Impacto de la alteración de la continuidad asistencial en los pacientes con diabetes tipo 2 durante la pandemia de COVID-19 / Impact of the alteration of the continuity of care in diabetes type 2 patients during the COVID-19 pandemic

Objetivo: Valorar la repercusión de la alteración de la continuidad asistencial en pacientes con diabetes mellitus tipo 2 (DM2) durante la pandemia de COVID-19. Material y método: Estudio de seguimiento entre los años 2018 y 2020 de los pacientes con DM2 de un centro de salud. Las actividades asistenciales y preventivas realizadas para su seguimiento fueron comparadas con pruebas estadísticas adecuadas al tipo y distribución de cada variable para un nivel de significación p≤0,05. Resultados: La muestra inicial fue de 587 pacientes con hemoglobina glicosilada (A1c) en 2018 (54% varones), con una edad de 66±11 años en un rango de 29-91 años. En 2020 disminuyeron todos los indicadores de atención: se determinó A1c al 68% de los pacientes (382/558 tras 29 fallecimientos); el 59% permanecía con buen control, el 17% con mal control, el 10% mejoró y el 14% empeoró (p<0,001). Empeoraron menos los pacientes que tenían realizados ECG y retinografía en 2018, aunque no en 2020, que aquellos que no los tenían en 2018, pero sí en 2020 (16 vs. 25%; p<0,001 y 13 vs. 42%; p=0,002). Quienes disminuyeron sus visitas al médico de familia y enfermera presentaron menor empeoramiento que los que las aumentaron (14 vs. 26%; p<0,001 y 17 vs. 23%; p<0,001). Conclusiones: La desatención impidió el control del 32% de los pacientes. El peor control en 2020 fue menor en quienes estaban controlados en 2018, y en quienes disminuyeron su asistencia al centro de salud en 2020. Probablemente una adecuada formación pre-pandémica en autocuidados ha llevado al empoderamiento del paciente durante periodo pandémico (AU)

Aim: To assess the impact of the alteration of the continuity of care in patients with type 2 diabetes during the COVID-19 pandemic. Material and method: Follow-up study with 587 primary care patients with DM2, and control according to the redGDPS-2018 criteria in 2018 and 2020. Activities carried out and control status of patients were compared using statistical tests appropriate to type and distribution of each variable, for a significance level P≤.05. Results: Sample was made up of 587 patients with glycosylated hemoglobin (A1c) in 2018 (54% men), age of 66±11, in range of 29-91 years. All the care indicators decreased in 2020: A1c was determined in 68% of patients (382/558 after 29 deaths); 59% remained with good control, 17% with poor control, 10% improved and 14% worsened (P<.001). Those who had ECG and retinography performed in 2018 and not in 2020 show a lower degree of worsening than those who did not have them done in 2018 but they did in 2020 (16% vs 25%, P<.001 and 13% vs 42%, P=.002). Those who decrease their visits to family doctor and nurse show less deterioration than those who increase them (14% vs 26%; P<.001 and 17% vs 23%; P<.001). Conclusions: Inattention impeded control of 32% of the patients. Poor control in 2020 was lower in those who were controlled in 2018, and who decreased their attendance at the health center in 2020. Possibly adequate pre-pandemic training in self-care has led to the empowerment of the patient during a pandemic period (AU)

[Impact of the alteration of the continuity of care in diabetes type 2 patients during the COVID-19 pandemic]. / Impacto de la alteración de la continuidad asistencial en los pacientes con diabetes tipo 2 durante la pandemia de COVID-19.

AIM: To assess the impact of the alteration of the continuity of care in patients with type 2 diabetes during the COVID-19 pandemic. MATERIAL AND METHOD: Follow-up study with 587 primary care patients with DM2, and control according to the redGDPS-2018 criteria in 2018 and 2020. Activities carried out and control status of patients were compared using statistical tests appropriate to type and distribution of each variable, for a significance level P≤.05. RESULTS: Sample was made up of 587 patients with glycosylated hemoglobin (A1c) in 2018 (54% men), age of 66±11, in range of 29-91 years. All the care indicators decreased in 2020: A1c was determined in 68% of patients (382/558 after 29 deaths); 59% remained with good control, 17% with poor control, 10% improved and 14% worsened (P<.001). Those who had ECG and retinography performed in 2018 and not in 2020 show a lower degree of worsening than those who did not have them done in 2018 but they did in 2020 (16% vs 25%, P<.001 and 13% vs 42%, P=.002). Those who decrease their visits to family doctor and nurse show less deterioration than those who increase them (14% vs 26%; P<.001 and 17% vs 23%; P<.001). CONCLUSIONS: Inattention impeded control of 32% of the patients. Poor control in 2020 was lower in those who were controlled in 2018, and who decreased their attendance at the health center in 2020. Possibly adequate pre-pandemic training in self-care has led to the empowerment of the patient during a pandemic period.

