Type 1 Diabetes Patient Experiences Before and After Transfer from a Paediatric to an Adult Hospital.

Introduction: The management of type 1 diabetes (T1D) is especially complex during adolescence when youths are transferred to adult care centres. The objectives of this qualitative study were to: a) determine the expectations of young T1D patients prior to transfer, b) evaluate the transfer process between the 2 centres, and c) evaluate the therapeutic education and care programme (TECP) in the adult centre from their point of view. Material and Methods: Opinion sampling of adolescents from 2018-2019 was performed: Phase 1: adolescents with T1D prior to transfer to the adult hospital; Phase 2: adolescents with T1D one or two years after transfer and having undergone TECP. A focus group (1.5h) and semi-structured interviews (45 min) were performed and taped, transcribed, and sent to the participants for confirmation. Date analysis was performed of the transcriptions of the focus group and interviews. Fragments were selected and meta-categories created. Results: Eleven youths accepted to participate: 7 in Phase 1, 4 repeated in Phase 2 and 4 more transferred 2 years previously were added. The meta-categories obtained were: 1) perception of the quality of care and therapeutic education in the paediatric hospital. 2) transfer to the adult hospital. 3) experience of the youths 1-2 years after transfer and having undergone TECP. The data are presented in narrative form and are supported with text fragments of the participants' discussions. Discussion and conclusions: Analysis of patients' experience complemented by clinical-educational evaluation of TECP provides understanding of the perspectives of youths on the complexity of living with a chronic disease since childhood. It also provides information regarding the factors favouring quality care and therapeutic education, the complexity of transfer from paediatric to adult care, determination of the strong and weak points and the establishment of strategies to improve the programme.

Impacto de las consultas y triajes telefónicos pediátricos en el uso del servicio de urgencias hospitalario / Pediatric televisits and telephone triage: impact on use of a hospital emergency department

Objetivos: Analizar las características de las teleconsultas y triajes telefónicos pediátricos atendidos por CatSalut Respon y describir su impacto sobre la actitud y la decisión final de los padres-usuarios de acudir o no a urgencias. Método: Estudio observacional transversal. Durante la teleconsulta los pacientes se clasificaron según los niveles del sistema español de triaje. Aquellos que fueron derivados a urgencias se volvieron a clasificar en el hospital, y se compararon los niveles de triaje. Posteriormente, se realizó una llamada de verificación. Se recogieron variables sociodemográficas y clínicas. Resultados: Se analizaron 370 teleconsultas, fundamentalmente no urgentes (n = 300; 81%). Un 20,3% (n = 75) fueron derivadas a urgencias. La fiebre (p = 0,002) y las dudas de medicación (p < 0,001) fueron motivos significativos de teleconsulta no urgente. Casi un 46% de los casos con niveles de gravedad altos en el triaje de la llamada también fueron clasificados con niveles de gravedad altos en el triaje posterior realizado en el servicio de urgencias hospitalario, mostrando una concordancia moderada. Más del 50% de los padres tenían intención de acudir a urgencias antes de la teleconsulta y un 46% cambiaron de actitud tras realizar esta llamada. Conclusiones: Fiebre y dudas de medicación fueron motivos estadísticamente significativos de teleconsulta no urgente. La consulta telefónica produjo un cambio de actitud en casi la mitad de los padres

Objectives: To analyze the characteristics of remote telephone consultations (televisits) and triage of pediatric emergencies attended by the 24-hour emergency service of Catalonia (CatSalut Respon), and to describe the impact of televisits on callers' decisions about whether or not to come to the emergency department and their opinion of the call service. Methods: Observational cross-sectional study. During the call, cases were classified according the Spanish and Andorran triage system. Patients who were sent to the hospital underwent triage again, and the 2 assigned triage levels were compared. The families were later called to check data and ask their opinion of the service. Sociodemographic and clinical data related to the cases were recorded. Results: A total of 370 televisits were made. Most cases (300, 81%) were not emergencies. Seventy-five callers (20.3%) were advised to go to an emergency department. Fever (P = .002) and questions about medication (P < .001) were the problems significantly associated with nonurgent cases. Nearly 46% of the cases classified as serious during telephone triage were also considered serious when the child was brought to the emergency department. The rate of agreement between the 2 triage levels was moderate. Over half the parents stated they had intended to go to the hospital before calling the service; 46% changed their mind based on the call. Conclusions: Fever and questions about medication were significantly associated with televisits for nonurgent cases. Nearly half the parents changed their mind about going to the emergency department after a televisit

Pediatric televisits and telephone triage: impact on use of a hospital emergency department. / Impacto de las consultas y triajes telefónicos pediátricos en el uso del servicio de urgencias hospitalario.

