[Can we prevent falls in the elderly from primary care?]. / ¿Podemos desde atención primaria prevenir las caídas en las personas mayores?

OBJECTIVE: To determine the effectiveness of multifactorial intervention by Primary Care in the prevention of falls in the elderly who had fallen the year before. DESIGN: Intervention study with a control group. SETTING: Three clinics in a rural area. SUBJECTS: 224 patients > or = 65 years, independent for mobility (113 in the intervention (IG) and 111 in the control (GC) group. INTERVENTIONS: Intervention Group. INITIAL ASSESSMENT: 1) Demographic data questionnaire, number, circumstances and consequences of falls, comorbidity and drugs. 2) Oriented examination. 3) Home risks assessment. INTERVENTIONS: referred to cardiology if arrhythmia or bradycardia, referred for eye examination if changes in acute vision, recommendation for systems support if gait or balance problems, postural measures if orthostatic hypotension, behavioural measures in urinary incontinence and recommendations to modify home risks. CONTROL GROUP: Questionnaire on: demographic data, number, circumstances and consequences of falls and medication use. They received normal medical care. RESULTS: At one year 44% of the IG and 33% in the CG fell again (P=0.123). In the sub-group with more than one fall at the beginning of the study, 63% in the IG, and 56% in CG fell again (P=0.599). There were serious consequences in 6% of the IG compared to 14% in the CG (P=0.277). CONCLUSIONS: Multifactorial intervention from primary care is not effective in reducing falls or for reducing the severity of their consequences.

Decreased Consumption of Added Fructose Reduces Waist Circumference and Blood Glucose Concentration in Patients with Overweight and Obesity. The DISFRUTE Study: A Randomised Trial in Primary Care.

The relationship between fructose intake and insulin resistance remains controversial. Our purpose was to determine whether a reduction in dietary fructose is effective in decreasing insulin resistance (HOMA2-IR). This field trial was conducted on 438 adults with overweight and obese status, without diabetes. A total of 121 patients in a low fructose diet (LFD) group and 118 in a standard diet (SD) group completed the 24-week study. Both diets were prescribed with 30-40% of energy intake restriction. There were no between-group differences in HOMA2-IR. However, larger decreases were seen in the LFD group in waist circumference (-7.0 vs. -4.8 = -2.2 cms, 95% CI: -3.7, -0.7) and fasting blood glucose -0.25 vs. -0.11 = -0.14 mmol/L, 95% CI: -0.028, -0.02). The percentage of reduction in calorie intake was similar. Only were differences observed in the % energy intake for some nutrients: total fructose (-2 vs. -0.6 = -1.4, 95% CI: -2.6, -0.3), MUFA (-1.7 vs. -0.4 = -1.3, 95% CI: -2.4, -0.2), protein (5.1 vs. 3.6 = 1.4, 95% CI: 0.1, 2.7). The decrease in fructose consumption originated mainly from the reduction in added fructose (-2.8 vs. -1.9 = -0.9, 95% CI: -1.6, -0.03). These results were corroborated after multivariate adjustments. The low fructose diet did not reduce insulin resistance. However, it reduced waist circumference and fasting blood glucose concentration, which suggests a decrease in hepatic insulin resistance.

Effectiveness of a low-fructose and/or low-sucrose diet in decreasing insulin resistance (DISFRUTE study): study protocol for a randomized controlled trial.

