Barómetro de diabetes tipo 2 en atención primaria. Control metabólico, estilos de vida y perfil de morbilidad / Barometer of type 2 diabetes in primary care. Metabolic control, styles of life and morbidity profile

Objetivo: Conocer el perfil de morbilidad cardiovascular, grado de control y estilos de vida en diabetes tipo 2. Método: Estudio transversal multicéntrico aleatorizado realizado en 2015 en atención primaria con 129 diabéticos. Incluyó variables sociodemográficas, complicaciones micro- y macrovasculares, daño orgánico, comorbilidad y estilos de vida de tabaquismo, ejercicio y adherencia a dieta mediterránea. El control metabólico se valoró con la última hemoglobina glucosilada anual. Resultados: El 57,4% eran hombres y el 42,6% mujeres. El control metabólico fue aceptable (HbAc1%, 7,15%) sin diferencias por municipio. El 74,4% tenía comorbilidad cardiovascular y el 99,2% factores de riesgo. El 23,3% era fumador y el 41,1% sedentario, con una adherencia a dieta mediterránea del 56%. Conclusiones: El perfil cardiometabólico de diabetes incluye retinopatías, enfermedad arterial periférica, comorbilidad de HTA y múltiples factores de riesgo cardiovascular. La educación para la salud individual o grupal en autocuidados y estilos saludables puede mejorar el control metabólico (AU)

Objective: Knowing the profile of cardiovascular morbidity, degree of control and lifestyles in type 2 diabetes. Method: Randomized multicenter cross-sectional study conducted in 2015 in primary care with 129 diabetics. It included sociodemographic variables, microvascular and macrovascular complications, organic damage, comorbidity and lifestyles of smoking, exercise and adherence to Mediterranean diet. Metabolic control was assessed with the latest annual glycosylated haemoglobin. Results: 57% were men and 43% women. Metabolic control was acceptable (HbAc1%, 7.15%) without differences by town. 74.4% had cardiovascular comorbidity and the 99.2% risk factors. 23% were smokers and 41% sedentary with a 56% adherence to Mediterranean diet. Conclusions: The cardiometabolic profile of diabetes includes retinopathy, peripheral arterial disease, comorbidity of hypertension and cardiovascular risk factors. Individual or group health education in self-care and healthy lifestyles can improve metabolic control (AU)

Evaluación de las habilidades en comunicación durante la entrevista nutricionista-paciente: desarrollo del cuestionario HCENP como herramienta de autoevaluación / EVALUATION OF SKILLS IN COMMUNICATION DURING THE NUTRITIONIST-PATIENT INTERVIEW: DEVELOPMENT OF THE HCENP QUESTIONNAIRE AS SELF-ASSESSMENT TOOL

Introducción: las habilidades en comunicación (HC) son esenciales en toda entrevista porque permiten establecer una relación que in uye en la calidad de atención. Objetivos: desarrollar e implementar un cuestionario como instrumento de autoevaluación para nutricionistas sobre HC en la entrevista con el paciente o con su cuidador/a (HCENP) y describir las características de la población estudiada. Materiales y métodos: estudio descriptivo, prospectivo, transversal. Incluyó nutricionistas graduados con experiencia mayor a seis meses que asisten a pacientes ambulatorios en instituciones de salud y un observador externo. La investigación se llevó a cabo en tres etapas: elaboración del cuestionario, evaluación de las propiedades psicométricas (validez y con abilidad), implementación del cuestionario. Resultados: el cuestionario es claro, fácil de entender y muy importante. El alfa de Cronbach (consistencia interna) se consideró aceptable. Para el 91,6% de las (HC) percibidas por el nutricionista y las observadas se obtuvo una concordancia leve (Kappa= 0,01 a 0,2). Conclusiones: el cuestionario desarrollado HCENP es una herramienta necesaria para re exionar sobre la comunicación nutricionista-paciente y existen habilidades que pueden desarrollarse no siendo percibidas como algo a mejorar.