OBJECTIVES: To analyze the characteristics of remote telephone consultations (televisits) and triage of pediatric emergencies attended by the 24-hour emergency service of Catalonia (CatSalut Respon), and to describe the impact of televisits on callers' decisions about whether or not to come to the emergency department and their opinion of the call service. MATERIAL AND METHODS: Observational cross-sectional study. During the call, cases were classified according the Spanish and Andorran triage system. Patients who were sent to the hospital underwent triage again, and the 2 assigned triage levels were compared. The families were later called to check data and ask their opinion of the service. Sociodemographic and clinical data related to the cases were recorded. RESULTS: A total of 370 televisits were made. Most cases (300, 81%) were not emergencies. Seventy-five callers (20.3%) were advised to go to an emergency department. Fever (P = .002) and questions about medication (P < .001) were the problems significantly associated with nonurgent cases. Nearly 46% of the cases classified as serious during telephone triage were also considered serious when the child was brought to the emergency department. The rate of agreement between the 2 triage levels was moderate. Over half the parents stated they had intended to go to the hospital before calling the service; 46% changed their mind based on the call. CONCLUSION: Fever and questions about medication were significantly associated with televisits for nonurgent cases. Nearly half the parents changed their mind about going to the emergency department after a televisit.

OBJETIVO: Analizar las características de las teleconsultas y triajes telefónicos pediátricos atendidos por CatSalut Respon y describir su impacto sobre la actitud y la decisión final de los padres-usuarios de acudir o no a urgencias. METODO: Estudio observacional transversal. Durante la teleconsulta los pacientes se clasificaron según los niveles del sistema español de triaje. Aquellos que fueron derivados a urgencias se volvieron a clasificar en el hospital, y se compararon los niveles de triaje. Posteriormente, se realizó una llamada de verificación. Se recogieron variables sociodemográficas y clínicas. RESULTADOS: Se analizaron 370 teleconsultas, fundamentalmente no urgentes (n = 300; 81%). Un 20,3% (n = 75) fueron derivadas a urgencias. La fiebre (p = 0,002) y las dudas de medicación (p < 0,001) fueron motivos significativos de teleconsulta no urgente. Casi un 46% de los casos con niveles de gravedad altos en el triaje de la llamada también fueron clasificados con niveles de gravedad altos en el triaje posterior realizado en el servicio de urgencias hospitalario, mostrando una concordancia moderada. Más del 50% de los padres tenían intención de acudir a urgencias antes de la teleconsulta y un 46% cambiaron de actitud tras realizar esta llamada. CONCLUSIONES: Fiebre y dudas de medicación fueron motivos estadísticamente significativos de teleconsulta no urgente. La consulta telefónica produjo un cambio de actitud en casi la mitad de los padres.

El papel de los enfermeros escolares / The role of school nurses

Después del hogar, la escuela representa el segundo entorno en el que se desarrolla la vida de los niños y su capacidad de aprendizaje está estrechamente relacionada con su bienestar y salud. El objetivo de este artículo es definir el concepto de enfermera escolar e identificar sus ámbitos de responsabilidad mediante una revisión de la literatura científica. Por otro lado, contribuye a valorar la importancia de los enfermeros escolares e identificar si esta es una necesidad para las escuelas o no (AU)

The school comes the second place where children’s lives developed. Their ability to learn is closely related to their welfare and health. This paper aimed to define the roles that school nurses can play in the schools to help the children reach their educational goals through keeping them healthy and safe, and on the other hand, it will help us to evaluate the significance of school nurses and find out whether it is needed in the schools or not (AU)

[The Role of School Nurses]. / El papel de los enfermeros escolares.

The school comes the second place where children's lives developed. Their ability to learn is closely related to their welfare and health. this paper aimed to define the roles that school nurses can play in the schools to help the children reach their educational goals through keeping them healthy and safe, and on the other hand, it will help us to evaluate the significance of school nurses and find out whether it is needed in the schools or not.

Obesity, knee osteoarthritis, and polypathology: factors favoring weight loss in older people.