[Effectiveness of the TG/HDL-C ratio to improve GLP-1 prescription in patients with type 2 diabetes in primary care]. / Efectividad de la ratio TG/c-HDL en la mejora de la prescripción de GLP-1 en pacientes con diabetes tipo 2 en atención primaria.

AIMS: Check the usefulness of ratio TG/HDL-C≥2.5 to improve the effectiveness of GLP-1 prescribing in patients with type 2 diabetes (DM2) in primary care, and determine whether any patient profile would higher benefit. DESIGN: Descriptive cross-sectional study. LOCATION: Barranco Grande Health Center, Tenerife. PARTICIPANTS: Random selection of patients with DM2 attended by 12 family doctors and 12 nurses. MAIN MEASUREMENTS: Poor control according to the current criteria was compared to poor control according to the proposed rule. To determine who would benefit, the sociodemographic, clinical, therapeutic and follow-up characteristics were analyzed. Descriptive, bivariate and multivariate statistical analysis was performed. RESULTS: No predominant characteristics were found in the patients who would be prescribed GLP-1 according to the proposed rule, but those that reached a significance P<.20 were included as potential explanatory factors in a multivariate binary logistic regression model. The adjustment of the model retained the factors of therapeutic non-compliance (OR 3.40 [1.58-5.02]; P=.003), evolution of DM2 less than 15 years (OR 2.74 [1.10-4.89]; P=.031), number of prescribed anti-diabetes drugs (OR 2.30 [1.88-2.81]; P<.001) and age under 65 years (OR 1.67 [1.08-2.58]; P=.021). CONCLUSIONS: The use of the rule that we propose for the prescription of GLP-1 (2018 recommendations of the GDPS network combined with the TG/HDL-C ratio≥2.5 or BMI≥30kg/m2), instead of the current criterion adopted by the National Health System, would allow to broaden the spectrum of application of the drug in patients with poor control of their DM2.

'Supporting a first-time mother': Assessment of success of a breastfeeding promotion programme.

BACKGROUND: The aim of this study was to measure the effectiveness on breast feeding rates by the program 'Supporting a First-time Mother', a web-based platform of interactionbetween first-time mothers and breastfeeding-experienced women who act as peer-supporters. METHODS: A randomized study with a control and intervention group was conducted between April and October 2016. Participants were recruited from Hospital Universitario de Canarias (Spain). Inclusive criteria were singleton pregnancy, healthy term baby, vaginal or assisted delivery. Participants were randomly assigned to either an intervention or control group. Type of feeding (exclusive, partial or artificial) was noted at 3 and 6 months. The study also gathered information from the peer-supporters. RESULTS: Data showed higher rates of exclusive breastfeeding in the intervention group,at both 3 and 6 months post delivery (76% vs 56%, p = 0.020; 47% vs 35%, p = 0.049). Taking part in the study also increased the overall success of breastfeeding 2.65 times (IC95%, 1.21-5.78, p = 0.014) at 3 months and 3.30 times (IC95% 1.52-7.17, p = 0.003) at 6 months. CONCLUSIONS: A limitation of the study is mainly related to participation in the intervention. In spite of this limitation, this support programme increased breastfeeding rates 3 fold.

The Grieving Nursing Diagnoses in the Primary Healthcare Setting.

PURPOSE: To estimate the prevalence of Grieving, risk for Complicated Grieving, and Complicated Grieving in the primary care setting. METHODS: Retrospective epidemiological study, analyzing data from electronic health records (EHR). FINDINGS: A total of 84% of the 9,063 records had diagnostic labels without defining characteristics, related factors, or risk factors. A larger frequency of complicated grieving was found in deceased mourners. CONCLUSIONS: The grieving epidemiology opens new chances for the research using data from EHR. PRACTICE IMPLICATIONS: The adequacy of the records is essential to develop a profile of the patient at risk of complications after the loss. This research is an important step to build an epidemiological basis for nursing diagnosis of grieving in the primary health care setting.

Aplicación de la Escala de Tabaquismo para Atención Primaria (ETAP) en la práctica clínica / Application of the Smoking Scale for Primary Care (ETAP) in clinical practice

OBJETIVO: Averiguar si la escala de tabaquismo ETAP, que mide la exposición acumulada al tabaco tanto activa como pasivamente, es aplicable y efectiva en la práctica clínica de la atención primaria para la prevención del infarto agudo de miocardio (IAM). Emplazamiento Centro de salud de Barranco Grande, en Tenerife. DISEÑO: Estudio de 61 casos (IAM) y 144 controles. Muestreo con arranque aleatorio, sin apareamiento. Se realizó análisis de curvas COR-II y se estimó la efectividad mediante sensibilidad y valor predictivo negativo (VPN). Se administró una encuesta a los médicos de familia participantes sobre la aplicabilidad de la ETAP en la consulta. RESULTADOS: La opinión de los médicos participantes fue unánimemente favorable: la ETAP fue de fácil uso en la consulta, necesitó menos de 3 min por paciente y resultó útil para reforzar la intervención preventiva. La curva COR-II de la ETAP mostró que 20 años de exposición era el mejor punto de corte, con un área bajo la curva de 0,70 (IC 95%: 0,62-0,78) y una combinación de sensibilidad (98%) y VPN (96%) para el IAM. Al estratificar edad y sexo, en todos los grupos se alcanzaron sensibilidades y VPN cercanos al 100%, salvo en los hombres de edad ≥ 55años, en quienes el VPN cayó hasta el 75%. CONCLUSIONES: Los resultados apuntan a que ETAP es una herramienta válida que puede ser aplicable y efectiva en la práctica clínica de la atención primaria para la prevención del IAM relacionado con el consumo de tabaco