Barometer of type 2 diabetes in primary care. Metabolic control, styles of life and morbidity profile. / Barómetro de diabetes tipo 2 en atención primaria. Control metabólico, estilos de vida y perfil de morbilidad.

OBJECTIVE: Knowing the profile of cardiovascular morbidity, degree of control and lifestyles in type 2 diabetes. METHOD: Randomized multicenter cross-sectional study conducted in 2015 in primary care with 129 diabetics. It included sociodemographic variables, microvascular and macrovascular complications, organic damage, comorbidity and lifestyles of smoking, exercise and adherence to Mediterranean diet. Metabolic control was assessed with the latest annual glycosylated haemoglobin. RESULTS: 57% were men and 43% women. Metabolic control was acceptable (HbAc1%, 7.15%) without differences by town. 74.4% had cardiovascular comorbidity and the 99.2% risk factors. 23% were smokers and 41% sedentary with a 56% adherence to Mediterranean diet. CONCLUSIONS: The cardiometabolic profile of diabetes includes retinopathy, peripheral arterial disease, comorbidity of hypertension and cardiovascular risk factors. Individual or group health education in self-care and healthy lifestyles can improve metabolic control.

Calidad de vida relacionada con la salud en niños y adolescentes con enfermedad renal crónica / Quality of life related to health in children and adolescents with chronic kidney disease

Introducción: La enfermedad renal crónica (ERC) es una patología compleja en la infancia siendo necesario evaluar el impacto de la misma en la vida del niño. Estudiar la calidad de vida relacionada con la salud (CVRS) facilita el conocimiento del estado de salud y mejora la elección de estrategias de tratamiento. Objetivo: Conocer la CVRS de los niños y adolescentes con ERC en tratamiento conservador, según su propia percepción y la de sus padres, y la relación con las restricciones del plan alimentario. Materiales y método: Diseño descriptivo, observacional, transversal. Se incluyeron niños de 2 a 18 años y sus padres. Se aplicó el cuestionario genérico validado PedsQLTM 4.0. Se evaluó la CVRS según la percepción de los padres y los niños y su relación con las restricciones del plan de alimentación. Paquete estadístico SPSS 20.0.Resultados: Participaron 84 pacientes y sus padres. La percepción de los padres fue mayor a la de los niños en el puntaje total (p=0,041), psicosocial (p= 0,042) y escolar (p=0,007). Según las restricciones del plan alimentario se hallaron diferencias significativas en el dominio físico de los padres (p=0,044).Conclusiones: Se evidenció discordancia en la percepción sobre la CVRS de los padres con respecto a los niños siendo los puntajes mayores en los primeros. En las restricciones alimentarias se observó diferencias en el dominio físico de los padres.

Implementation of a health-related quality of life questionnaire for children and adolescents with celiac disease.

INTRODUCTION: Measuring health-related quality of life inpatients with celiac disease allows a comprehensive approach. OBJECTIVE: To assess the implementation and sensitivity to change of the Argentine version of the CDDUX disease-specific questionnaire to measure health-related quality of life in children and adolescents. METHODS: Descriptive, observational, longitudinal and prospective study. Participants were 8 to 18 year old children and adolescents with celiac disease, their parents or legal guardians and their gastroenterologists. The CDDUX questionnaire was used to assess health-related quality of life, and sensitivity to change was evaluated using the variation in the score obtained on two different occasions and a scale of change perception from the patient's and his/her parent's standpoint. The questionnaire implementation was appraised using a strength and weakness form completed by patients, parents and gastroenterologists. RESULTS: The first interview was conducted among 118 child/parent dyads who completed the CDDUX and recorded their experience; 102 completed the questionnaire on two occasions. Total scores were higher the second time (p = 0.009 and 0.003, respectively). There was consistency between the perception of change expressed by the child/adolescent and the father/ mother, and the difference in the CDDUX score obtained at different consultations (p < 0.001). Standardized effect size: 0.52 for children/adolescents, and 0.45 for parents. A 64% agreement was observed among the opinions of children/ adolescents and their parent'´ opinion (kappa 0.20), and a 51% agreement was found among them and their gastroenterologists (kappa 0.10) in terms of change between consultations (better, the same, or worse).Gastroenterologists also recorded their experience with the CDDUX. They agreed that it was satisfactory and useful. CONCLUSIONS: The CDDUX questionnaire demonstrated test-retest stability and sensitivity to change. Different opinions were obtained regarding change in children/adolescents health-related quality of life, with a better agreement among children/adolescents and their parents than among them and their physicians. The CDDUX questionnaire has been accepted by children/adolescents, their parents and gastroenterologists.

