Dr. Josep Vidal-Alaball

Eur J Gen Pract. 2006;12(4):169-73. Vidal-Alaball J , Butler CC , Potter CC . National Public Health Service for Wales, Swansea, UK, Wales. Objective: To establish whether savings could be made by changing patients from intramuscular to high doses of oral vitamin B12 in primary care without compromising their wellbeing. Methods: Cost-minimization analysis from a UK perspective, using secondary data obtained from the literature available and expert opinion. Results: The cost of the resources used to treat patients with vitamin B12 deficiency with intramuscular vitamin B12 was calculated as between pound55.99 (euro83.1) and pound99.99 (euro148.5) per year. The cost of treating patients with high doses of oral vitamin B12 during the first year was between pound125.55 (euro186.5) and pound248.55 (euro369.1). However, once patients receiving intramuscular treatment had been converted to oral treatment, or in new patients treated orally from the outset, the cost was pound35.55 per year (eu...

EXPERT'S WARNING ON WARSHIP ILLNESS 02 September 2006 An expert in public health has warned that more potentially deadly illnesses on a front-line warship could follow after two further cases of active tuberculosis (TB) were diagnosed on a Westcountry-based vessel. The Ministry of Defence (MoD) has confirmed that five crew members of HMS Ocean, the Devonport-based amphibious helicopter carrier and assault ship, now have the infectious form of the disease after TB first emerged in May. The unidentified crewmen have been prescribed with up to six months of antibiotics to keep the life-threatening illness under control. The MoD last night said that all five cases of active TB were confined to the marine engineering department, which is responsible for mechanics and electrics. Fifty-five latent forms of the illness emerged on board following a screening process of the entire crew. The latent form produces no symptoms and is not contagious, as the bacteria are not active, although they ...

Eurosurveillance weekly releases 2006 > Volume 11 / Issue 9 J Vidal-Alaball ( Josep.Vidal-Alaball@nphs.wales.nhs.uk ), S Hayes, R Jones National Public Health Service for Wales, Health Protection Team, Mid and West Wales Region, Swansea, United Kingdom On 10 February 2004, the specialist respiratory nurse for a hospital in a city in South Wales alerted the local health authorities that Mycobacterium tuberculosis infections in a particular area of the city appeared to be higher than expected in a relatively young age group. All the cases were in patients who reported visiting a particular pub (bar) regularly. As a result of this alert, an outbreak investigation team compiled an initial list of six possible associated cases in five men and one woman who were aged between 25 and 55 years and all lived in the city. Initial interviews established that there were many shared social links between the patients, who were part of a network of regular drinkers at four pubs in a suburb of the ...

28/07/06 Disorders of Erythropoiesis • Brief Report Andrew Goringe, Richard Ellis, Ian McDowell, Josep Vidal-Alaball , Christopher Jenkins, Christopher Butler, Mark Worwood Treatment of B12 deficiency is important to prevent progressive neurological and/or hematologic disease but requires a secure diagnosis. The aim of this study was to evaluate second line tests of B12 status as prognostic indicators of a hematologic response to vitamin B12 therapy. Forty-nine patients referred with low, serum vitamin B12 concentrations were treated with intramuscular B12 and re-assessed after 3 months. Methylmalonic acid, homocysteine, holotranscobalamin and neutrophil hypersegmentation index were measured before and after treatment. Before treatment 27/49 patients were anemic or macrocytic of whom 15 had a clear hematologic response. All the tests had a similar prognostic accuracy. Symptomatic improvement did not correlate with hematologic response. Supplementary tests of vitamin B12 status were not...

Wednesday, 10 August 2005 From The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd. All rights reserved. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency (Cochrane Review) Vidal-Alaball J, Butler CC, Cannings-John R, Goringe A, Hood K, McCaddon A, McDowell I, Papaioannou A ABSTRACT Background : Vitamin B12 deficiency is common and rises with age. Most people with vitamin B12 deficiency are treated in primary care with intramuscular vitamin B12 which is a considerable source of work for health care professionals. Several case control and case series studies have reported equal efficacy of oral administration of vitamin B12 but it is rarely prescribed in this form, other than in Sweden and Canada. Doctors may not be prescribing oral formulations because they are unaware of this option or have concerns regarding effectiveness. Objectives: To assess the effectiveness of oral vitamin B12 versus intramuscular vitamin B12 for vitamin B1...

Dr Josep Vidal-Alaball Public Health Medicine July 2006 Risk Communication • Is an interactive process of exchange of information • People’s fears should be taken seriously and steps should be taken to address them even if they are not necessary from a technical perspective • Management of Environmental Health issues requires more than technical expertise. Social issues such as house prices, house ownership or stigma of the neighbourhood are also important and should be considered from day one Risk perception • Clearly, emotions play a large role in public perception of risk • When people become aware of a threat, they are naturally inclined to: – Fear the unknown – Want to maintain control – Protect home and family – Be alienated by dependence on others (government, industry officials) – Protect their belief in a just world • Experts and responsible authorities often think that the perception of the public is mistaken and irrational. • They then try to correct the mistaken perception ...

Cochrane Library, reproduced with permission Butler CC, Vidal-Alaball J, Cannings-John R, McCaddon A, Hood K, Papaioannou A, McDowell I and Goringe A. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials. Family Practice 2006; Pages 1–7 of 7. Background . Vitamin B12 deficiency is common, increasing with age. Most people are treated in primary care with intramuscular vitamin B12. Several studies have reported equal efficacy of oral administration of vitamin B12. Objectives . We set out to identify randomized controlled trial (RCT) evidence for the effectiveness of oral versus intramuscular vitamin B12 to treat vitamin B12 deficiency. Methods . We conducted a systematic review searching databases for relevant RCTs. Outcomes included levels of serum vitamin B12, total serum homocysteine and methylmalonic acid, haemoglobin and signs and symptoms of vitamin B12 deficiency. Results . Two RCTs comparing oral with in...

Dr Josep Vidal-Alaball 2005 Who is it for? GPs and any doctor with an interest in family planning. When did you do it? In 2002, during my GP registrar year. Why did you do it? In general practice we see many patients wanting advice on family planning and I wanted to have a diploma certifying my proficiency in this specialty. I like the way the diploma is assessed—it requires practical and theoretical training. How much effort did it entail? The diploma has two components; a basic theoretical course and a practical training. There are several approved courses available around the country, which take place over three consecutive days. You organise your own practical training, which needs to be supervised by a faculty approved instructing doctor. Is there an exam? (and fee) No, this is the great thing about the DFFP; no exam is required to obtain the diploma. There is a fee to go to the theoretical course and you may need to pay a small fee to attend practical training. Top tip Book yo...

Friday, 02 April 2004 I am in favour of Appraisal and Continuous Professional Development for health care professionals but I also strongly believe that any intervention in Health Services needs to be evaluated. The efficacy of Revalidation and Appraisal needs to be evaluated moreover when this is going to be an expensive intervention. I was surprised to find very vague references about evaluation on the Department of Health web side mainly regarding at the number of doctors appraised and the quality of the process. In a discussion group during one session of the Masters of Public Health at the UWCM in Cardiff I asked how we could possible evaluate Revalidation and Appraisal. We though that it is difficult to evaluate an intervention when the objectives of the intervention are not clear. According to the objectives of the intervention we can design a correct evaluation. Looking at the numbers of doctors appraised and revalidated is a measure of activity but not a measure of outcome of ...