Healthcare use among people with diabetes mellitus in Europe: a population-based cross-sectional study.

OBJECTIVE: This study aimed to determine the association of health determinants, lifestyle and socioeconomic variables on healthcare use in people with diabetes in Europe. DESIGN: A cross-sectional study was conducted using data from the European Health Interview Survey wave 2 (ie, secondary analysis). SETTING: The sample included data from 25 European countries. PARTICIPANTS: The sample included 16 270 patients with diabetes aged 15 years or older (49.1% men and 50.9% women). RESULTS: The survey data showed that 58.2% of respondents had seen their primary care physician in the past month and 22.6% had been admitted to the hospital in the past year. Use of primary care was associated with being retired (prevalence ratio (PR) 1.13, 95% CI 1.07 to 1.19) and having very poor self-perceived health (PR 1.80, 95% CI 1.51 to 2.15), long-standing health problems (PR 1.14, 95% CI 1.04 to 1.24), high blood pressure (PR 1.06, 95% CI 1.03 to 1.10) and chronic back pain (PR 1.07, 95% CI 1.04 to 1.11). Hospital admission was associated with very poor self-perceived health (PR 3.03, 95% CI 2.14 to 4.31), accidents at home (PR 1.54, 95% CI 1.40 to 1.69), chronic obstructive pulmonary disease (COPD) (PR 1.34, 95% CI 1.22 to 1.47), high blood pressure (PR 1.08, 95% CI 1.01 to 1.17), chronic back pain (PR 0.91, 95% CI 0.84 to 0.98), moderate difficulty walking (PR 1.33, 95% CI 1.21 to 1.45) and severe difficulty walking (PR 1.67, 95% CI 1.51 to 1.85). CONCLUSIONS: In the European diabetic population, the high cumulative incidences of primary care visits and hospital admissions are associated with labour status, alcohol consumption, self-perceived health, long-standing health problems, high blood pressure, chronic back pain, accidents at home, COPD and difficulty walking.

Risk Factors for Cancer Mortality in Spain: Population-Based Cohort Study.

BACKGROUND: Cancer is considered a major public health problem due to its increasing incidence and high mortality. This study aims to identify risk factors for cancer mortality in Spain. METHODS: Retrospective population-based cohort study in 20,397 participants of the 2011/2012 National Health Survey in Spain. Risk factors associated with mortality due to neoplasm from 2011 to 2017 were analyzed, and hazard ratios were calculated with a multivariate Cox model with competing risks for mortality from other causes. RESULTS: Myocardial infarction, chronic obstructive pulmonary disease, cirrhosis, and mental disorders were associated with an increased risk of mortality due to neoplasm. Male sex, age over 50 years, history or current smoking habit, negligible intake of legumes, and poorer self-perceived health were also associated with increased cancer mortality. CONCLUSIONS: Comorbidities, tobacco use, poor diet, and worse self-perceived health were the main risk factors for cancer mortality in Spain.

Prevalencia del síndrome de burnout en profesionales de medicina y enfermería de Atención Primaria en centros de salud acreditados para Formación Sanitaria Especializada de dos áreas de salud de Alicante / Prevalence of burnout syndrome in Primary Care medicine and nursing professionals in accredited health centres for specialized training in two Alicante health areas

Objetivo: estimar la prevalencia del síndrome de burnout en profesionales de medicina y enfermería de los centros de salud acreditados para formación sanitaria especializada de las Áreas de Salud de Elda y Alicante-San Juan. Diseño: estudio descriptivo observacional transversal. Emplazamiento: estudio multicéntrico realizado en equipos de Atención Primaria de dos áreas de salud de la Comunidad Valenciana. Participantes: profesionales de enfermería y medicina de Atención Primaria de las Áreas de Salud participantes.Mediciones principales: prevalencia de burnout a través del cuestionario validado Maslach Burnout Inventory y variables sociodemográficas y laborales. Análisis descriptivo de las variables cualitativas mediante cálculo de frecuencias y comparación de proporciones (test chi-cuadrado) para el análisis de la asociación entre las mismas. Resultados: se analizaron 125 cuestionarios (porcentaje de respuesta 54%). La prevalencia de burnout fue alta en la población estudiada: el 56,8% mostró agotamiento emocional (siendo la dimensión más afectada); 39,2%, alto grado de despersonalización, y 36%, realización personal baja. La afectación de dos subescalas (burnout moderado-grave) fue mayor en los profesionales de medicina de forma estadísticamente significativa (p = 0,002). No se objetivó asociación estadísticamente significativa entre el burnout y las variables sociodemográficas y laborales. Conclusiones: la prevalencia de burnout es elevada en los profesionales de medicina y enfermería de Atención Primaria.(AU)