OBJECTIVE: To determine if the ETAP smoking scale, which measures accumulated exposure to tobacco, both actively and passively, is applicable and effective in the clinical practice of Primary Care for the prevention of acute myocardial infarction (AMI). Location Barranco Grande Health Centre in Tenerife, Spain. DESIGN: A study of 61 cases (AMI) and 144 controls. Sampling with random start, without matching. COR-II curves were analysed, and effectiveness was estimated using sensitivity and negative predictive value (NPV). A questionnaire was provided to participating family physicians on the applicability of ETAP in the clinic. RESULTS: The opinion of the participating physicians was unanimously favourable. ETAP was easy to use in the clinic, required less than 3 min per patient, and was useful to reinforce the preventive intervention. The ETAP COR-II curve showed that 20 years of exposure was the best cut-off point, with an area under the curve of 0.70 (95%CI: 0.62-0.78), and a combination of sensitivity (98%) and NPV (96%) for AMI. When stratifying age and gender, all groups achieved sensitivities and NPVs close to 100%, except for men aged ≥ 55years, in whom the NPV fell to 75%. CONCLUSIONS: The results indicate that ETAP is a valid tool that can be applied and be effective in the clinical practice of Primary Care for the prevention of AMI related to smoking exposure

[Application of the Smoking Scale for Primary Care (ETAP) in clinical practice]. / Aplicación de la Escala de Tabaquismo para Atención Primaria (ETAP) en la práctica clínica.

OBJECTIVE: To determine if the ETAP smoking scale, which measures accumulated exposure to tobacco, both actively and passively, is applicable and effective in the clinical practice of Primary Care for the prevention of acute myocardial infarction (AMI). Location Barranco Grande Health Centre in Tenerife, Spain. DESIGN: A study of 61 cases (AMI) and 144 controls. Sampling with random start, without matching. COR-II curves were analysed, and effectiveness was estimated using sensitivity and negative predictive value (NPV). A questionnaire was provided to participating family physicians on the applicability of ETAP in the clinic. RESULTS: The opinion of the participating physicians was unanimously favourable. ETAP was easy to use in the clinic, required less than 3min per patient, and was useful to reinforce the preventive intervention. The ETAP COR-II curve showed that 20years of exposure was the best cut-off point, with an area under the curve of 0.70 (95%CI: 0.62-0.78), and a combination of sensitivity (98%) and NPV (96%) for AMI. When stratifying age and gender, all groups achieved sensitivities and NPVs close to 100%, except for men aged ≥55years, in whom the NPV fell to 75%. CONCLUSIONS: The results indicate that ETAP is a valid tool that can be applied and be effective in the clinical practice of Primary Care for the prevention of AMI related to smoking exposure.

A hospital-based matched case-control study to identify risk factors for clinical infection with OXA-48-producing Klebsiella pneumoniae in rectal carriers.

Asymptomatic colonisation of the gastrointestinal tract by carbapenemase-producing Enterobacteriaceae is an important reservoir for transmission, which may precede infection. This retrospective observational case-control study was designed to identify risk factors for developing clinical infection with OXA-48-producing Klebsiella pneumoniae in rectal carriers during hospitalisation. Case patients (n = 76) had carbapenemase-producing K. pneumoniae (CPKP) infection and positive rectal culture for CPKP. Control patients (n = 174) were those with rectal colonisation with CPKP but without CPKP infection. Multivariate analysis identified the presence of a central venous catheter (OR 4·38; 95% CI 2·27-8·42; P = 0·008), the number of transfers between hospital units (OR 1·27; 95% CI (1·06-1·52); P < 0·001) and time at risk (OR 1·02 95% CI 1·01-1·03; P = 0·01) as independent risk factors for CPKP infection in rectal carriers. Awareness of these risk factors may help to identify patients at higher risk of developing CPKP infection.

Risk factors of hepatocellular carcinoma recurrence after liver transplantation: accuracy of the alpha-fetoprotein model in a single-center experience.