BACKGROUND: Research published to date on the relationship between insulin resistance (IR) and fructose consumption is scarce, has used different methods, and has yielded sometimes contradictory results. This study aims to determine whether a low-fructose and/or low-sucrose diet supervised by a physician or nurse decreases IR compared to a standard diet. METHODS/DESIGN: This field trial is located at primary care centers. The participants are adults aged 29 to 66 years, with a Body mass Index (BMI) between 29 and 40.99 kg/m2 and without diabetes. To date, 245 participants have been assigned randomly to the low-fructose diet intervention group (LFDI) at health centers in the western health service zone of Tenerife island, and 245 to the standard-diet control group (SDC) at health centers in the eastern health service zone. Recruitment is opportunistic and is carried out by physicians and nurses at participating health centers. Initially (baseline), and after 24 weeks of intervention, dietary records, physical activity, waist circumference, BMI, blood pressure, fasting blood glucose and insulin concentrations (HOMA2-IR) and lipid profile are recorded; blood glucose and insulin and lipid profile are also recorded 2 h after a 75-g glucose overload. After 48 weeks (24 weeks after the intervention), fasting blood samples are again obtained and a physical examination is performed. All tests and measures are repeated and recorded except dietary records, physical activity and oral glucose overload. Low-fructose diets are designed by calculating free and total (free + fructose associated with sucrose) fructose contents in standard diets, and removing foods with a fructose content in the highest quartile for the amounts in the standard diet. Participants in both groups are prescribed a diet that contains 30 to 40% less than the participant's energy requirements. The primary endpoint is change in HOMA2-IR between baseline and week 24, and other outcomes are change in HDL-cholesterol, LDL-cholesterol, triglycerides , waist circumference to height ratio and BMI. The secondary endpoint is change in HOMA2-IR between week 24 and week 48 together with the outcomes noted above. Comparisons between groups for variables used to indicate IR levels are done with a Student's t test for unpaired variables or the Mann-Whitney U test if the distribution is not normal. Multivariate regression models will be used to control for confounding factors not accounted for in the study design, and for independent prognostic factors. DISCUSSION: If the dietary intervention being tested, i.e., a diet low in fructose/sucrose, is able to reduce IR, the results - if translated into regular clinical practice - could provide a hitherto unavailable tool to prevent type-2 diabetes mellitus. TRIAL REGISTRATION: ISRCTN, ID: ISRCTN41579277 . Registered retrospectively on 15 November 2016.

[Opportune intervention of family doctors in the programme of early detection of breast cancer]. / Intervención oportunista de los médicos de familia en el programa de diagnóstico precoz del cáncer de mama.

OBJECTIVE: To study to what extent a brief intervention increases the rate of participation in the programme of early diagnosis of breast cancer (EDBC). DESIGN: Before-and-after intervention study without a control group on women who had not had a mammography. SETTING: Primary care: 3 rural lists and 2 urban ones. PARTICIPANTS: All women between 52 and 67 who attended the clinic during a 6-month period. INTERVENTION: If they had had no mammography in the previous 2 years, the reasons were explored and a brief structured intervention, depending on the reason, was conducted. After this, the woman was invited to make an appointment with the EDBC Unit. MAIN MEASUREMENTS: Effective intervention: checking that the mammography had been done at the EDBC Unit. It was checked whether women who had not attended for consultation attended the unit with their mammography done. RESULTS: Out of a target population of 565 women, 403 (71%) attended for consultation. Of these, 315 (78%) were in the programme, 51 (13%) had had a mammography outside the programme, and 37 (9%) had not had a mammography. After the intervention, 21 women had a mammography (56.7% [95% CI, 41-73] success of intervention). Seventy of the 162 women who did not attend for consultation had a mammography in the programme. The rate of participation in the EDBC rose from 68% (385/565) to 72% (406/565). CONCLUSIONS: The brief intervention was effective in over half the women. This small increase contributed to reaching the minimum levels of coverage recommended in a programme of this kind.

¿Podemos desde atención primaria prevenir las caídas en las personas mayores? / Can we prevent falls in the elderly from primary care?

Objetivo. Determinar la efectividad de una intervención multifactorial en atención primaria para prevenir caídas en personas mayores que se habían caído el año anterior. Diseño. Estudio de intervención con grupo control. Emplazamiento. Tres consultorios de área rural. Sujetos. Doscientos veinticuatro pacientes de 65 años o mayores, independientes para la movilidad (113 en el grupo de intervención [GI] y 111 en el de control [GC]). Intervenciones. Se intervino a los pacientes del GI. Valoración inicial. 1) Cuestionario de datos demográficos, número, circunstancias y consecuencias de las caídas, comorbilidad y fármacos; 2) exploración orientada, y 3) valoración domiciliaria de riesgos. Intervención. Remisión a cardiología si presentaba arritmia o bradicardia, remisión a valoración ocular si presentaba alteración de agudeza visual, modificación en fármacos de riesgo, recomendación de sistemas de apoyo si presentaba trastornos de marcha o equilibrio, medidas posturales si presentaba hipotensión ortostática, medidas conductuales en incontinencia urinaria y recomendación de modificación de riesgos en domicilios. Grupo control. Cuestionario de datos demográficos, número y consecuencias de las caídas, comorbilidad y uso de fármacos. Reciben la atención médica habitual. Resultados. Al año se había vuelto a caer el 44% del GI y el 33% del GC (p=0,123). En el subgrupo con más de una caída al inicio, en el GI se volvió a caer el 63% y en el GC el 56% (p=0,599). El GI presentó un 6% de consecuencias graves frente al 14% en el GC (p=0,277). Conclusiones. La intervención multifactorial en atención primaria no es efectiva para disminuir las caídas ni para reducir la gravedad de sus consecuencias (AU)