Objective: to estimate the prevalence of burnout syndrome in physicians and nurses of accredited health centres for Specialized Health Training in Elda and Alicante-San Juan Health Areas. Design: Descriptive observational cross-sectional study. Location: a multicentre study performed by Primary Care professionals of two Health Departments in the Valencian Community. Participants: primary care healthcare professionals (physicians and nurses) from the Health Departments taking part. Main measurements: prevalence of burnout using the validated Maslach Burnout Inventory questionnaire and socio-demographic and work-related variables. A descriptive analysis of the qualitative variables was performed by calculating frequencies and comparison of proportions (Chi-square test) to analyze the association between them. Results: a total of 125 questionnaires were analyzed (response rate 54%). The prevalence of burnout was high: 56.8%, 39.2% and 36.0% revealed a high degree of emotional exhaustion (the most affected dimension), depersonalization and low personal fulfilment, respectively. The involvement of two subscales (moderate-severe burnout) was statistically significantly higher in medical professionals (P=0.002). No statistically significant association was observed between burnout and sociodemographic and work-related variables. Conclusions: the prevalence of burnout is high in primary care medical and nursing professionals.(AU)

Factors Associated with Acute Community-Acquired Pyelonephritis Caused by Extended-Spectrum ß-Lactamase-Producing Escherichia coli.

This study aimed to identify the factors associated with the presence of extended-spectrum ß-lactamase-(ESBL) in patients with acute community-acquired pyelonephritis (APN) caused by Escherechia coli (E. coli), with a view of optimising empirical antibiotic therapy in this context. We performed a retrospective analysis of patients with community-acquired APN and confirmed E. coli infection, collecting data related to demographic characteristics, comorbidities, and treatment. The associations of these factors with the presence of ESBL were quantified by fitting multivariate logistic models. Goodness-of-fit and predictive performance were measured using the ROC curve. We included 367 patients of which 51 presented with ESBL, of whom 90.1% had uncomplicated APN, 56.1% were women aged ≤55 years, 33.5% had at least one mild comorbidity, and 12% had recently taken antibiotics. The prevalence of ESBL-producing E. coli was 13%. In the multivariate analysis, the factors independently associated with ESBL were male sex (OR 2.296; 95% CI 1.043-5.055), smoking (OR 4.846, 95% CI 2.376-9.882), hypertension (OR 3.342, 95% CI 1.423-7.852), urinary incontinence (OR 2.291, 95% CI 0.689-7.618) and recurrent urinary tract infections (OR 4.673, 95% CI 2.271-9.614). The area under the ROC curve was 0.802 (IC 95% 0.7307-0.8736), meaning our model can correctly classify an individual with ESBL-producing E. coli infection in 80.2% of cases.

Degree of Accuracy of the BMI Z-Score to Determine Excess Fat Mass Using DXA in Children and Adolescents.

Obesity is caused by fat accumulation. BMI Z-score is used to classify the different degrees of weight status in children and adolescents. However, this parameter does not always express the true percentage of body fat. Our objective was to determine the degree of agreement between the fat mass percentage measured by DXA and the stratification of weight according to BMI Z-score in the pediatric age group. We designed a descriptive cross-sectional study. The patients were classified as underweight/normal weight with Z-scores between -2 and +0.99, overweight from 1 to 1.99, obese from 2 to 2.99, and very obese ≥3. We included 551 patients (47% girls), with a mean age of 11.5 ± 2.8 years (3.7-18 years). Higher BMI Z-scores were associated with a higher percentage of total fat (p < 0.001). However, there were important overlaps between both parameters, such that the BMI Z-score classified patients with the same percentage of total fat mass as having a different nutritional status classification. In conclusion, the stratification of weight status according to BMI Z-score revealed that 46.7% of patients had a fat percentage that did not correspond to their classification. For a more accurate weight assessment in clinical practice, we recommend combining anthropometric indices with diagnostic tools that better correlate with DXA, such as electrical bioimpedance.

Prevalence of Computer Vision Syndrome and Its Relationship with Ergonomic and Individual Factors in Presbyopic VDT Workers Using Progressive Addition Lenses.

This cross-sectional study estimated computer vision syndrome (CVS) prevalence and analysed its relationship with video display terminal (VDT) exposure, as well as sociodemographic, refractive, environmental, and ergonomic characteristics in 109 presbyopic VDT workers wearing progressive addition lenses (PALs). Usual spectacles were measured with a lens analyser, and subjective refraction was performed by an optometrist. CVS was measured with the CVS-Q©. VDT exposure was collected. Ergonomic evaluations were conducted in a normal working posture looking at the screen. Air temperature and relative humidity were measured (thermohygrometer), and illumination was measured (luxmeter). Descriptive analysis and differences in CVS prevalence, as a function of the explanatory variables, were performed (chi-square test). Multivariate logistic regression was used to identify factors associated with CVS (OR and 95% CI). The mean age was 54.0 ± 4.8 years, and 43.1% were women. The mean hours of VDT use at work was 6.5 ± 1.3 hours/day. The prevalence of CVS was 74.3%. CVS was significantly associated with women (OR 3.40; 95% CI, 1.12-10.33), non-neutral neck posture (OR 3.27; 95% CI, 1.03-10.41) and altered workplace lighting (OR 3.64; 95% CI, 1.22-10.81). Providing training and information to workers regarding the importance of adequate lighting and ergonomic postures during VDT use is advised to decrease CVS and increase workplace quality of life.