BACKGROUND: Recurrence of hepatocellular carcinoma (HCC) and cirrhosis after a liver transplantation (LT) is a major concern, and a strict Milan criteria selection of candidates does not accurately discriminate the relapse rate after LT. PURPOSE: This study sought to analyze the risk factors affecting tumor recurrence after LT for related cirrhosis HCC and the application of the French prognostic model (preLT alpha-fetoprotein [AFP], size, number) in a single center. METHODS: In a retrospective observational study of LT for HCC and cirrhosis, clinicopathological features were analyzed. Also, the preoperative and postoperative AFP model score was calculated with a cutoff of 2. RESULTS: Of 480, 109 patients underwent cadaveric LT for HCC. Eight of them had a relapse (7%). High AFP level, AFP model score >2, high pathological tumor-node-metastasis (pTNM) stage, poor differentiation, macrovascular-microvascular invasion, infiltration, and R1 margin were statistically significant (P < .05) for recurrence. Also, in the preoperative model, AFP score >2 was a predictor of worse survival (1-, 3-, 5-, 10-year survival of 81%, 51%, 30%, 30% vs 90%, 76%, 73%, 69% in ≤2, with P = .005). Regarding the postoperative model, similar results were found (1-, 3-, 5-, 10-year survival of 84%, 47%, 37%, 37% vs 90%, 78%, 73%, 52%, P = .028) between AFP model score >2 and ≤2, respectively. However, Milan and up-to-7 criteria were not accurate in recurrence nor in survival. CONCLUSIONS: The French AFP model has proven to be a more discerning prognostic tool than other established criteria in the prediction of recurrence and survival. Also, in postoperative prognosis, pathological risk factors for relapse such as pTNM, differentiation grade, macrovascular-microvascular invasion, infiltration, and R1 margin have been predictors of recurrence.

El esquema de biopsia transrectal puede predecir la gradación histológica incorrecta del cáncer de próstata / Transrectal biopsy scheme can predict incorrect histological grading in prostate cancer

Objetivo: Identificar los factores por los que un sumatorio de Gleason (SG) < 7 en la biopsia pase a ser ≥ 7 en la pieza quirúrgica. Material y métodos: Se estudiaron 185 pacientes operados por cáncer de próstata comparando el SG de las biopsias con el de las piezas quirúrgicas. Se calcularon la sensibilidad, especificidad y los valores predictivos del SG de la biopsia. La concordancia de la biopsia y la intervención quirúrgica para establecer SG < 7 y ≥ 7 fue estimada con el estadístico Kappa de Cohen. Se analizaron la edad, los antecedentes familiares de cáncer prostático, el antígeno prostático específico total (PSAt), el tacto transrectal, la estructura y el volumen prostáticos, y el número de cilindros de la biopsia (esquema de biopsia) utilizando una regresión logística multivariante. Resultados: La biopsia tuvo una alta sensibilidad (98%) y una baja especificidad (49%) para los SG ≤ 6; y una baja sensibilidad (35, 26%) y una alta especificidad (93, 99%) para los SG de 7 y ≥ 7, respectivamente. El índice Kappa de los SG fue de 0,43 (IC del 95%: 30-56%). El esquema de biopsia fue el único predictor del desacuerdo. Del resto de variables, solo el PSAt mostró una asociación significativa discreta. Tomando como referencia el esquema con < 7 cilindros, no hallamos diferencia con 8-9 cilindros, pero sí con 10-11, y ≥ 12 cilindros, con una razón de prevalencia de 0,138 (IC 95%: 0,030-0,513) y de 0,277 (IC 95%: 0,091-0,806), respectivamente. Conclusión: El SG de la biopsia depende del esquema. Este factor tiene que ser considerado a la hora de elegir una opción terapéutica en aquellos pacientes con un grado tumoral bajo en la biopsia (AU)

Objective: To identify factors that might explain why a prostate with a Gleason score (GS) <7 in the biopsy specimen can turn out to have a GS ≥7 in the surgical specimen.Material and methods: We compared the GS of biopsy specimens with the GS of surgical specimens in 185 patients who underwent surgery for prostate cancer. We calculated the sensitivity, specificity, and predictive values for the GS of the biopsy specimens. We used Cohen’s kappa to determine the degree of concordance between a GS of <7 and ≥7 for the biopsy specimen and the surgical specimen. Age, a family history of prostate cancer, total prostate-specific antigen (tPSA), digital rectal examination, prostate structure and volume, and the number of biopsy cores (biopsy scheme) were analyzed using multivariable logistic regression. Results: Histological study of biopsy specimens yielded high sensitivity (98%) but low specificity (49%) for GS ≤6 and low sensitivity (35, 26%) and high specificity (93, 99%) for GS=7 and GS ≥7, respectively. Cohen’s kappa for the GS from the biopsy and surgical specimens was 0.43 (95% CI=30-56%). The biopsy scheme was the only predictor of discordance in the GS between the two techniques. Among the other variables included in the model, only tPSA showed a slightly significant association. Taking a scheme with less than 7 cores as a reference, we found no difference with 8 to 9 cores but we did find a difference with 10 to 11 cores and with 12 or more cores, with a prevalence ratio of 0.138 (95% CI=0.030-0.513) and 0.277 (95% CI=0.091-0.806), respectively. Conclusion: The GS of the biopsy depends on the scheme. This factor must be taken into account when choosing a treatment option in patients with low tumor grade in biopsy specimens (AU)

[Transrectal biopsy scheme can predict incorrect histological grading in prostate cancer]. / El esquema de biopsia transrectal puede predecir la gradación histológica incorrecta del cáncer de próstata.