AIM: We aimed to explore the meaning of obesity in elderly persons with knee osteoarthritis (KO) and to determine the factors that encourage or discourage weight loss. BACKGROUND: Various studies have demonstrated that body mass index is related to KO and that weight loss improves symptoms and functional capacity. However, dietary habits are difficult to modify and most education programs are ineffective. DESIGN: A phenomenological qualitative study was conducted. Intentional sampling was performed in ten older persons with KO who had lost weight and improved their health-related quality of life after participating in a health education program. A thematic content analysis was conducted following the stages proposed by Miles and Huberman. FINDINGS: Participants understood obesity as a risk factor for health problems and stigma. They believed that the cause of obesity was multifactorial and criticized health professionals for labeling them as "obese" and for assigning a moral value to slimness and diet. The factors identified as contributing to the effectiveness of the program were a tolerant attitude among health professionals, group education that encouraged motivation, quantitative dietary recommendations, and a meaningful learning model based on social learning theories. CONCLUSION: Dietary self-management without prohibitions helped participants to make changes in the quantity and timing of some food intake and to lose weight without sacrificing some foods that were deeply rooted in their culture and preferences. Dietary education programs should focus on health-related quality of life and include scientific knowledge but should also consider affective factors and the problems perceived as priorities by patients.

Perceptions of diabetes obtained through drawing in childhood and adolescence.

OBJECTIVE: To examine whether drawing is useful in the detection of problems of psychosocial adaptation in children and adolescents with type 1 diabetes (T1D) and in improving communication with health professionals. METHODS: We performed an exploratory descriptive study in 199 children and adolescents with T1D aged 4-13 years. The participants were asked to render a drawing on a suggested topic. The variables analyzed were related to the drawing and to clinical and sociodemographic data. RESULTS: Most participants showed evidence of having a well-balanced personality, but there were also signs of affective or psychosocial difficulties. CONCLUSION: Drawing is a useful technique by which to identify children's and adolescents' feelings and possible problems in adapting to T1D, as well as to gain information directly from the children themselves. Future studies should delimit the possibilities of this technique in clinical practice in greater detail.

[Chronic complications of diabetes mellitus. Recommendations from the American Diabetes Association 2011. Prevention and management]. / Complicaciones crónicas de la diabetes mellitus. Recomendaciones de la American Diabetes Association (ADA) 2011. Prevención y manejo.

Diabetes mellitus (DM) is one of the diseases with greater impact public health, not only because of its high prevalence, but, above all, by the consequences of the chronic complications arising from this disease. Hyperglycemia generates damage both in the field of microcirculation and the great vessels causing injury, macroangiopathies and microangiopathies. Macroangiopathies complications are generated from alterations or injury in the great vessels of the arterial to the most important, being from the clinical point of view, ischemic heart disease, disease stroke and peripheral arterial disease. Microangiopathies complications are due to alterations or injury of small vessels being the most important, from a clinical point of view, nephropathy, retinopathy and diabetic neuropathy. Macroangiopathies complications are generated from alterations or injury in the great vessels of the arterial to the most important, being from the clinical point of view, ischemic heart disease, disease stroke and peripheral arterial disease. Microangiopathies complications are due to alterations or injury of small vessels being the most important, from a clinical point of view, nephropathy, retinopathy and diabetic neuropathy.

Complicaciones crónicas de la diabetes mellitas. Recomendaciones de la American Diabetes Association (ADA) 2011. Prevención y manejo / Chronic complications of diabetes mellitus. Recommendations from the American Diabetes Association 2011. Prevention and management

La diabetes mellitus (DM) es una de las enfermedades con mayor impacto sociosanitario, no sólo por su elevada prevalencia, sino, sobre todo, por las consecuencias de las complicaciones crónicas que genera. La hiperglucemia ocasiona daño tanto en el ámbito de la microcirculación como en los grandes vasos provocando lesiones macroangiopáticas y microangiopáticas. Las complicaciones macroangiopáticas se originan a partir de alteraciones o lesiones en los grandes vasos arteriales siendo las más importantes, desde el punto de vista clínico, la cardiopatía isquémica, la enfermedad cerebrovascular y la arteriopatía periférica. Las complicaciones microangiopáticas son consecuencia de alteraciones o lesiones de pequeños vasos siendo las más importantes, desde el punto de vista clínico, la nefropatía, la retinopatía y la neuropatía diabéticas(AU)

Diabetes mellitus (DM) is one of the diseases with greater impact public health, not only because of its high prevalence, but, above all, by the consequences of the chronic complications arising from this disease. Hyperglycemia generates damage both in the field of microcirculation and the great vessels causing injury, macroangiopathies and microangiopathies. Macroangiopathies complications are generated from alterations or injury in the great vessels of the arterial to the most important, being from the clinical point of view, ischemic heart disease, disease stroke and peripheral arterial disease. Microangiopathies complications are due to alterations or injury of small vessels being the most important, from a clinical point of view, nephropathy, retinopathy and diabetic neuropathy. Macroangiopathies complications are generated from alterations or injury in the great vessels of the arterial to the most important, being from the clinical point of view, ischemic heart disease, disease stroke and peripheral arterial disease. Microangiopathies complications are due to alterations or injury of small vessels being the most important, from a clinical point of view, nephropathy, retinopathy and diabetic neuropathy(AU)

