Glycemic Variability and Its Association With Demographics and Lifestyles in a General Adult Population.

OBJECTIVE: The objective was to investigate glycemic variability indices in relation to demographic factors and common environmental lifestyles in a general adult population. METHODS: The A Estrada Glycation and Inflammation Study is a cross-sectional study covering 1516 participants selected by sampling of the population aged 18 years and over. A subsample of 622 individuals participated in the Glycation project, which included continuous glucose monitoring procedures. Five glycemic variability indices were analyzed, that is, SD, MAGE, MAG, CONGA1, and MODD. RESULTS: Participants had a mean age of 48 years, 62% were females, and 12% had been previously diagnosed with diabetes. In the population without diabetes, index distributions were not normal but skewed to the right. Distributional regression models that adjusted for age, gender, BMI, alcohol intake, smoking status, and physical activity confirmed that all indices were positively and independently associated with fasting glucose levels and negatively with heavy drinking. SD, MAGE, and CONGA1 were positively associated with aging, and MAG was negatively associated with BMI. None of the GVI studied were influenced by physical activity. Age-group-specific reference values are given for the indices. CONCLUSIONS: This study yielded age-specific reference values for glucose variability indices in a general adult population. Significant increases were observed with aging. Heavy drinking of more than 140 g/week was associated with significant decreases in variability indices. No differences were found between males and females. These normative ranges provide a guide for clinical care, and may offer an alternative treatment target among persons with diabetes.

La cartera de servicios en atención primaria: un rey sin camisa. Informe SESPAS 2012 / The health basket in primary care: an emperor without clothes. SESPAS Report 2012

La evolución de atención primaria como respuesta a los cambios sociales en las últimas décadas es innegable, tanto en cifras como en la percepción de los que trabajamos o somos atendidos en ella. Pero las tradicionales dificultades de definición de funciones y asignación de recursos entre los niveles asistenciales deben reconducirse para basarse en la evaluación y no en la rentabilidad política ni en el racionamiento. Se necesita un modelo que, con visión de área, integralidad y autogestión, adecue la cartera de servicios en atención primaria a la sociedad actual, a las nuevas necesidades y demandas de los ciudadanos, y al progreso legítimo de los profesionales. Un modelo con una nueva asignación de recursos, que facilite una mayor capacidad resolutiva en atención primaria y de esta forma mejorar la eficiencia en el área. Por equidad, por economías de escala, corresponde al Consejo Interterritorial, como representación de las comunidades autónomas, establecer el cuaderno de bitácora; el apoyo de la Red de Agencias de Evaluación de Tecnologías, Instituto de Información Sanitaria, Guía Salud y la participación de la sociedad civil en sus múltiples formas, pueden aportar el conocimiento y la experiencia para diseñar, implantar y evaluar actuaciones dirigidas tanto para mejorar la práctica asistencial como la infraestructura organizativa y económica necesaria para sustentarla (AU)

Despite the apparent stagnation, the development of primary care in response to social changes in recent decades is undeniable, both in figures and in the perception of those providing or using primary care. The traditional difficulties of defining roles and allocating resources among levels of care should be reassessed. A model is required that adjusts the health basket in primary care to today's society, to citizen's new needs and demands, and to the legitimate progress of health professionals, while maintaining the comprehensiveness of this level of care. A model with new resource allocation would increase decision-making in primary health care, thereby improving efficiency in this setting. With a view to equity, because of economies of scale, these changes should be agreed on by the Interregional Council, as the representative of the autonomous communities. The support of the Network of Agencies for Health Technology Assessment, the Institute for Health Information, the GuíaSalud Project and the participation of civil society in its many forms, can offer knowledge and experience for the design, implementation and evaluation of actions designed both to improve clinical practice and enhance the organizational and economic infrastructure necessary to support it (AU)

[The health basket in primary care: an emperor without clothes. SESPAS Report 2012]. / La cartera de servicios en atención primaria: un rey sin camisa. Informe SESPAS 2012.

Despite the apparent stagnation, the development of primary care in response to social changes in recent decades is undeniable, both in figures and in the perception of those providing or using primary care. The traditional difficulties of defining roles and allocating resources among levels of care should be reassessed. A model is required that adjusts the health basket in primary care to today's society, to citizen's new needs and demands, and to the legitimate progress of health professionals, while maintaining the comprehensiveness of this level of care. A model with new resource allocation would increase decision-making in primary health care, thereby improving efficiency in this setting. With a view to equity, because of economies of scale, these changes should be agreed on by the Interregional Council, as the representative of the autonomous communities. The support of the Network of Agencies for Health Technology Assessment, the Institute for Health Information, the GuíaSalud Project and the participation of civil society in its many forms, can offer knowledge and experience for the design, implementation and evaluation of actions designed both to improve clinical practice and enhance the organizational and economic infrastructure necessary to support it.