OBJECTIVE: To identify factors that might explain why a prostate with a Gleason score (GS) <7 in the biopsy specimen can turn out to have a GS ≥7 in the surgical specimen. MATERIAL AND METHODS: We compared the GS of biopsy specimens with the GS of surgical specimens in 185 patients who underwent surgery for prostate cancer. We calculated the sensitivity, specificity, and predictive values for the GS of the biopsy specimens. We used Cohen's kappa to determine the degree of concordance between a GS of <7 and ≥7 for the biopsy specimen and the surgical specimen. Age, a family history of prostate cancer, total prostate-specific antigen (tPSA), digital rectal examination, prostate structure and volume, and the number of biopsy cores (biopsy scheme) were analyzed using multivariable logistic regression. RESULTS: Histological study of biopsy specimens yielded high sensitivity (98%) but low specificity (49%) for GS ≤6 and low sensitivity (35, 26%) and high specificity (93, 99%) for GS=7 and GS ≥7, respectively. Cohen's kappa for the GS from the biopsy and surgical specimens was 0.43 (95% CI=30-56%). The biopsy scheme was the only predictor of discordance in the GS between the two techniques. Among the other variables included in the model, only tPSA showed a slightly significant association. Taking a scheme with less than 7 cores as a reference, we found no difference with 8 to 9 cores but we did find a difference with 10 to 11 cores and with 12 or more cores, with a prevalence ratio of 0.138 (95% CI=0.030-0.513) and 0.277 (95% CI=0.091-0.806), respectively. CONCLUSION: The GS of the biopsy depends on the scheme. This factor must be taken into account when choosing a treatment option in patients with low tumor grade in biopsy specimens.

Factors related to the development of cat scratch colon during colonoscopy.

Cat scratch colon (CSC) is an entity characterized by bright red linear tears which appear in the colonic mucosa during colonoscopy. Although they do not generally have clinical implications, cases of secondary pneumoperitoneum have been reported. To date, the prevalence, associated diseases, and factors that determine the appearance of CSC have not been adequately determined. We report a series of 20 cases of CSC found in 10715 consecutive colonoscopies. Demographic data, indication for the colonoscopy, endoscopy findings, and complications related to the procedure were recorded. Older age and male sex were significantly associated with CSC. In 15 of the 20 cases the CSC was related to diversion colitis, and 5 cases appeared in patients with collagenous colitis. In patients with diversion colitis, the longer the time elapsed since surgery, the greater the risk of these lesions occurring. None of the patients with CSC had complications related to the colonoscopy.

[Environmental tobacco smoke exposure in children and its relationship with the severity of asthma]. / Exposición al humo de tabaco del niño asmático y su asociación con la gravedad del asma.

INTRODUCTION: Environmental tobacco smoke (ETS) exposure produces serious respiratory problems in childhood. The aim of the study was to evaluate if environmental tobacco smoke affects the severity of asthma in asthmatic children. MATERIAL AND METHODS: A prospective, multicentre study was conducted on asthmatic children and their parents in 2007-2008, using an exposure questionnaire, pulmonary function, level of cotinine in urine, and evaluation of the severity of asthma according to GEMA guide. The characteristics of the sample are summarised using the appropriate statistical tools, and the comparisons were made using the Pearson chi2 test, Mann-Whitney U test or Studentis t, according to the variable and number of groups compared. RESULTS: Four hundred and eighty four households in 7 Autonomous Communities were included. The population included, 61% male children with asthma, 56% with a smoking caregiver in their home, 34% fathers, 31% mothers and 17% both. Home exposure was 37%, with 11% daily and 94% passive smokers since birth. There was 20% with exposure during whole period of pregnancy of 5±1 cigarettes/day. Children exposed to 6±1 cigarettes/day, 27%, up to 10 cigarettes/day, and 10% to more than 10. Severity of asthma during the survey was worse among those exposed (episodic-occasional 47%, episodic-frequent 35% and persistent-moderate 18% versus 59%, 25% and 16%, respectively, P=.040). Severity of asthma in the last year was worse in those exposed (episodic - occasional 22%, episodic - frequent 37% and persistent - moderate 50% versus 38%, 28% and 25% respectively, P=.037). The spirometry was abnormal in 64% of the exposed against to 36% in the non-exposed for FEV(1) (P=.003, 63% vs 38% for FVC (P=.038), and 54% vs 46% for the PEF (P=.050). The cotinine was higher in exposed: 51 (0-524) ng/ml vs 27 (0-116) ng/ml (P=.032). A relationship was observed between cotinine and level of exposure: 120 (0-590) ng/ml for >10 cigarettes/day as opposed to 44 (0-103) ng/ml ≤10 cigarettes/day (P=.035), which corroborates the consistency of the data collected. CONCLUSIONS: The exposure of children with asthma to environmental tobacco smoke has a highly negative effect on the severity of their asthma.