Repercusiones de la diabetes en el niño y el adolescente / Impact of diabetes in children and adolescents

La DM1 se puede presentar a cualquier edad, pero su mayor incidencia se observa en menores de 15 años, con mayor frecuencia en edad preescolar y especialmente prepuberal. Representa alrededor del 10% del total de formas de DM y constituye una de las alteraciones crónicas más frecuentes en la infancia y la adolescencia. La destrucción de las células β pancreáticas comporta un déficit absoluto de insulina en estos enfermos por lo que precisan tratamiento con insulina desde el momento del diagnóstico (AU)

DM1 can occur at any age, but its higher incidence seen in under 15 years of age with greater frequency in age preschool and especially prepuberal. It represents about 10 of the total number of forms of DM and is one of chronic disturbances more frequent in children and adolescents. The destruction of the pancreatic cells involves a total deficit of insulin in these patients by requiring treatment with insulin from the time of diagnosis (AU)

[Therapy in diabetes education. Where are we?]. / Educación terapéutica diabetes. Dónde estamos?

Patients with diabetes mellitus (DM) who receive no education cannot make informed decisions to maintain acceptable metabolic control, increasing the likelihood of complications [1]. Education and prevention of diabetes mellitus (DM) are the central theme of World Diabetes Day during the period 2009/2073. The key messages of this campaign advocating: 1) Know the risks of DM and its warning signs, 2) Know what to do and who to call and 3) Learn how to manage and control. Education is the primary theme of this campaign promoted by the International Diabetes Federation (IDF) and the World Health Organization (WHO) [1].

Educación terapéutica en diabetes. ¿Dónde estamos? / Therapy in diabetes education. Where are we?

Los enfermos con diabetes mellitus (DM) que no reciben educación no pueden tomar decisiones informadas para mantener un control metabólico aceptable, lo cual aumenta la probabilidad de desarrollar complicaciones [1]. La educación y la prevención son el tema central del Día Mundial de la Diabetes durante el período 2009/2013. Los mensajes clave de esta campaña propugnan: 1) Conocer los riesgos de la DM y sus síntomas de alerta; 2) Saber cómo actuar y a quién acudir y 3) Saber cómo gestionarla y controlarla. La educación es el tema primordial de esta campaña promovida por la Federación Internacional de Diabetes (IDF) y por la Organización Mundial de la Salud (OMS)(AU)

Patients with diabetes mellitus (DM) who receive no education cannot make informed decisions to maintain acceptable metabolic control, increasing the likelihood of complications [1]. Education and prevention of diabetes mellitus (DM) are the central theme of World Diabetes Day during the period 2009/2013. The key messages of this campaign advocating: 1) Know the risks of DM and its warning signs, 2) Know what to do and who to call and 3) Learn how to manage and control. Education is the primary theme of this campaign promoted by the International Diabetes Federation (IDF) and the World Health Organization (WHO) (AU)

[Perception among college students of the healthcare law against smoking]. / Tabaco y universidad. Percepción de los estudiantes universitarios sobre la ley de medidas sanitarias frente al tabaquismo.

OBJECTIVE: To understand smoking habits among college students and their opinion about the anti-smoking law. METHOD: Cross-sectional descriptive study conducted. Data gathering was carried out through surveys. RESULTS: Sample of 284 students. 42.6% were smokers and 11.6% were ex-smokers. The heaviest smokers were among the 24-29 age group and those who combined work and school. 13.2% did not perceive any risk in smoking, and 16.1% were unconcerned about the risks to passive smokers. 66.3% of smokers were worried about the effects of smoking on their health. Women perceived more than men that the anti-smoking law implementation was effective and was socially beneficial. Since the anti-smoking law came into effect, 16.5% of the sample had quit smoking and 35.5% had considered quitting. 24.6% did not abide by the law. Agreeing with the law was correlated with being a non-smoker or an ex-smoker being between 18 and 23 years of age or older than 30, studying health sciences, perceiving that smoking creates health hazards and being female. CONCLUSION: These results are of interest because they facilitate the planning of specific activities targeted to this type of people, who in the future will become social points of references. Since smoking constitutes one of the biggest public health problems it should be tackled with a greater commitment from health and academic authorities, including assistance for those willing to quit smoking.

[Diabetes mellitus in teenagers]. / Diabetes mellitus en el adolescente.

Diabetes Mellitus during infancy childhood or adolescence does not differ from adult diabetes mellitus in terms of basic principles nor therapeutic treatment methods but the characteristics patients have during those ages signify that diabetes has a special repercussion and becomes harder to treat in patients during those ages.