Implementación de un cuestionario de calidad de vida relacionada con la salud para niños y adolescentes con enfermedad celíaca / Implementation of a health-related quality of life questionnaire for children and adolescents with celiac disease

Introducción. En los pacientes con enfermedad celíaca, medir la calidad de vida relacionada con la salud permite un abordaje integral. Objetivo. Evaluar la implementación y la sensibilidad al cambio de la versión argentina del cuestionario específco CDDUX para medir la calidad de vida relacionada con la salud en niños y adolescentes. Métodos. Estudio descriptivo, observacional, longitudinal y prospectivo. Participaron niños y adolescentes de 8 a 18 años con enfermedad celíaca, su padre o tutor, y un gastroenterólogo. La calidad de vida relacionada con la salud se evaluó con el CDDUX y la sensibilidad al cambio, mediante la variación de su puntaje aplicado en dos oportunidades y una escala de percepción del cambio desde la opinión del paciente y su padre. También la experiencia en su implementación con un formulario sobre fortalezas y debilidades completado por pacientes, padres y gastroenterólogos. Resultados. En la primera entrevista 118 binomios niño/padre completaron el CDDUX y registraron la experiencia; 102 lo completaron en dos oportunidades. Los puntajes totales fueron más elevados en la segunda (p= 0,009 y 0,003, respectivamente). Hubo congruencia entre la percepción de cambio expresada por el niño y por el padre, y la diferencia en el puntaje del CDDUX entre consultas (p <0,001). Tamaño del efecto estandarizado: 0,52 en el caso de los niños y 0,45 en los padres. Hubo acuerdo del 64% en las opiniones de los niños con los padres (kappa 0,20) y del 51% con los médicos (kappa 0,10) respecto del cambio entre consultas (mejor-igual-peor). Los gastroenterólogos también registraron su experiencia con el CDDUX. Hubo consenso en que fue satisfactoria y de utilidad. Conclusiones. El CDDUX demostró estabilidad test-retest y sensibilidad al cambio. Hubo visiones diferentes respecto del cambio en la calidad de vida relacionada con la salud del niño, con mayor acuerdo entre los niños y los padres que con el médico. Este cuestionario es aceptado por los niños, los padres y los gastroenterólogos.(AU)

Introduction. Measuring health-related quality of life inpatients with celiac disease allows a comprehensive approach. Objective. To assess the implementation and sensitivity to change of the Argentine version of the CDDUX disease-specifc questionnaire to measure health-related quality of life in children and adolescents. Methods. Descriptive, observational, longitudinal and prospective study. Participants were 8 to 18 year old children and adolescents with celiac disease, their parents or legal guardians and their gastroenterologists. The CDDUX questionnaire was used to assess health-related quality of life, and sensitivity to change was evaluated using the variation in the score obtained on two different occasions and a scale of change perception from the patients and his/her parents standpoint. The questionnaire implementation was appraised using a strength and weakness form completed by patients, parents and gastroenterologists. Results. The frst interview was conducted among 118 child/parent dyads who completed the CDDUX and recorded their experience; 102 completed the questionnaire on two occasions. Total scores were higher the second time (p = 0.009 and 0.003, respectively). There was consistency between the perception of change expressed by the child/adolescent and the father/ mother, and the difference in the CDDUX score obtained at different consultations (p < 0.001). Standardized effect size: 0.52 for children/adolescents, and 0.45 for parents. A 64% agreement was observed among the opinions of children/ adolescents and their parents´ opinion (kappa 0.20), and a 51% agreement was found among them and their gastroenterologists (kappa 0.10) in terms of change between consultations (better, the same, or worse).Gastroenterologists also recorded their experience with the CDDUX. They agreed that it was satisfactory and useful. Conclusions. The CDDUX questionnaire demonstrated test-retest stability and sensitivity to change. Different opinions were obtained regarding change in children/adolescents health-related quality of life, with a better agreement among children/adolescents and their parents than among them and their physicians. The CDDUX questionnaire has been accepted by children/adolescents, their parents and gastroenterologists.(AU)