Serum levels of gamma-glutamyl transferase are associated with markers of nocturnal hypoxemia in a general adult population.

BACKGROUND: Serum gamma-glutamyl transferase (GGT) is a well-known marker of alcohol consumption and liver dysfunction. GGT is also associated with components of metabolic syndrome, cardiovascular risk factors and obstructive sleep apnea. In a population-based study, we investigated serum GGT levels in relation to markers of nocturnal hypoxemia, adjusting for potential confounders. In addition, we investigated the possible relationship between GGT concentrations and serum levels of tumour necrosis factor-alpha and interleukin-6. METHODS: Demographic data, alcohol consumption, components of metabolic syndrome, serum liver enzymes, pro-inflammatory cytokines and nocturnal pulse oximetry were available for 220 individuals, randomly selected from a general adult population. Of these, overnight polysomnography was available for 70. RESULTS: A smoothing regression model confirmed that serum GGT levels were associated positively and independently with male sex (P<0.001), ageing (P=0.001), heavy smoking (P=0.039), alcohol drinking (P<0.001), and body mass index (P=0.019). Serum GGT levels were associated negatively and independently with average arterial oxygen saturation during sleep (P=0.001). CONCLUSIONS: Serum concentrations of GGT are associated with nocturnal arterial oxygen desaturations.

[Prevalence of respiratory disorders during sleep and associated factors]. / Prevalencia de los trastornos respiratorios del sueño y factores asociados.

OBJECTIVE: To calculate the prevalence of respiratory disorders during sleep (RDS), apnoea, and related factors, in a rural population. DESIGN: Prevalence study. PARTICIPANTS: Random sample of 228 individuals chosen from a health centre's appointment records. MAIN MEASUREMENTS: Anamnesis about sleep and respiratory disorders during sleep, anthropometric measurements, Epworth Sleepiness Scale, nocturnal pulse oximetry, and polysomnography. RESULTS: Five subjects were found to have RDS plus sleepiness. The estimated prevalence of apnoea was 2.1% (95% CI, 0.3-3.9). The prevalence of RDS, daytime sleepiness and habitual snoring was 25.4% (20.2-30.5), 7.4% (3.9-10.8), and 30.7% (25.4-36.4), respectively. RDS was associated with age, body mass index (BMI), and snoring. CONCLUSIONS: RDS is a common problem in our population. In this study, age, BMI and snoring were found to be factors associated with RDS.

Prevalencia de los trastornos respiratorios del sueño y factores asociados / Prevalence of respiratory disorders during sleep and associated factors

Objetivo. Estimar la prevalencia de los trastornos respiratorios (TRS) y el síndrome de apnea durante el sueño (SAS), así como de los factores asociados, en una población rural. Diseño. Estudio de prevalencia. Participantes. Muestra aleatoria de 228 individuos elegidos del fichero de cita previa de un centro de salud. Mediciones principales. Anamnesis dirigida al sueño y trastornos respiratorios durante éste, medidas antropométricas, escala de hipersomnolencia de Epworth, pulsioximetría nocturna y polisomnografía. Resultados. Hemos encontrado 5 personas con TRS e hipersomnolencia. La prevalencia de SAS es del 2,1% (intervalo de confianza [IC] del 95%, 0,3-3,9). La prevalencia de TRS, hipersomnolencia diurna y ronquido habitual es del 25,4% (IC del 95%, 20,2-30,5), el 7,4% (IC del 95%, 3,9-10,8) y el 30,7% (IC del 95%, 25,0-36,4), respectivamente. La edad, el índice de masa corporal (IMC) y la presencia de ronquido son factores asociados a los TRS. Conclusiones. Los TRS son una entidad frecuente en nuestra población. En este estudio, la edad, el IMC y el ronquido son factores asociados con las alteraciones respiratorias del sueño

Objective. To calculate the prevalence of respiratory disorders during sleep (RDS), apnoea, and related factors, in a rural population. Design. Prevalence study. Participants. Random sample of 228 individuals chosen from a health centre's appointment records. Main measurements. Anamnesis about sleep and respiratory disorders during sleep, anthropometric measurements, Epworth Sleepiness Scale, nocturnal pulse oximetry, and polysomnography. Results. Five subjects were found to have RDS plus sleepiness. The estimated prevalence of apnoea was 2.1% (95% CI, 0.3-3.9). The prevalence of RDS, daytime sleepiness and habitual snoring was 25.4% (20.2-30.5), 7.4% (3.9-10.8), and 30.7% (25.4-36.4), respectively. RDS was associated with age, body mass index (BMI), and snoring. Conclusions. RDS is a common problem in our population. In this study, age, BMI and snoring were found to be factors associated with RDS