainment strategy involving a music concert, and a participatory class experience involving the description and making of a healthy breakfast, as educational vehicles for delivering obesity-preventing/cardiovascular health messages to children aged 7-8 years. METHODS/DESIGN: This study will involve a cluster-randomised trial with blinded assessment. The study subjects will be children aged 7-8 years of both sexes attending public primary schools in the Madrid Region. The participating schools (n=30) will be randomly assigned to one of two groups: 1) Group MC, in which the children will attend a music concert that delivers obesity-preventing/cardiovascular health messages, or 2) Group HB, in which the children will attend a participatory class providing the same information but involving the description and making of a healthy breakfast. The main outcome measured will be the increase in the number of correct answers scored on a knowledge questionnaire and in an attitudes test administered before and after the above interventions. The secondary outcome recorded will be the reduction in BMI percentile among children deemed overweight/obese prior to the interventions. The required sample size (number of children) was calculated for a comparison of proportions with an α of 0.05 and a ß of 0.20, assuming that the Group MC subjects would show values for the measured variables at least 10% higher than those recorded for the subjects of Group HB. Corrections were made for the design effect and assuming a loss to follow-up of 10%. The maximum sample size required will be 2107 children. Data will be analysed using summary measurements for each cluster, both for making estimates and for hypothesis testing. All analyses will be made on an intention-to-treat basis. DISCUSSION: The intervention providing the best results could be recommended as part of health education for young schoolchildren. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01418872.

Cuidados continuos. Un modelo de atención integral / Continuous cares. A complete care model

El cuidado de los pacientes oncológicos abarca desde el diagnóstico hasta la fase final de la enfermedad, cubriendo las necesidades de la unidad familiar que se enfrenta al cuidado y muerte del ser querido. En su quehacer diario, los oncólogos atienden a pacientes cuya enfermedad progresa a pesar de los esfuerzos para controlar la misma y cerca del 50 % de los enfermos van a fallecer por su enfermedad o por complicaciones relacionadas con la misma. Los tratamientos curativos y paliativos no deben ser mutuamente excluyentes y progresivamente se aplicarán una mayor proporción de medidas paliativas a medida que avanza la enfermedad y el paciente deja de responder al tratamiento específico. El alivio de los síntomas debe ser un objetivo primordial de los cuidados continuos, enfatizando al máximo este control durante la fase avanzada. Las personas mueren de diferentes enfermedades, en diferentes circunstancias y ámbitos culturales. En este trabajo se analizan los distintos sistemas de organización de los recursos asistenciales

Cancer care goes from diagnosis through the late stages of advanced illness, covering the needs of the family unit, which copes with caregiving and death of the beloved. Clinicians working in the field of oncology routinely encounter patients whose illness progresses despite intensive efforts to extend life. Approximately half of all current cancer patients will eventually die as a consequence of their illness or related complications. In cancer patients, curative treatments and palliative care should not be mutually exclusive and a greater proportion of palliative care must be applied in a higher proportion as the illness progresses and the patient no longer responds to specific treatment. Relief of symptoms must be a very important target in continuous care, emphasizing this control during the advanced illness as much as possible. People die of different illness process, in different circumstances and in with different cultural settings. In this work we analyze the different organization systems of the care resources