Implementación de un cuestionario de calidad de vida relacionada con la salud para niños y adolescentes con enfermedad celíaca / Implementation of a health-related quality of life questionnaire for children and adolescents with celiac disease

Introducción. En los pacientes con enfermedad celíaca, medir la calidad de vida relacionada con la salud permite un abordaje integral. Objetivo. Evaluar la implementación y la sensibilidad al cambio de la versión argentina del cuestionario específco CDDUX para medir la calidad de vida relacionada con la salud en niños y adolescentes. Métodos. Estudio descriptivo, observacional, longitudinal y prospectivo. Participaron niños y adolescentes de 8 a 18 años con enfermedad celíaca, su padre o tutor, y un gastroenterólogo. La calidad de vida relacionada con la salud se evaluó con el CDDUX y la sensibilidad al cambio, mediante la variación de su puntaje aplicado en dos oportunidades y una escala de percepción del cambio desde la opinión del paciente y su padre. También la experiencia en su implementación con un formulario sobre fortalezas y debilidades completado por pacientes, padres y gastroenterólogos. Resultados. En la primera entrevista 118 binomios niño/padre completaron el CDDUX y registraron la experiencia; 102 lo completaron en dos oportunidades. Los puntajes totales fueron más elevados en la segunda (p= 0,009 y 0,003, respectivamente). Hubo congruencia entre la percepción de cambio expresada por el niño y por el padre, y la diferencia en el puntaje del CDDUX entre consultas (p <0,001). Tamaño del efecto estandarizado: 0,52 en el caso de los niños y 0,45 en los padres. Hubo acuerdo del 64% en las opiniones de los niños con los padres (kappa 0,20) y del 51% con los médicos (kappa 0,10) respecto del cambio entre consultas (mejor-igual-peor). Los gastroenterólogos también registraron su experiencia con el CDDUX. Hubo consenso en que fue satisfactoria y de utilidad. Conclusiones. El CDDUX demostró estabilidad test-retest y sensibilidad al cambio. Hubo visiones diferentes respecto del cambio en la calidad de vida relacionada con la salud del niño, con mayor acuerdo entre los niños y los padres que con el médico. Este cuestionario es aceptado por los niños, los padres y los gastroenterólogos.

Introduction. Measuring health-related quality of life inpatients with celiac disease allows a comprehensive approach. Objective. To assess the implementation and sensitivity to change of the Argentine version of the CDDUX disease-specifc questionnaire to measure health-related quality of life in children and adolescents. Methods. Descriptive, observational, longitudinal and prospective study. Participants were 8 to 18 year old children and adolescents with celiac disease, their parents or legal guardians and their gastroenterologists. The CDDUX questionnaire was used to assess health-related quality of life, and sensitivity to change was evaluated using the variation in the score obtained on two different occasions and a scale of change perception from the patient's and his/her parent's standpoint. The questionnaire implementation was appraised using a strength and weakness form completed by patients, parents and gastroenterologists. Results. The frst interview was conducted among 118 child/parent dyads who completed the CDDUX and recorded their experience; 102 completed the questionnaire on two occasions. Total scores were higher the second time (p = 0.009 and 0.003, respectively). There was consistency between the perception of change expressed by the child/adolescent and the father/ mother, and the difference in the CDDUX score obtained at different consultations (p < 0.001). Standardized effect size: 0.52 for children/adolescents, and 0.45 for parents. A 64% agreement was observed among the opinions of children/ adolescents and their parents´ opinion (kappa 0.20), and a 51% agreement was found among them and their gastroenterologists (kappa 0.10) in terms of change between consultations (better, the same, or worse).Gastroenterologists also recorded their experience with the CDDUX. They agreed that it was satisfactory and useful. Conclusions. The CDDUX questionnaire demonstrated test-retest stability and sensitivity to change. Different opinions were obtained regarding change in children/adolescents health-related quality of life, with a better agreement among children/adolescents and their parents than among them and their physicians. The CDDUX questionnaire has been accepted by children/adolescents, their parents and gastroenterologists.

