Prediction of outcomes in subjects with type 2 diabetes and diabetic foot ulcers in Catalonian primary care centers: a multicenter observational study.

BACKGROUND: Diabetic foot and lower limb complications are an important cause of morbidity and mortality among persons with diabetes mellitus. Very few studies have been carried out in the primary care settings. The main objective was to assess the prognosis of diabetic foot ulcer (DFU) in patients from primary care centers in Catalonia, Spain, during a 12-month follow-up period. METHODS: We included participants with type 2 diabetes and a new DFU between February 2018 and July 2019. We estimated the incidence of mortality, amputations, recurrence and healing of DFU during the follow-up period. A multivariable analysis was performed to assess the association of these outcomes and risk factors. RESULTS: During the follow-up period, 9.7% of participants died, 12.1% required amputation, 29.2% had a DFU recurrence, and 73.8% healed. Having a caregiver, ischemia or infection were associated with higher mortality risk (hazard ratio [HR]:3.63, 95% confidence interval [CI]:1.05; 12.61, HR: 6.41, 95%CI: 2.25; 18.30, HR: 3.06, 95%CI: 1.05; 8.94, respectively). Diabetic retinopathy was an independent risk factor for amputation events (HR: 3.39, 95%CI: 1.37; 8.39). Increasing age decreased the risk for a DFU recurrence, while having a caregiver increased the risk for this event (HR: 0.97, 95%CI: 0.94; 0.99). The need for a caregiver and infection decreased the probability of DFU healing (HR: 0.57, 95%CI: 0.39; 0.83, HR: 0.64, 95%CI: 0.42; 0.98, respectively). High scores for PEDIS (≥7) or SINBAD (≥3) were associated with an increased risk for DFU recurrence and a lower probability of DFU healing, respectively. CONCLUSIONS: We observed high morbidity among subjects with a new DFU in our primary healthcare facilities. Peripheral arterial disease, infection, and microvascular complications increased the risk of poor clinical outcomes among subjects with DFU.

Espirometría como método de cribado y de intervención antitabaco en fumadores de alto riesgo en atención primaria / Spirometry as method of screening and intervention in high- risk smokers in primary care

Objetivo: Mostrar la efectividad del cribado en la detección de nuevos casos de enfermedad pulmonar obstructiva crónica (EPOC) en fumadores de alto riesgo, describir las características asociadas a EPOC y determinar la predisposición a dejar el tabaco. Diseño: Estudio transversal y multicéntrico. Emplazamiento: Áreas básicas de salud representativas de diferentes zonas rurales y urbanas de Lleida. Participantes: 497 fumadores activos sin EPOC de 40 a 70 años seleccionados aleatoriamente de la base de datos e-CAP de la historia clínica electrónica. Intervención: Se realiza espirometría. Se informa de los resultados espirométricos, se da consejo breve para dejar de fumar y se determina su predisposición a dejar el tabaco. Variables: Edad, género, altura, peso, hábito tabáquico, síntomas respiratorios y actividad física. Resultados: El 65,4% son hombres, edad 51±7,6 años. Fuman media de 32 paquetes/año, el 40,4% realiza actividad moderada, el 27,4% refiere algún síntoma respiratorio. El 25% presentan patrón obstructivo o mixto con grado de severidad moderado en el 75,8% de los casos. El 38,8% se plantea dejar el tabaco. Análisis multivariante, resultaron asociados a EPOC: género, edad 50 a 59 años e índice tabáquico >40. Realizar una actividad física moderada o intensa disminuye el riesgo de EPOC. Conclusiones: Realizar espirometría en fumadores de alto riesgo, mostrar los resultados espirométricos y consejo breve antitabaco permite detectar a casos de EPOC no diagnosticados previamente, ver su predisposición a dejar el tabaco y establecer un plan de tratamiento y seguimiento individualizado(AU)