Statistical quality control charts for liver transplant process indicators: evaluation of a single-center experience.

Liver transplantation, the best option for many end-stage liver diseases, is indicated in more candidates than the donor availability. In this situation, this demanding treatment must achieve excellence, accessibility and patient satisfaction to be ethical, scientific, and efficient. The current consensus of quality measurements promoted by the Sociedad Española de Trasplante Hepático (SETH) seeks to depict criteria, indicators, and standards for liver transplantation in Spain. According to this recommendation, the Canary Islands liver program has studied its experience. We separated the 411 cadaveric transplants performed in the last 15 years into 2 groups: The first 100 and the other 311. The 8 criteria of SETH 2010 were correctly fulfilled. In most indicators, the outcomes were favorable, with an actuarial survivals at 1, 3, 5, and 10 years of 84%, 79%, 76%, and 65%, respectively; excellent results in retransplant rates (early 0.56% and long-term 5.9%), primary nonfunction rate (0.43%), waiting list mortality (13.34%), and patient satisfaction (91.5%). On the other hand, some indicators of mortality were worse as perioperative, postoperative, and early mortality with normal graft function and reoperation rate. After the analyses of the series with statistical quality control charts, we observed an improvement in all indicators, even in the apparently worst, early mortality with normal graft functions in a stable program. Such results helped us to discover specific areas to improve the program. The application of the quality measurement, as SETH consensus recommends, has shown in our study that despite being a consuming time process, it is a useful tool.

Progresión de la obesidad infantil en Tenerife / Children obesity progression in Tenerife Island

Introducción: En nuestra práctica asistencial hemos observado recientemente un aumento de la obesidad en la población infantil y un adelanto en su edad de aparición. Nuestro objetivo es comprobar estos fenómenos, identificando la edad de mayor riesgo de inicio de obesidad infantil y estudiar su asociación a otros factores, como el sexo y el peso al nacimiento. Material, pacientes y métodos: Se analizan las historias clínicas de todos los niños (n= 660), pertenecientes a tres cohortes, según el año de nacimiento (1989, 1997 y 2000), en tres centros de salud del área de Tenerife. El peso al nacimiento se expresó como z-score, se calculó el índice de masa corporal(IMC) anualmente a partir del año de edad y hasta los 8 años. La progresión del IMC se representa gráficamente con su valor medio anual, por sexos y cohortes. Las diferencias de evolución del IMC por sexos, intra/intercohortes, se obtienen mediante un modelo lineal general multivariante para medidas repetidas, usándose modelos ANOVA para diferenciar la edad a laque se separan las diferentes cohortes en relación con el IMC. El poder predictivo independiente del año de nacimiento, elz-score del peso al nacer y el sexo del recién nacido sobre el IMC a los 8 años de edad se valora con modelos de regresión lineal múltiple. El riesgo de estos tres factores en relación con la aparición de la obesidad a los 8 años de edad se evalúa mediante modelos de regresión logística binaria multivariable. Resultados: El año de nacimiento, el z-score del peso al nacer y el sexo muestran un poder predictivo sobre el IMC a los 8 años de edad, y el primero es el factor de mayor significación y el que supone un riesgo significativo para presentar obesidad a esta edad. La edad más probable de inicio de obesidad infantiles a los 4 años. Conclusiones: a) la edad de inicio de la obesidad se ha adelantado en nuestra población infantil; b) la obesidad se inicia, como promedio, a la edad de 4 años, aunque es mayor en los varones, y c) al menos hasta los 8 años de edad, un mayor peso al nacer se asocia a un aumento del IMC (AU)

Introduction and aim: We have perceived an increased frequency and earlier onset of child overweight and obesity. Our objetive is to prove this hypothesis by identifying the age of higher risk of child obesity onset and by studying its association to gender and birth weight. Material and methods: Birth weight was expressed as zscore and yearly Body Mass Index (BMI) from the first year to the age of eight were collected from all clinical records of 660children of three Primary Health Centers of Tenerife. Data were classified into three cohorts by their birth year (1989, 1997 and 2000). BMI progression plots were done by gender and cohort.BMI evolution by gender, so intra as among cohorts, has been tested using a multivariate generalized linear model for iterated measurements. ANOVA test was used to estimate at which age the cohorts show a different BMI. The independent predictive power of birth year, birth weight z-score and gender on BMI at the age of eight was evaluated using multiple linear regression models, whereas the influence of these variables on the risk of obesity at eight years old was evaluated using binary multivariable logistic regression models. Results: Birth year, birth weight z-score and gender show predictive power on BMI at eight years of age, being the former which implies as significant risk of obesity at that age. Obesity onset is more frequent at the age of four years. Conclusions: a) obesity onset occur at earlier age in our children; b) obesity begins at four years of age in average and is more frequent in boys, and c) a higher birth weight is associated with an increased BMI, at least until the age of eight(AU)

Impaired fasting glucose, ancestry and waist-to-height ratio: main predictors of incident diagnosed diabetes in the Canary Islands.