Objective: To determine the effectiveness of multifactorial intervention by Primary Care in the prevention of falls in the elderly who had fallen the year before. Design: Intervention study with a control group. Setting: Three clinics in a rural area. Subjects: 224 patients Z65 years,independent for mobility (113 in the intervention (IG) and 111 in the control(GC)group. Interventions: Intervention Group. Initial assessment: 1) Demographic data questionnaire,number,circumstances and consequences off alls, comorbidity and drugs. 2)Oriented examination. 3)Home risks assessment. Interventions: referred to cardiology if arrhythmia or bradycardia, referred for eye examination if changes in acute vision, recommendation for systems support if gait or balance problems, postural measures if orthostatichy potension, behavioural measures in urinary incontinence and recommendations to modify home risks. Control group: Questionnaire on: demographic data, number, circumstances and consequences off alls and medication use. They received normal medical care. Results: At one year 44% of the IGand 33% in the CG fell again(P = 0.123).In the sub-group with more than one fall at the beginning of the study,63% in theIG,and 56%in CG fell again (P = 0.599). There were serious consequences in 6% of the IG compared to 14% in the CG (P=0.277). Conclusions: Multifactorial intervention from primary care is not effective in reducing falls or for reducing the severity of their consequences (AU)

Intervención oportunista de los médicos de familia en el programa de diagnóstico precoz del cáncer de mama / Opportune intervention of family doctors in the programme of early detection of breast cancer

Objetivo. Estudiar en qué medida una intervención breve aumenta la tasa de participación del programa de diagnóstico precoz de cáncer de mama (PDPCM). Diseño. Estudio de intervención antes-después sin grupo control. Emplazamiento. Atención primaria: 3 cupos rurales y 2 urbanos. Participantes. Todas las mujeres de 52 a 67 años que durante 6 meses acudieron a consulta. Intervención. En las mujeres que en los 2 años previos no se había realizado mamografía, se exploraban las razones y se realizaba una intervención breve estructurada en función de la causa. Tras esto se las invitaba a solicitar cita a la unidad del PDPCM. Mediciones principales. Se comprobó la realización de la mamografía en la unidad del PDPCM. Resultados. De una población objetivo del estudio de 565 mujeres, acudieron a consulta 403 (71%). De ellas, 315 (78,%) estaban en programa, 51 (13%) se habían realizado una mamografía fuera del programa y 37 (9%) no se habían hecho mamografía. Tras la intervención, 21 (56,7% [intervalo de confianza del 95%, 41-73] de éxito de la intervención) se hicieron la mamografía; 70 de las 162 mujeres que no acudieron a consulta tenían mamografía realizada en programa. La tasa de participación del PDPCM subió del 68% (385/565) al 72% (406/565). Conclusiones. La intervención breve es efectiva en más de la mitad de las mujeres. Este pequeño incremento contribuyó a alcanzar la cobertura mínima recomendable en un programa de este tipo

Objective. To study to what extent a brief intervention increases the rate of participation in the programme of early diagnosis of breast cancer (EDBC). Design. Before-and-after intervention study without a control group on women who had not had a mammography. Setting. Primary care: 3 rural lists and 2 urban ones. Participants. All women between 52 and 67 who attended the clinic during a 6-month period. Intervention. If they had had no mammography in the previous 2 years, the reasons were explored and a brief structured intervention, depending on the reason, was conducted. After this, the woman was invited to make an appointment with the EDBC Unit. Main measurements. Effective intervention: checking that the mammography had been done at the EDBC Unit. It was checked whether women who had not attended for consultation attended the unit with their mammography done. Results. Out of a target population of 565 women, 403 (71%) attended for consultation. Of these, 315 (78%) were in the programme, 51 (13%) had had a mammography outside the programme, and 37 (9%) had not had a mammography. After the intervention, 21 women had a mammography (56.7% [95% CI, 41-73] success of intervention). Seventy of the 162 women who did not attend for consultation had a mammography in the programme. The rate of participation in the EDBC rose from 68% (385/565) to 72% (406/565). Conclusions. The brief intervention was effective in over half the women. This small increase contributed to reaching the minimum levels of coverage recommended in a programme of this kind