Medical sharps in Portugal: a cross-sectional survey of disposal practices among the diabetic population.

OBJECTIVE: We aim to determine the disposal site for biohazardous materials resulting from diabetes surveillance and therapy. DESIGN: Cross-sectional study. SETTING: Five Portuguese primary care facilities. PARTICIPANTS: We randomly sampled diabetic patients representative of five primary care facilities. Inclusion criteria consisted in patients≥18 years old with an active diagnosis of diabetes mellitus (DM). Patients unable to provide written informed consent were excluded. OUTCOME MEASURE: Sociodemographic variables, diabetes duration, type of treatment, medical sharps disposal practices and whether adequate disposal information were provided. RESULTS: A total of 1436 diabetics were included. Overall, 53.8% of diabetics conducted regular capillary glicemia measurements, although 45.3% of them had no medical indication. Statistically significant predictors of adequate disposal were not having an active professional status (p=0.011) and having a DM duration between 5 and 10 years (p=0.014). Only being professionally inactive remained an independent predictor after multivariate logistic regression. Less than a fifth of patients on injectable therapy report having been advised by healthcare staff regarding sharps disposal. Over a fifth of the latter report having received wrong advice. The majority of diabetics dispose of biohazardous materials in unsorted household waste (68.1% of needles/devices with needles and 71.6% of lancets). Other incorrect disposal sites identified were recycling bins, toilet and home accumulation. Only 19.1% of the needles/devices with needles and 13.1% of the lancets were disposed of at healthcare facilities. CONCLUSIONS: Most diabetics have unsafe disposal practices for their biohazardous materials, mostly in unsorted household waste. We identified that being unemployed independently predicts adequate disposal of medical sharps and found evidence of low patient literacy on the topic, as well as poor patient education. Therefore, educating and raising awareness among healthcare professionals is crucial to address this public health issue.

Management of dyslipidemia in diabetic patients: The situation in primary health care units.

INTRODUCTION: Cardiovascular disease is one of the main causes of morbidity and mortality worldwide. Control of its risk factors, particularly diabetes and dyslipidemia, through reduction of LDL cholesterol, is crucial to reduce cardiovascular risk. This work aims to assess and improve the medical approach to dyslipidemia in diabetic patients. METHODS: This is a quality improvement study aimed at family doctors. It included patients with diabetics and dyslipidemia enrolled in the primary health care units of Além D'Ouro, S. Miguel and Oceanos. A quality standard was defined for each of the criteria assessed, and the results were compared using the chi-square test with p-value<0.05. Data analysis was performed using Microsoft Excel 2010® and IBM SPSS®. RESULTS: Comparing the first and second assessments, 14.6% vs. 22.2% (p=0.016) of the patients, respectively, achieved the LDL cholesterol target level of <70 mg/dl. Of those who did not meet the target level, 11.0% vs. 13.6% (p=0.395) had their pharmacological therapy changed and 4.6% vs. 3.3% (p=0.448) had their lipid profile reassessed within three months. CONCLUSIONS: Control of dyslipidemia in patients with diabetes continues to be a major factor in the health of these patients, but it is carried out in an unsatisfactory way in the three health units studied. It is essential to increase the literacy of family doctors and to encourage the search for the best possible lipid control, in order to reduce cardiovascular risk, as well as to raise awareness among patients to increase adherence to therapy.