Assessing the Feasibility and Acceptability of a Primary Care Socio-Ecological Approach to Improve Physical Activity Adherence among People with Type 2 Diabetes: The SENWI Project.

Maintaining an active lifestyle is a key health behavior in people with type 2 diabetes (T2D). This study assessed the feasibility and acceptability of a socio-ecological Nordic walking intervention (SENWI) to enhance healthy behaviors in primary healthcare settings. Participants included individuals with T2D (n = 33; age 70 (95% CI 69-74)) and healthcare professionals (HCPs, n = 3). T2D participants were randomly assigned to a SENWI, active comparator, or control group for twelve weeks. Feasibility and acceptability were evaluated based on a mixed methodology. Quantitative data reported adherence information, differences between follow-up and dropout participants and pre- and post-intervention on physical activity, sedentary behavior, and health outcomes. Qualitative data acquisition was performed using focus groups and semi-structured interviews and analyzed using thematic analysis. Thirty-three T2D invited participants were recruited, and twenty-two (66.7%) provided post-intervention data. The SENWI was deemed acceptable and feasible, but participants highlighted the need to improve options, group schedules, gender inequities, and the intervention's expiration date. Healthcare professionals expressed a lack of institutional support and resources. Nevertheless, no significant difference between the SENWI follow-up and dropout participants or pre- and post- intervention was found (only between the active comparator and control group in the physical quality of life domain). Implementing the SENWI in primary healthcare settings is feasible and acceptable in real-world conditions. However, a larger sample is needed to assess the program's effectiveness in improving healthy behaviors and its impact on health-related outcomes in the long term.

Spanish Version of the Anterior Cruciate Ligament-Quality of Life Questionnaire: Translation, Cross-cultural Adaptation, and Validation.

Background: The Anterior Cruciate Ligament-Quality of Life (ACL-QOL) questionnaire is a patient-reported outcome measure used to assess the effect of an anterior cruciate ligament (ACL) injury on the lives of patients. It was originally written in English, which may affect its use when completed by nonnative English speakers. Purpose: To translate and adapt the ACL-QOL to Spanish and provide evidence of its psychometric properties. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 183 patients with an ACL injury from 4 Catalan hospitals were included: 99 patients who had undergone ACL reconstruction (ACLR) completed the Spanish version of the ACL-QOL (ACL-QOL-Sp) twice (mean interval, 15.2 days) in 2 weeks for test-retest reliability, and 84 patients completed the ACL-QOL-Sp, the Lysholm knee scoring scale, the Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Scale, and the 12-item Short Form Health Survey (SF-12) before and at 4 and 9 months after ACLR to assess responsiveness. The association between the ACL-QOL-Sp and the other outcome measures was evaluated with the Spearman correlation coefficient. Results: The ACL-QOL-Sp showed good internal consistency (Cronbach alpha = 0.96) and test-retest reliability (intraclass correlation coefficient = 0.97). The standard error of measurement was 3.6, also suggesting the precision of measurements. The smallest detectable change was 9.98 in 94% of patients. No association was found between the ACL-QOL-Sp score and the Tegner score or SF-12 mental component summary score; however, a moderate correlation was found with the overall KOOS score (r = -0.545), Lysholm score (r = 0.509), and SF-12 physical component summary score (r = 0.607). The correlation ranged from weak for the KOOS-Symptoms subscore (r = -0.290) to moderate for the KOOS-Quality of Life subscore (r = -0.698). No ceiling or floor effects were observed. The ACL-QOL-Sp showed a moderate effect size (0.73) at 4 months but a large effect size (1.70) at 9 months. Conclusion: The ACL-QOL-Sp showed adequate internal consistency, test-retest reliability, and responsiveness in evaluating quality of life after ACLR in Spanish-speaking patients.

Experiencias de los pacientes con diabetes sobre la promoción de la actividad física durante las consultas enfermeras en Cataluña / How patients with diabetes experience physical activity promotion during nursing consultations in the Spanish context

