Quality of life of women from a quilombola community in northeastern Brazil

Abstract Quilombola communities are present in many Brazilian states living in precarious health conditions. This is due to geographic isolation, limitations to the access of the area in which they live in, and the lack of quality in the service when it is needed to be provided. Therefore, the aim of this study was to analyze the quality of life of women from a quilombola community in northeastern Brazil. It is an observational, cross-sectional and descriptive study. 160 adult women were first interviewed through a form to collect a profile and then it was applied the WHOQOL Quality of Life questionnaire bref. It was observed that the women were on average 40.7 years old (±17.25), married, self-declared black, who did not finish elementary school, housewife, had no income, with their own masonry house, with up to 6 rooms, supplied by a box of community treated water. Quality of Life had median scores in the domains: physical (3.18), psychological (3.4), social relationships (3.45) and environment (2.59). With this research, it was possible to characterize the quilombola community of Santa Luzia do Norte-AL regarding the difficulties of access to health and income generation, issues that affect their health condition. The problems described in this study can contribute to health actions being planned and carried out in order to improve socioeconomic and health conditions in this community, considering the social, political and environmental context, valuing their traditional knowledge and practices.

Resumo As comunidades quilombolas, estão presentes em diversos estados brasileiros, vivendo em condições de saúde mais precárias. Isto ocorre por conta do isolamento geográfico, das limitações de acesso e da falta de qualidade no serviço quando este é prestado. Nesse sentido, o objetivo do estudo foi analisar a qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro. Estudo observacional, transversal e descritivo. Foram entrevistadas 160 mulheres adultas, através de um formulário para a coleta de perfil e do questionário de Qualidade de Vida WHOQOL bref. Foi observado que as mulheres tinham em média 40,7 anos (±17,25), casadas, autodeclaradas negras, com fundamental incompleto, do lar, sem renda, com moradia de alvenaria, própria, com até 6 cômodos, abastecidas por caixa de água comunitária, tratada. A Qualidade de Vida, apresentou escores medianos nos domínios: físico (3,18), psicológico (3,4), relações sociais (3,45) e meio ambiente (2,59). Com a realização desta pesquisa foi possível caracterizar a comunidade quilombola de Santa Luzia do Norte-AL quanto as dificuldades de acesso a saúde e geração de renda, fatos que repercutem na sua condição de saúde. Os problemas descritos neste estudo podem contribuir para que ações de saúde sejam planejadas e efetivadas com o intuito de melhorar as condições socioeconômicas e de saúde nessa comunidade, considerando-se o contexto social, político e ambiental, valorizando seus saberes e práticas tradicionais.

Quality of life of women from a quilombola community in northeastern Brazil / Qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro

Abstract Quilombola communities are present in many Brazilian states living in precarious health conditions. This is due to geographic isolation, limitations to the access of the area in which they live in, and the lack of quality in the service when it is needed to be provided. Therefore, the aim of this study was to analyze the quality of life of women from a quilombola community in northeastern Brazil. It is an observational, cross-sectional and descriptive study. 160 adult women were first interviewed through a form to collect a profile and then it was applied the WHOQOL Quality of Life questionnaire - bref. It was observed that the women were on average 40.7 years old (±17.25), married, self-declared black, who did not finish elementary school, housewife, had no income, with their own masonry house, with up to 6 rooms, supplied by a box of community treated water. Quality of Life had median scores in the domains: physical (3.18), psychological (3.4), social relationships (3.45) and environment (2.59). With this research, it was possible to characterize the quilombola community of Santa Luzia do Norte-AL regarding the difficulties of access to health and income generation, issues that affect their health condition. The problems described in this study can contribute to health actions being planned and carried out in order to improve socioeconomic and health conditions in this community, considering the social, political and environmental context, valuing their traditional knowledge and practices.