Objective: To show the effectiveness of screening in the detection of new cases of COPD in smokers of high-risk, and to describe the characteristics associated with COPD, as well as determine the predisposition to quit. Design: A cross-sectional and multicentre study. Location: Basic Primary Care Centres representing different rural and urban areas of Lleida. Participants: A total of 497 active smokers without COPD from 40 to 70 years selected from the database Primary Care Database (e-CAP). Intervention: Spirometry was performed on all patients. The spirometry results were reported and brief counselling was given on quitting smoking and the readiness to stop smoking was determined. Variables: Age, gender, height, weight, smoking, respiratory symptoms and physical activity. Results: The majority of patients (65.4%) were men, age 51± 7.6 years. They smoked an average of 32 packs/year; 40.4% performed moderate activity and 27.4% referred to some respiratory symptoms. Of the 25% who had an obstructive or mixed pattern, 75.8% of the cases had a moderate level of severity. A decision to quit was made by 38.8%.In the multivariate analysis, gender, age 50 to 59 years and a smoking index >40 were associated with COPD. Moderate or intense physical activity decreased the risk of COPD. Conclusions: To perform spirometry in high-risk smokers, to show the spirometry results and give brief anti-smoking counselling, enables not previously diagnosed cases of COPD to be detected. It also helps to determine the readiness to stop smoking and to establish individualised treatment and follow-up plans(AU)

[Spirometry as method of screening and intervention in high- risk smokers in primary care]. / Espirometría como método de cribado y de intervención antitabaco en fumadores de alto riesgo en atención primaria.

OBJECTIVE: To show the effectiveness of screening in the detection of new cases of COPD in smokers of high-risk, and to describe the characteristics associated with COPD, as well as determine the predisposition to quit. DESIGN: A cross-sectional and multicentre study. LOCATION: Basic Primary Care Centres representing different rural and urban areas of Lleida. PARTICIPANTS: A total of 497 active smokers without COPD from 40 to 70 years selected from the database Primary Care Database (e-CAP). INTERVENTION: Spirometry was performed on all patients. The spirometry results were reported and brief counselling was given on quitting smoking and the readiness to stop smoking was determined. VARIABLES: Age, gender, height, weight, smoking, respiratory symptoms and physical activity. RESULTS: The majority of patients (65.4%) were men, age 51± 7.6 years. They smoked an average of 32 packs/year; 40.4% performed moderate activity and 27.4% referred to some respiratory symptoms. Of the 25% who had an obstructive or mixed pattern, 75.8% of the cases had a moderate level of severity. A decision to quit was made by 38.8%. In the multivariate analysis, gender, age 50 to 59 years and a smoking index>40 were associated with COPD. Moderate or intense physical activity decreased the risk of COPD. CONCLUSIONS: To perform spirometry in high-risk smokers, to show the spirometry results and give brief anti-smoking counselling, enables not previously diagnosed cases of COPD to be detected. It also helps to determine the readiness to stop smoking and to establish individualised treatment and follow-up plans.

Predicción del rendimiento académico en alumnos de ESO y Bachillerato mediante el Inventario Clínico para Adolescentes de Millon (escala MACI) / Prediction of academic achievement in obligatory compulsory education and baccalaureate students through the Millon Adolescent Clinical Inventory

El aumento creciente de la conflictividad en las aulas, los problemas de comportamiento entre alumnos y profesores y la aparición progresiva y creciente de trastornos de personalidad, unido a un rendimiento académico cada vez menor en algunos grupos de alumnos, al que se unen aspectos familiares disfuncionales y cuestiones sociales e interpersonales en los jóvenes cada vez más heterogéneas ha hecho plantearnos desde una perspectiva psicopatológica y clínica (dada la insuficiencia explicativa de las variables únicamente organizativas y pedagógicas de los centros de enseñanza), un estudio preferentemente correlacional multivariante (diseño “ex post facto”), con técnicas de regresión logística binaria, que intente encontrar relaciones iniciales entre variables de personalidad y educativas (rendimiento) que ayuden a clarificar dichos problemas y que puedan servir, de forma complementaria, para el diseño y puesta en práctica de programas de salud mental en la escuela, su derivación a los servicios correspondientes de la red sanitaria o la puesta en práctica de medidas psicopedagógicas más idóneas. Alrededor de 380 alumnos de un instituto público de educación secundaria (ESO -12 a 16 años- y Bachillerato -16 a 19 años-), formaron parte de esta investigación, a los que se les administró la escala MACI (entre otras), así como medidas de rendimiento escolar

The progressive increase of the conflicting in the classrooms, the behavior problems among students and teachers and the increasing appearance of personality disorders, added to a bigger academic failure in some groups of adolescents joined to social and familiar dysfunctions have done posed us, from a clinical and psychopatological perspective, a research basically correlational multivariable with binary logistic regression techniques, intending to found initial relationships between personality and educational (achievement) variables. About 380 students of Compulsory Secondary Education (ESO – 12 to 16, and Baccalaureate –16 to 19 years) were administered the Millon Adolescents Clinical Inventory (and other materials) as well as academic performance measures