Objetivo: Aunque la actividad física (AF) es un comportamiento clave para el control de la diabetes tipo 2 (DT2), los problemas de adopción-adherencia a la AF dificultan el manejo de la enfermedad. Este estudio tiene como objetivo entender cómo los pacientes con DT2 experimentan la promoción de la AF durante las consultas de enfermería en centros de atención primaria de Cataluña. Método: Estudio cualitativo. Entre 2019-2020, en pre-COVID-19, 22 pacientes con DT2 de la provincia de Barcelona participaron en cinco grupos focales y/o cuatro entrevistas semiestructuradas. Todas las reuniones fueron registradas, transcritas y analizadas usando el enfoque de análisis de contenido convencional a través del método comparativo constante. Resultados: El análisis de datos reveló dos temas principales con 16 subtemas. Los dos temas principales fueron: «Procesos conscientes intrapersonales de adopción de la AF» y «Procesos inconscientes estructurales de (no)adherencia a la AF». Conclusión: La experiencia de los pacientes refleja dos problemas concurrentes e interconectados. En primer lugar, la mayoría adoptan rápidamente la AF después del apoyo de las enfermeras, los cuales fueron los principales promotores de la AF. En efecto, según los pacientes, la adopción de la AF parece ser la prioridad de la mayoría de las enfermeras. En segundo lugar, los pacientes perciben que pocas enfermeras dedican tiempo a la adherencia, lo que la convierte en un problema casi universal y una fuente de decepción para el paciente. Para la adherencia, los pacientes experimentan que la atención de las enfermeras debe centrarse en la activación de procesos y habilidades que apoyen la participación continua en la AF ya adoptada.(AU)

Objective: Although physical activity (PA) is a key behaviour for controlling Type 2 Diabetes, problematic adoption and/or adherence continues to impair disease management. This study aims to understand how patients with T2D live and experience nurses PA promotion during consultations in Spanish context. Method: The present study is a qualitative research. In 2019-2020, pre-COVID-19, 22 people living with T2D from Barcelona province contributed either to focus groups (n = 5) or to semi-structured interviews (n = 4). All interviews were recorded, transcribed, and analysed using conventional content analysis approach through constant comparative method. Results: Data analysis revealed two major themes with 16 subthemes. The two major themes include: «Intra-personal conscious PA adoption processes» and «Structural unconscious PA (non)adherence processes». Conclusion: Patients’ experiences reflect two concurrent and interconnected issues. First, most patients readily adopted new PA after encouragement from nurses, who were the main proponents of PA. Indeed, adoption seemed to be most nurses’ PA priority and it was effective for most patients. Second, few nurses discussed adherence, making it an almost universal problem and source of disappointment. For adherence, patients experience that nurses’ attention needs to focus on activating processes and skills that support continued involvement in already-adopted PA.(AU)

How patients with diabetes experience physical activity promotion during nursing consultations in the Spanish context.

OBJECTIVE: Although physical activity (PA) is a key behaviour for controlling Type 2 Diabetes, problematic adoption and/or adherence continues to impair disease management. This study aims to understand how patients with T2D live and experience nurses PA promotion during consultations in Spanish context. METHOD: The present study is a qualitative research. In 2019-2020, pre-COVID-19, Twenty-two people living with T2D from Barcelona province contributed either to focus groups (n = 5) or to semi-structured interviews (n = 4). All interviews were recorded, transcribed, and analysed using conventional content analysis approach through constant comparative method. RESULTS: Data analysis revealed two major themes with sixteen subthemes. The two major themes include: "Intra-personal conscious PA adoption processes" and "Structural unconscious PA (non)adherence processes". CONCLUSION: Patients' experiences reflect two concurrent and interconnected issues. First, most patients readily adopted new PA after encouragement from nurses, who were the main proponents of PA. Indeed, adoption seemed to be most nurses' PA priority and it was effective for most patients. Second, few nurses discussed adherence, making it an almost universal problem and source of disappointment. For adherence, patients experience that nurses' attention needs to focus on activating processes and skills that support continued involvement in already-adopted PA.

A socio-ecological approach to reduce the physical activity drop-out ratio in primary care-based patients with type 2 diabetes: the SENWI study protocol for a randomized control trial.

BACKGROUND: Physical activity (PA) is a key behaviour for patients with type 2 diabetes (T2DM). However, healthcare professionals' (HCP) recommendations (walking advice), which are short-term and individually focused, did not reduce the PA drop-out ratio in the long run. Using a socio-ecological model approach may contribute to reducing patient dropout and improving adherence to PA. The aim of this study is threefold: first, to evaluate the effectiveness of a theory-driven Nordic walking intervention using a socio-ecological approach with T2DM patients in Spain; second, to explore the feasibility on the PA adherence process in T2DM patients while participating in the SENWI programme; and third, to understand the HCPs' opinion regarding its applicability within the Spanish healthcare system. METHODS: A three-arm randomized control trial (n = 48 each group) will assess the efficacy of two primary care-based PA interventions (Nordic walking vs. Nordic walking plus socio-ecological approach; two sessions per week for twelve weeks) compared to a control group (usual HCPs' walking advice on PA). Inclusion criteria will include physically inactive patients with T2DM, older than 40 years and without health contraindications to do PA. PA levels and drop-out ratio, quality of life and metabolic and health outcomes will be assessed at baseline, post-intervention and at 9- and 21-month follow-ups. The effect of the different interventions will be assessed by a two-factor analysis of variance: treatment group vs time. Also, a two-factor ANOVA test will be performed with linear mixed models for repeated measures. A qualitative analysis using focus groups will explore the reasons for the (in)effectiveness of the new PA interventions. Qualitative outcomes will be assessed at post-intervention using thematic analysis. DISCUSSION: Compared with the general PA walking advice and Nordic walking prescriptions, integrating a socio-ecological approach into Spanish primary care visits could be an effective way to reduce the PA drop-out ratio and increase PA levels in patients with T2DM. Such interventions are necessary to understand the role that multiple socio-complex process in day-to-day PA behaviour has in patients with T2DM in the Spanish context. TRIAL REGISTRATION: ClinicalTrials.gov NCT05159089. Physical Activity Drop-out Ratio in Patients' Living with Type 2 Diabetes. Prospectively registered on 15 December 2021.