Resumo As comunidades quilombolas, estão presentes em diversos estados brasileiros, vivendo em condições de saúde mais precárias. Isto ocorre por conta do isolamento geográfico, das limitações de acesso e da falta de qualidade no serviço quando este é prestado. Nesse sentido, o objetivo do estudo foi analisar a qualidade de vida de mulheres de uma comunidade quilombola do nordeste brasileiro. Estudo observacional, transversal e descritivo. Foram entrevistadas 160 mulheres adultas, através de um formulário para a coleta de perfil e do questionário de Qualidade de Vida WHOQOL - bref. Foi observado que as mulheres tinham em média 40,7 anos (±17,25), casadas, autodeclaradas negras, com fundamental incompleto, do lar, sem renda, com moradia de alvenaria, própria, com até 6 cômodos, abastecidas por caixa de água comunitária, tratada. A Qualidade de Vida, apresentou escores medianos nos domínios: físico (3,18), psicológico (3,4), relações sociais (3,45) e meio ambiente (2,59). Com a realização desta pesquisa foi possível caracterizar a comunidade quilombola de Santa Luzia do Norte-AL quanto as dificuldades de acesso a saúde e geração de renda, fatos que repercutem na sua condição de saúde. Os problemas descritos neste estudo podem contribuir para que ações de saúde sejam planejadas e efetivadas com o intuito de melhorar as condições socioeconômicas e de saúde nessa comunidade, considerando-se o contexto social, político e ambiental, valorizando seus saberes e práticas tradicionais.

The role of microglia in 67NR mammary tumor-induced suppression of brain responses to immune challenges in female mice.

It is poorly understood how solid peripheral tumors affect brain neuroimmune responses despite the various brain-mediated side effects and higher rates of infection reported in cancer patients. We hypothesized that chronic low-grade peripheral tumor-induced inflammation conditions microglia to drive suppression of neuroinflammatory responses to a subsequent peripheral immune challenge. Here, Balb/c murine mammary tumors attenuated the microglial inflammatory gene expression responses to lipopolysaccharide (LPS) and live Escherichia coli (E. coli) challenges and the fatigue response to an E. coli infection. In contrast, the inflammatory gene expression in response to LPS or a toll-like receptor 2 agonist of Percoll-enriched primary microglia cultures was comparable between tumor-bearing and -free mice, as were the neuroinflammatory and sickness behavioral responses to an intracerebroventricular interleukin (IL)-1ß injection. These data led to the hypothesis that Balb/c mammary tumors blunt the neuroinflammatory responses to an immune challenge via a mechanism involving tumor suppression of the peripheral humoral response. Balb/c mammary tumors modestly attenuated select circulating cytokine responses to LPS and E. coli challenges. Further, a second mammary tumor/mouse strain model (E0771 tumors in C57Bl/6 mice) displayed mildly elevated inflammatory responses to an immune challenge. Taken together, these data indicate that tumor-induced suppression of neuroinflammation and sickness behaviors may be driven by a blunted microglial phenotype, partly because of an attenuated peripheral signal to the brain, which may contribute to infection responses and behavioral side effects reported in cancer patients. Finally, these neuroimmune effects likely vary based on tumor type and/or host immune phenotype.

Uncertainty estimation and statistical comparative methodology for mammography x-ray energy spectra.

Numerical models are an alternative to measurements of x-ray energy spectra when validated by comparative methods that assess the similarity of experimental and calculated spectra. In this work, we compared x-ray energy spectra using several methodologies and determined the methodology with highest statistical power among them. Experiments and Monte Carlo (MC) simulations were used to generate a set of 65 experimental and simulated x-ray mammography spectra pairs typically used in mammography applications. They were generated using Tungsten and Molybdenum targets and Molybdenum and Rhodium filters. The x-ray beams were transmitted through breast tissue equivalent material (bTEM) plates with different glandularities and thicknesses, and the transmitted beam was detected using solid-state x-ray spectrometry with a Cadmium Telluride (CdTe) diode. The MC simulations used the PENELOPE code. Additional uncertainties, beyond that from counting, were propagated using the MC method. Quantitative comparative methods based on the [Formula: see text] statistics, the first and second half-value layers, the mean energy, the effective energy, and the non-parametric u-test were applied and their specificity (true negative rate) was assessed. The polyenergetic normalized glandular dose (DgNp) to a 6 cm breast of 50/50 glandularity was derived from the spectra. In this work, the [Formula: see text] statistics attained the highest score; therefore, it is the most indicated metric for the x-ray energy spectra comparative evaluations. The contribution of the additional uncertainties was important, being responsible for up to 98% of the spectra total uncertainty and shifting the mean of the evaluated [Formula: see text] to 1.2(1), compatible with its expected value. The use of non-parametric test is discouraged by our results, since it failed to distinguish spectra pairs that resulted in up to 72% discrepant DgNp.

Preventive therapy compliance in pediatric tuberculosis - A single center experience.