AIMS: To estimate the incidence rate and risk factors for diabetes in the Canary Islands. METHODS: A total of 5521 adults without diabetes were followed for a median of 3.5 years. Incident cases of diabetes were self-declared and validated in medical records. The following factors were assessed by Cox regression to estimate the hazard ratios for diabetes: impaired fasting glucose (5.6 mmol/l ≤ fasting glucose ≤ 6.9 mmol/l), BMI, waist-to-height ratio (≥ 0.55), insulin resistance (defined as triglycerides/HDL cholesterol ≥ 3), familial antecedents of diabetes, Canarian ancestry, smoking, alcohol intake, sedentary lifestyle, Mediterranean diet, social class and the metabolic syndrome. RESULTS: The incidence rate was 7.5/10(3) person-years (95% CI 6.4-8.8). The greatest risks were obtained for impaired fasting glucose (hazard ratio 2.6; 95% CI 1.8-3.8), Canarian ancestry (hazard ratio 1.9; 95% CI 1.0-3.4), waist-to-height ratio (hazard ratio 1.7; 95% CI 1.1-2.5), insulin resistance (hazard ratio 1.5; 95% CI 1.0-2.2) and paternal history of diabetes (hazard ratio 1.5; 95% CI 1.0-2.3). The metabolic syndrome (hazard ratio 1.9; 95% CI 1.3-2.8) and BMI ≥ 30 kg/m(2) (hazard ratio 1.7; 95% CI 1.0-2.7) were significant only when their effects were not adjusted for impaired fasting glucose and waist-to-height ratio, respectively. CONCLUSIONS: The incidence of diabetes in the Canary Islands is 1.5-fold higher than that in continental Spain and 1.7-fold higher than in the UK. The main predictors of diabetes were impaired fasting glucose, Canarian ancestry, waist-to-height ratio and insulin resistance. The metabolic syndrome predicted diabetes only when its effect was not adjusted for impaired fasting glucose. In individuals with Canarian ancestry, genetic susceptibility studies may be advisable. In order to propose preventive strategies, impaired fasting glucose, waist-to-height ratio and triglyceride/HDL cholesterol should be used to identify subjects with an increased risk of developing diabetes.

Occupational risk prevention in endoscopy units: a pending issue.

UNLABELLED: The degree of Knower and compliance with occupational risk prevention measures in the Spanish gastrointestinal endoscopy units is unknown. AIM: 1. To assess compliance with occupational risk prevention measures in GIE units. 2. To determine which factors influence the fulfillment of occupational risk prevention measures. METHODS: a validated survey was supplied to 300 GIE units, including questions on: 1. General occupational risk prevention measures; 2. occupational risk prevention measures during disinfection; 3. occupational risk prevention measures during examination. The following Hospital or GIE Unit characteristics were evaluated: Type of hospital according to the Spanish National Health Service; Number of hospital beds; Advanced diagnostic and therapeutic procedures performed and; Centers providing training in the field of endoscopy. RESULTS: response: 196 GIE units (65%). 104 GIE units (53% CI95%: 46-60) fulfill less than 50% of the occupational risk prevention measures studied.The RR of less than 50% of the ORP measures being fulfilled is 1.975 times higher at public hospitals than at private facilities (CI95%: 1.11-3.52). None of the remaining factors analyzed proved to have a significant influence. CONCLUSIONS: compliance with occupational risk prevention measures in Spanish GIE units is inadequate and must be improved. Public hospitals in Spain comply with fewer occupational risk prevention measures than their private counterparts.

Prevención de riesgos laborales en unidades de endoscopia. Una asignatura pendiente / No disponible

En la actualidad desconocemos el grado de conocimiento y aplicación de medidas de prevención de riesgos laborales en las Unidades de Endoscopia Españolas. Objetivo: valorar la aplicación de la prevención de riesgos laborales en las unidades de endoscopia y establecer los factores que determinan su cumplimiento. Diseño: se pasó un cuestionario validado a 300 unidades de endoscopia. Se incluían preguntas sobre: Medidas generales de pre - vención de riesgos laborales, medidas de prevención durante la desinfección y medidas de prevención durante las exploraciones. Se valoraron el tipo de hospital en función de su adscripción al sistema público de salud, el tamaño de los hospitales según el número de camas, la realización o no de técnicas avanzadas y la realización de docencia de endoscopia o no. Se estimó el porcentaje de cumplimiento de cada medida con un intervalo de confianza del 95% y se realizó una regresión logística para determinar los factores que determinan su cumplimiento. Resultados: respondieron 196 unidades (65%). 104 (53% CI95%: 46-60) cumplían menos del 50% de las medidas de PRL estudiadas. Los Hospitales Españoles de titularidad pública tienen un RR 1,975 veces mayor (IC95%: 1.11-3.52) de aplicar menos del 50% de las medidas de PRL frente a los privados. El resto de los factores estudiados no mostraron influencia significativa. Conclusiones: la aplicación de medidas de prevención de riesgos laborales en las unidades de endoscopia españolas no es adecuada y debe ser mejorada. Los hospitales públicos cumplen con menor número de medidas que los privados(AU)