Análisis del ajuste de mascarillas autofiltrantes en combinación con las mascarillas quirúrgicas para la protección del profesional sanitario en su atención a pacientes afectos de SARS-COV-2 a partir de un estudio experimental / Analysis of the adjustment of self-filtering masks in combination with surgical masks for the protection of health professionals in the care of patients sffected by SARS-COV-2 from an experimental study

Introducción: Un componente importante del equipo de protección individual (EPI) frente al SARS-CoV-2 son las mascarillas quirúrgicas y las mascarillas autofiltrantes (FFP). La norma europea EN 149 establece y clasifica las mascarillas autofiltrantes en tres niveles de protección dependiendo del porcentaje de fuga del total de partículas en suspensión del aire exterior hacia el aire interior FFP1, FFP2, FFP3. El objetivo de este e ensayo de laboratorio es determinar y cuantificar el nivel de ajuste de las mascarillas autofiltrantes FFP2 combinadas con las mascarillas quirúrgicas mediante series de pruebas de ajuste (fit test). Material y Métodos: Se utilizó el equipo medidor de ajuste de mascarillas FFP modelo PortaCount® Pro + 8038 compatible con las normas y metodología de la OSHA (Occupational Safety and Health Administration) de los EEUU. Se realizaron series de pruebas de ajuste sobre diferentes modelos de mascarillas autofiltrantes FFP2 con y sin mascarilla quirúrgica para diferentes situaciones de respiración del trabajador participante en este experimento. Resultados: El uso de la mascarilla quirúrgica sobre una mascarilla autofiltrante FFP2 aporta una mejora en la protección respiratoria determinante, incrementando el factor de ajuste hasta de +200 (el factor de ajuste mínimo debe ser 100). Conclusiones: Las mascarillas quirúrgicas cuando se usan conjuntamente con las mascarillas autofiltrantes, podrían mejorar significativamente el grado de ajuste de todas las mascarillas autofiltrantes proporcionando una mayor eficacia de filtración y una mayor protección al usuario frente a la exposición a aerosoles (AU)

Introduction: Frontline healthcare workers have a high risk of exposure to SARS-CoV-2 coronavirus, which causes COVID-19. The use of appropriate personal protective equipment (PPE) is essential to prevent this occupational disease. Surgical masks and filtering face piece (FFP) respirators are important parts of this PPE. European standard EN 149 establishes three protection levels for FFP respirators (FFP1, FFP2, FFP3), depending on the particle infiltration degree through their materials, and these, in turn, are based on their filtration effectiveness. The aim of this laboratory test is to determine and quantify the filtration and fit rate of different FFP respirators, singly and in combination with surgical masks, by performing a series of fit tests and consequently, to check whether this combination improves protection levels for healthcare workers who care for COVID-19 patients. Material and Methods: Several FFP respirators and surgical masks, singly and in combination, were fit tested with a PortaCount Pro + 8038, which fulfills OSHA standards, in a series of tests performed on healthcare workers in seven different breathing situations when taking care on COVID-19 patients, in order to determine and quantify their fit to the workers' face. Results: Wearing a surgical mask together with a highly efficient FFP respirator provided increased respiratory protection. Interestingly, one of these highly efficient FFP models, combined with a surgical mask, achieved a protection factor over 200 (whereas 100 is the minimum required protection factor). Conclusions: Surgical masks, when used together with a FFP2 respirator, could significantly improve the degree of fit of all self-filtering face piece by providing greater filtration efficiency and greater user protection from exposure to aerosols (AU)

[Analysis of the Adjustment of Self-Filtering Masks in Combination with Surgical Masks for the Protection of Health Professionals in the Care of Patients Affected by SARS-COV-2 from an Experimental Study]. / Análisis del ajuste de mascarillas autofiltrantes en combinación con las mascarillas quirúrgicas para la protección del profesional sanitario en su atención a pacientes afectos de SARS-COV-2 a partir de un estudio experimental.