Implementation of a health-related quality of life questionnaire for children and adolescents with celiac disease. / Implementation of a health-related quality of life questionnaire for children and adolescents with celiac disease.

INTRODUCTION: Measuring health-related quality of life inpatients with celiac disease allows a comprehensive approach. OBJECTIVE: To assess the implementation and sensitivity to change of the Argentine version of the CDDUX disease-specific questionnaire to measure health-related quality of life in children and adolescents. METHODS: Descriptive, observational, longitudinal and prospective study. Participants were 8 to 18 year old children and adolescents with celiac disease, their parents or legal guardians and their gastroenterologists. The CDDUX questionnaire was used to assess health-related quality of life, and sensitivity to change was evaluated using the variation in the score obtained on two different occasions and a scale of change perception from the patients and his/her parents standpoint. The questionnaire implementation was appraised using a strength and weakness form completed by patients, parents and gastroenterologists. RESULTS: The first interview was conducted among 118 child/parent dyads who completed the CDDUX and recorded their experience; 102 completed the questionnaire on two occasions. Total scores were higher the second time (p = 0.009 and 0.003, respectively). There was consistency between the perception of change expressed by the child/adolescent and the father/ mother, and the difference in the CDDUX score obtained at different consultations (p < 0.001). Standardized effect size: 0.52 for children/adolescents, and 0.45 for parents. A 64

agreement was observed among the opinions of children/ adolescents and their parent´ opinion (kappa 0.20), and a 51

agreement was found among them and their gastroenterologists (kappa 0.10) in terms of change between consultations (better, the same, or worse).Gastroenterologists also recorded their experience with the CDDUX. They agreed that it was satisfactory and useful. CONCLUSIONS: The CDDUX questionnaire demonstrated test-retest stability and sensitivity to change. Different opinions were obtained regarding change in children/adolescents health-related quality of life, with a better agreement among children/adolescents and their parents than among them and their physicians. The CDDUX questionnaire has been accepted by children/adolescents, their parents and gastroenterologists.

Informe final del grupo de estudio de enfermedad celíaca / Final report of the group of celiac disease

Elección del tema de trabajo: Enfermedad Celíaca. Adherencia a la Dieta Libre de Gluten. Revisión bibliográfica sobre el tema: Diferentes formas de medir la Adherencia a la Dieta Libre de Gluten. Revisiones y artículos de los últimos 10 años y trabajos de mayor antig³edad referentes en el tema. Los objetivos son: 1. Resumir el conocimiento existente sobre la definición de la adherencia terapéutica. 2. Identificar qué entiende la comunidad científica por adherencia y definir la magnitud del problema.3. Listar las diferentes formas de medir adherencia y si cuentan con validez científica. 4. Promover el debate de los temas relacionados con la adherencia terapéutica.(AU)

Informe final del grupo de estudio de enfermedad celíaca / Final report of the group of celiac disease

Elección del tema de trabajo: Enfermedad Celíaca. Adherencia a la Dieta Libre de Gluten. Revisión bibliográfica sobre el tema: Diferentes formas de medir la Adherencia a la Dieta Libre de Gluten. Revisiones y artículos de los últimos 10 años y trabajos de mayor antigüedad referentes en el tema. Los objetivos son: 1. Resumir el conocimiento existente sobre la definición de la adherencia terapéutica. 2. Identificar qué entiende la comunidad científica por adherencia y definir la magnitud del problema.3. Listar las diferentes formas de medir adherencia y si cuentan con validez científica. 4. Promover el debate de los temas relacionados con la adherencia terapéutica.