The degree of Knower and compliance with occupational risk prevention measures in the Spanish gastrointestinal endoscopy units is unknown. Aim: 1. To assess compliance with occupational risk prevention measures in GIE units. 2. To determine which factors influence the fulfillment of occupational risk prevention measures. Methods: a validated survey was supplied to 300 GIE units, including questions on: 1. General occupational risk prevention measures; 2. occupational risk prevention measures during disinfection; 3. occupational risk prevention measures during examination. The following Hospital or GIE Unit characteristics were evaluated: Type of hospital according to the Spanish National Health Service; Number of hospital beds; Advanced diagnostic and therapeutic procedures performed and; Centers providing training in the field of endoscopy. Results: response: 196 GIE units (65%). 104 GIE units (53% CI95%: 46-60) fulfill less than 50% of the occupational risk prevention measures studied. The RR of less than 50% of the ORP measures being fulfilled is 1.975 times higher at public hospitals than at private facilities (CI95%: 1.11-3.52). None of the remaining factors analyzed proved to have a significant influence. Conclusions: compliance with occupational risk prevention measures in Spanish GIE units is inadequate and must be improved. Public hospitals in Spain comply with fewer occupational risk prevention measures than their private counterparts(AU)

The 6-min walk distance in healthy subjects: reference standards from seven countries.

The 6-min walk distance (6MWD) predicted values have been derived from small cohorts mostly from single countries. The aim of the present study was to investigate differences between countries and identify new reference values to improve 6MWD interpretation. We studied 444 subjects (238 males) from seven countries (10 centres) ranging 40-80 yrs of age. We measured 6MWD, height, weight, spirometry, heart rate (HR), maximum HR (HR(max)) during the 6-min walk test/the predicted maximum HR (HR(max) % pred), Borg dyspnoea score and oxygen saturation. The mean ± sd 6MWD was 571 ± 90 m (range 380-782 m). Males walked 30 m more than females (p < 0.001). A multiple regression model for the 6MWD included age, sex, height, weight and HR(max) % pred (adjusted r² = 0.38; p < 0.001), but there was variability across centres (adjusted r² = 0.09-0.73) and its routine use is not recommended. Age had a great impact in 6MWD independent of the centres, declining significantly in the older population (p < 0.001). Age-specific reference standards of 6MWD were constructed for male and female adults. In healthy subjects, there were geographic variations in 6MWD and caution must be taken when using existing predictive equations. The present study provides new 6MWD standard curves that could be useful in the care of adult patients with chronic diseases.

Measurement of body temperature in adult patients: comparative study of accuracy, reliability and validity of different devices.

BACKGROUND AND AIMS: We compared a range of alternative devices with core body temperature measured at the pulmonary artery to identify the most valid and reliable instrument for measuring temperature in routine conditions in health services. METHODS: 201 patients from the intensive care unit of the Candelaria University Hospital, Canary Islands, admitted to hospital between April 2006 and July 2007. All patients (or their families) gave informed consent. Readings from gallium-in-glass, reactive strip and digital in axilla, infra-red ear and frontal thermometers were compared with the pulmonary artery core temperature simultaneously. External factors suspected of having an influence on the differences were explored. The cut-off point readings for each thermometer were fixed for the maximum negative predictive value in comparison with the core temperature. The validity, reliability, accuracy, external influence, the waste they generated, ease of use, speed, durability, security, comfort and cost of each thermometer was evaluated. An ad hoc overall valuation score was obtained from these parameters for each instrument. RESULTS: For an error of ± 0.2°C and concordance with respect to fever, the gallium-in-glass thermometer gave the best results. The largest area under the receiver operating characteristic (ROC) curve is obtained by the digital axillar thermometer with probe (0.988 ± 0.007). The minimum difference between readings was given by the infrared ear thermometer, in comparison with the core temperature (-0.1 ± 0.3°C). Age, weight, level of conscience, male sex, environmental temperature and vaso-constrictor medication increases the difference in the readings and fever treatment reduces it, although this is not the same for all thermometers. The compact digital axillar thermometer and the digital thermometer with probe obtained the highest overall valuation score. CONCLUSION: If we only evaluate the aspects of validity, reliability, accuracy and external influence, the best thermometer would be the gallium-in-glass after 12 min. The gallium-in-glass thermometer is less accurate after only 5 min in comparison with the reading taken after being placed for 12 min. If we add the evaluation of waste production, ease-of-use, speed, durability, security, patient comfort and costs, the thermometers that obtain the highest score are the compact digital and digital with probe in right axilla.