INTRODUCTION: Despite its importance, there are some barriers to patient compliance in preventive therapy (PT) of tuberculosis (TB). The purpose of this study was to evaluate the compliance to appointments, PT and follow-up in a pediatric population after TB exposure, followed in a single TB outpatient center, and the subsequent identification of compliance determinants. METHODS: Retrospective analysis of all pediatric patients who underwent PT in Gaia TB outpatient center from January 2015 to June 2016. Patients were divided into two groups: compliant and non-compliant, according to adherence to screening, visits and medication. The data collection was based on review of medical records. RESULTS: A total of 72 patients were enrolled, 33 (45.8%) on chemoprophylaxis and 39 (54.2%) on latent tuberculosis infection (LTBI) treatment. The majority of patients were compliant (63.9%, n=46). Non-compliance was found in 36.1% (n=26): in 12 patients to contact screening, in 11 patients to PT and 22 patients did not attend medical appointments in the first place. In 10 patients, non-compliance was related to social problems/family dysfunction (low socioeconomic status and parent's unemployment). After putting in place several strategies, such as telephone contact, activating social services and direct observation of therapy, a compliance of 98.6% was achieved. Isoniazid was the main drug used (91.7%), during 9 months for LBTI. CONCLUSION: PT compliance in TB can be challenging, probably related to the lack of risk perception and caregiver's reluctance to undergo a prolonged treatment to an asymptomatic condition. We conclude that implementing interventions can considerably improve treatment compliance and reduce the risk of future tuberculosis development. We emphasize the success in compliance to a 9 month regimen of isoniazid in the vast majority of patients with LTBI.

Evaluation of anti-nociceptive and anti-inflammatory activity of low-level laser therapy on temporomandibular joint inflammation in rodents.

The aim of this study was to investigate the analgesic and anti-inflammatory activity of low-level laser therapy (LLLT) on the nociceptive behavioral as well as histomorphological aspects induced by injection of formalin and carrageenan into the rat temporomandibular joint. The 2.5% formalin injection (FRG group) induced behavioral responses characterized by rubbing the orofacial region and flinching the head quickly, which were quantified for 45 min. The pretreatment with systemic administration of diclofenac sodium-DFN group (10 mg/kg i.p.) as well as the irradiation with LLLT infrared (LST group, 780 nm, 70 mW, 30 s, 2.1 J, 52.5 J/cm(2), GaAlAs) significantly reduced the formalin-induced nociceptive responses. The 1% carrageenan injection (CRG group) induced inflammatory responses over the time-course of the study (24 h, and 3 and 7 days) characterized by the presence of intense inflammatory infiltrate rich in neutrophils, scanty areas of liquefactive necrosis and intense interstitial edema, extensive hemorrhagic areas, and enlargement of the joint space on the region. The DFN and LST groups showed an intensity of inflammatory response that was significantly lower than in CRG group over the time-course of the study, especially in the LST group, which showed exuberant granulation tissue with intense vascularization, and deposition of newly formed collagen fibers (3 and 7 days). It was concluded that the LLLT presented an anti-nociceptive and anti-inflammatory response on the inflammation induced in the temporomandibular joint of rodents.

Illustrated and annotated checklist of Brazilian gall morphotypes.

The analysis on nine inventories on the richness and diversity of galling herbivores in Brazil accounted for 806 gall systems occurring in 443 host-plant species from 74 plant families. This checklist of the Brazilian gall morphotypes proposes seven standardized morphotypes and five additional shapes that group the majority of the three-dimensional shapes reported in literature. Criteria are proposed to standardize the terminology, and a critical analysis is provided aiming to avoid possible inconsistencies in order to generate easily comparable data in future inventories. The morphotypes are herein catalogued in alphabetical order, accompanied by a conceptual definition, an illustration, and examples that best represent the shape. It is proposed that the inventories should present at least the (1) host-plant species, (2) galling herbivore species or its identification to the lowest possible taxonomic level, (3) host-plant galled organ and gall position, (4) gall morphotype, (5) gall color and registration of indumentum when present, (6) gall phenological and developmental data, (7) association with other trophic levels, and (8) additional information, such as dimension, and number of chamber(s).