[Quality of life in children and adolescents with celiac disease: Argentinian version of the specific questionnaire CDDUX]. / Calidad de vida en niños y adolescentes con enfermedad celíaca: versión argentina del cuestionario específico CDDUX.

UNLABELLED: The treatment of the celiac disease implies lifelong alimentary restrictions, with impact on social and family activities. Therefore, it is important to consider the health-related quality of life (HRQL) in the approach. OBJECTIVE: To validate the Argentinian version of the specific tool CDDUX in order to measure HRQL in children and adolescents with celiac disease. METHODS: In this prospective and transversal investigation, children and adolescents from 8 to 18 years-old who attended the "Prof Dr. J P Garrahan" Hospital and their father or tutor were recruited, between June 2009 and May 2010. Participants were given the informed consent sheet, the Argentinian version of CDDUX, a visual analogue scale (VAS) and the PedsQL 4.0, generic questionnaire. Sociodemographic data were also registered. RESULTS: We included 193 patients, female 56.5%, with these age categories: 8 to 11 years-old 48.7%, 12 to 15 years-old 43%, 16 to 18 years-old 8.3%. Schooling was below the standard level in children in 23.4% of cases, primary school incomplete in adults in 11.4%. Socioeconomic status was poor in 24.4% of cases and indigent in 4.7%. Unsatisfied basic needs were observed in 41.5% of patients. The feasibility was: average filling time: 4 minutes in children and parents. All completed the questionnaire. Without help: 91.7% in children and 79.8% in parents. The reliability was: Cronbach alpha's internal consistency 0.84 in children and 0.88 in parents. The construction validity was: moderate correlation between CDDUX and PedsQL (P < 0.001), low between parents and children in CDDUX (P < 0.001), moderate and negative between CDDUX and VAS (P < 0.001). Scores of CDDUX were lower in poor people and significant for parents (P = 0.04). Higher scores of CDDUX were observed in those patients who complied with the gluten-free diet (P < 0001). Conclusion. The Argentinian version of CDDUX was both feasible and easy to administer in the studied population. It shows good psychometric properties in children and parents.

Detection of hepatitis C virus RNA and core protein in keratinocytes from patients with cutaneous lichen planus and chronic hepatitis C.

Cutaneous lichen planus has been associated in patients with chronic hepatitis C virus infection. It is still unknown whether hepatitis C virus infects keratinocytes of lichen planus lesions. In this report we have analyzed the presence of genomic and anti-genomic hepatitis C virus RNA in skin biopsies from 26 patients with chronic hepatitis C and healthy skin and from 24 patients with cutaneous lichen planus (five with and 19 without hepatitis C virus infection) by in situ hybridization. Hepatitis C virus RNA was detected in the keratinocytes of 69% of the patients with healthy skin and chronic hepatitis C, in 100% of the patients with lichen planus and hepatitis C virus infection, and in none of lichen planus patients without hepatitis C virus infection. The percentage of keratinocytes showing genomic or anti-genomic hepatitis C virus RNA was statistically lower (p < 0.01 in all cases) in patients with healthy skin (mean +/- SD: 5.7 +/- 3.5% and 2.7 +/- 3.1% of keratinocytes with genomic or anti-genomic hepatitis C virus RNA, respectively) than in those with lichen planus lesions (31.7 +/- 7.9% and 18.8 +/- 7.4%, mean +/- SD) or the unaffected adjacent skin (24.8 +/- 6.9% and 14.3 +/- 3.8%, mean +/- SD). In conclusion, we have demonstrated that hepatitis C virus infects keratinocytes from patients with lichen planus and hepatitis C virus infection.