Tabaco y Universidad. Percepción de los estudiantes universitarios sobre la ley de medidas sanitarias frente al tabaquismo / Perception among college students of the healthcare law against smoking

Objetivo: conocer el consumo de tabaco de los estudiantes universitarios y su opinión respecto a la ley antitabaco. Método: estudio descriptivo transversal. La recogida de datos se realizó mediante cuestionario. Resultados: se estudiaron 284 estudiantes. Fumaba el 42,6% y era ex-fumador el 11,6%. Los más consumidores de cigarrillos se encuentran en la franja de 24-29 años y compaginan estudios y trabajo. El 13,2% no percibe el riesgo del tabaco y al 16,1% no le preocupa sus efectos en el fumador pasivo. El 66,3% de fumadores está preocupado por sus efectos en la salud. Las mujeres perciben más que los hombres que la ley antitabaco se cumple y que resulta beneficiosa socialmente. A partir de dicha ley ha dejado de fumar el 16,5% y se ha planteado abandonarlo el 35,5%. El 24,6% no la respeta. Estar de acuerdo con la ley antitabaco se relacionó con no fumar o ser ex-fumador, tener entre 18 y 23 años o más de 30 años, estudiar ciencias sanitarias, percibir que el tabaco supone riesgo para la salud y ser mujer. Conclusión: estos resultados tienen interés porque facilitan planificar actividades específicas dirigidas a este grupo de personas que, en un futuro, serán referentes sociales. Puesto que el tabaquismo constituye uno de los principales problemas de salud pública debería abordarse un mayor compromiso de las autoridades sanitarias y académicas y facilitar ayuda para dejar de fumar(AU)

Objective: to understand smoking habits among college students and their opinion about the anti-smoking law. Method: cross-sectional descriptive study conducted. Data gathering was carried out through surveys. Results: sample of 284 students. 42.6% were smokers and 11.6% were ex-smokers. The heaviest smokers were among the 24-29 age group and those who combined work and school. 13.2% did not perceive any risk in smoking, and 16.1% were unconcerned about the risks to passive smokers. 66.3% of smokers were worried about the effects of smoking on their health. Women perceived more than men that the anti-smoking law implementation was effective and was socially beneficial. Since the anti-smoking law came into effect, 16.5% of the sample had quit smoking and 35.5% had considered quitting. 24.6% did not abide by the law. Agreeing with the law was correlated with being a non-smoker or an ex-smoker, being between 18 and 23 years of age or older than 30, studying health sciences, perceiving that smoking creates health hazards and being female. Conclusion: these results are of interest because they facilitate the planning of specific activities targeted to this type of people, who in the future will become social points of references. Since smoking constitutes one of the biggest public health problems it should be tackled with a greater commitment from health and academic authorities, including assistance for those willing to quit smoking(AU)

Diabetes mellitus en el adolescente / Diabetes mellitus in teenagers

La Diabetes Mellitus (DM), en la infancia o en la adolescencia, no se diferencia de la del adulto ni en los principios ni en los medios terapéuticos, pero las características de estos grupos de edad implican que tenga una repercusión especial y que sea más difícil de tratar(AU)

Diabetes Mellitus during infancy, childhood or adolescence does not differ from adult diabetes mellitus in terms of basic principles nor therapeutic treatment methods but the characteristics patients have during those ages signify that diabetes has a special repercussion and becomes harder to treat in patients during those ages(AU)

Quality of life in simultaneous pancreas-kidney transplant recipients.

BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK Tx) allows dialysis and insulin therapy to be discontinued and improves the complications of diabetes mellitus type 1 (DM1). This study measure quality of life (QoL) in SPK transplant recipients and determine if there are differences in QoL between these patients and those with DM1 in renal replacement therapy (RRT). METHODS: Short Form Health Survey 36-Item (SF-36) was administered to 69 SPK transplant recipients and 34 patients with DM1 under RRT. A descriptive analysis, multiple linear regression, ANOVA, and ordinal regression (PLUM) models were constructed. RESULTS: QoL was higher in SPK transplant recipients than in patients receiving RRT. The best results were in the recently transplanted patients. Respect to Spanish population the men with SPK transplants scored higher on vitality and lower on general health, role limitations-physical and role limitations-emotional. Women with SPK transplants scored lower on general health. Among patients under RRT, men scored lower on the general health, physical functioning, vitality, and bodily pain while women scored lower on all dimensions. In both groups, greater age was associated with better mental health. CONCLUSION: Positive predictive factors of QoL are SPK Tx and age while negative predictive factors are female sex and RRT.