INTRODUCTION: Frontline healthcare workers have a high risk of exposure to SARS-CoV-2 coronavirus, which causes COVID-19. The use of appropriate personal protective equipment (PPE) is essential to prevent this occupational disease. Surgical masks and filtering face piece (FFP) respirators are important parts of this PPE. European standard EN 149 establishes three protection levels for FFP respirators (FFP1, FFP2, FFP3), depending on the particle infiltration degree through their materials, and these, in turn, are based on their filtration effectiveness. The aim of this laboratory test is to determine and quantify the filtration and fit rate of different FFP respirators, singly and in combination with surgical masks, by performing a series of fit tests and consequently, to check whether this combination improves protection levels for healthcare workers who care for COVID-19 patients. MATERIAL AND METHODS: Several FFP respirators and surgical masks, singly and in combination, were fit tested with a PortaCount Pro + 8038, which fulfills OSHA standards, in a series of tests performed on healthcare workers in seven different breathing situations when taking care on COVID-19 patients, in order to determine and quantify their fit to the workers' face. RESULTS: Wearing a surgical mask together with a highly efficient FFP respirator provided increased respiratory protection. Interestingly, one of these highly efficient FFP models, combined with a surgical mask, achieved a protection factor over 200 (whereas 100 is the minimum required protection factor). CONCLUSIONS: Surgical masks, when used together with a FFP2 respirator, could significant ly improve the degree of fit of all self-filtering face piece by providing greater filtration efficiency and greater user protection from exposure to aerosols.

INTODUCCIÓN: Un componente importante del equipo de protección individual (EPI) frente al SARS-CoV-2 son las mascarillas quirúrgicas y las mascarillas autofiltrantes (FFP). La norma europea EN 149 establece y clasifica las mascarillas autofiltrantes en tres niveles de protección dependiendo del porcentaje de fuga del total de partículas en suspensión del aire exterior hacia el aire interior FFP1, FFP2, FFP3. El objetivo de este e ensayo de laboratorio es determinar y cuantificar el nivel de ajuste de las mascarillas autofiltrantes FFP2 combinadas con las mascarillas quirúrgicas mediante series de pruebas de ajuste (fit test). MATERIAL Y MÉTODOS: Se utilizó el equipo medidor de ajuste de mascarillas FFP modelo PortaCount® Pro + 8038 compatible con las normas y metodología de la OSHA (Occupational Safety and Health Administration) de los EEUU. Se realizaron series de pruebas de ajuste sobre diferentes modelos de mascarillas autofiltrantes FFP2 con y sin mascarilla quirúrgica para diferentes situaciones de respiración del trabajador participante en este experimento.  RESULTADOS: El uso de la mascarilla quirúrgica sobre una mascarilla autofiltrante FFP2 aporta una mejora en la protección respiratoria determinante, incrementando el factor de ajuste hasta de +200 (el factor de ajuste mínimo debe ser 100). CONCLUSIONES: Las mascarillas quirúrgicas cuando se usan conjuntamente con las mascarillas autofiltrantes, podrían mejorar significativamente el grado de ajuste de todas las mascarillas autofiltrantes proporcionando una mayor eficacia de filtración y una mayor protección al usuario frente a la exposición a aerosoles.

Drop-out ratio between moderate to high-intensity physical exercise treatment by patients with, or at risk of, type 2 diabetes mellitus: A systematic review and meta-analysis.

AIMS: Physical exercise represents the cornerstone in the treatment for patients with type 2 diabetes mellitus (T2DM). However, it is not clear how different physical exercise intensities might affect the drop-out ratio. The aim of this review is to examine the extent to which exercise interventions impact dropout risk in patients with, or at risk of, T2DM. METHODS: A Systematic review and meta-analysis of dropouts to aerobic exercise training interventions of varying intensity were conducted. Randomized controlled trials with exercise interventions on patients with, or at risk of, T2DM were included. The intervention had to last a minimum of three months and the studies had to include at least two groups (moderate- vs high-intensity exercise). RESULTS: Twenty-three studies were selected for both systematic revision and meta-analysis. Although no difference between intensities groups have been seen (OR 1,12 [CI95% 0,85-1,47] p = 0,41), high intensity exercise training has a higher dropout risk than moderate exercise when both are conducted over a similar time period (OR 1,81 [CI95% 1,12-2,91] p=0,01). CONCLUSION: It seems that high-intensity protocols did not decrease drop-out ratio. Although high-intensities are more time efficient than moderate intensities, the difficult to carry on the exercise might also become a barrier to take into consideration. Further research is needed to explore barriers and enablers to better understand patients' participation.