Relationship of IL-1 and TNF-α polymorphisms with Helicobacter pylori in gastric diseases in a Brazilian population

It is well known that the risk of development of gastric cancer (GC) in Helicobacter pylori-infected patients depends on several factors. Thus, the aim of this study was to investigate the effect of proinflammatory cytokine gene polymorphisms for IL-1β, IL-1RN and TNF-α on the development of GC in a Brazilian population. A total of 202 biopsies obtained from Brazilian patients with chronic gastritis and GC were included in the study. Infection with H. pylori cagA+ was determined by the polymerase chain reaction (PCR) as previously described. IL-1β, IL-1RN and TNF-α polymorphism genotyping was performed by restriction fragment length polymorphism PCR. Associations between gene polymorphisms, clinical diseases and virulence markers were evaluated using either the χ² test or the Fisher exact test. Our results demonstrated that the IL-1β -511 C/C and IL-1β -511 C/T alleles were associated with chronic gastritis in H. pylori-positive patients (P = 0.04 and P = 0.05, respectively) and the IL-1β -511 C/C genotype was associated with GC (P = 0.03). The frequency of IL-1RN alleles from patients with chronic gastritis and GC indicated that there was no difference between the genotypes of the groups studied. Similar results were found for TNF-α -308 gene polymorphisms. Our results indicate that the IL-1β -511 C/C and C/T gene polymorphisms are associated with chronic gastritis and GC development in H. pylori-infected individuals.

Relationship of IL-1 and TNF-α polymorphisms with Helicobacter pylori in gastric diseases in a Brazilian population.

It is well known that the risk of development of gastric cancer (GC) in Helicobacter pylori-infected patients depends on several factors. Thus, the aim of this study was to investigate the effect of proinflammatory cytokine gene polymorphisms for IL-1ß, IL-1RN and TNF-α on the development of GC in a Brazilian population. A total of 202 biopsies obtained from Brazilian patients with chronic gastritis and GC were included in the study. Infection with H. pylori cagA+ was determined by the polymerase chain reaction (PCR) as previously described. IL-1ß, IL-1RN and TNF-α polymorphism genotyping was performed by restriction fragment length polymorphism PCR. Associations between gene polymorphisms, clinical diseases and virulence markers were evaluated using either the χ² test or the Fisher exact test. Our results demonstrated that the IL-1ß -511 C/C and IL-1ß -511 C/T alleles were associated with chronic gastritis in H. pylori-positive patients (P = 0.04 and P = 0.05, respectively) and the IL-1ß -511 C/C genotype was associated with GC (P = 0.03). The frequency of IL-1RN alleles from patients with chronic gastritis and GC indicated that there was no difference between the genotypes of the groups studied. Similar results were found for TNF-α -308 gene polymorphisms. Our results indicate that the IL-1ß -511 C/C and C/T gene polymorphisms are associated with chronic gastritis and GC development in H. pylori-infected individuals.

Chemopreventive potential of the tannase-mediated biotransformation of green tea.

Green tea (Camellia sinensis) is one of the most widely consumed beverages in the world. The cancer chemopreventive qualities of green tea have been well documented. Epigallocatechin gallate (EGCG) is often described as the most potently chemopreventive green tea catechin; however, the low bioavailability of EGCG is a limiting factor for its biological effect. Thus, the aim of this work was to test the chemopreventive potential of green tea extract and EGCG after tannase-mediated hydrolysis. The results showed that the biotransformed compounds retained most of the beneficial properties of the original compounds, and some beneficial properties were improved in the biotransformed compounds. Biotransformation of EGCG decreased its toxicity without affecting its antiproliferative effects. Furthermore, human cells gene expression profiling showed that the biotransformed compounds modulated the expression of several genes related to carcinogenesis. These results demonstrate the benefits of the biotechnological modification of natural food molecules, allowing the improvement of the nutraceutical potential of a beverage as green tea.

Statin effects on regulatory and proinflammatory factors in chronic idiopathic urticaria.

Immunological dysfunction has been described to occur in chronic idiopathic urticaria (CIU), most notably in association with an inflammatory process. Some pharmacological agents as statins--drugs used in hypercholesterolaemia--display a broad effect on the immune response and thus should be tested in vitro in CIU. Our main objectives were to evaluate the effects of statins on the innate and adaptive immune response in CIU. Simvastatin or lovastatin have markedly inhibited the peripheral blood mononuclear cells (PBMC) proliferative response induced by T and B cell mitogens, superantigen or recall antigen. Simvastatin arrested phytohaemaglutinin (PHA)-induced T cells at the G0/G1 phase, inhibiting T helper type 1 (Th1), Th2, interleukin (IL)-10 and IL-17A cytokine secretion in both patients and healthy control groups. Up-regulation of suppressor of cytokine signalling 3 (SOCS3) mRNA expression in PHA-stimulated PBMCs from CIU patients was not modified by simvastatin, in contrast to the enhancing effect in the control group. Statin exhibited a less efficient inhibition effect on cytokine production [IL-6 and macrophage inflammatory protein (MIP)-1α] induced by Toll-like receptor (TLR)-4, to which a statin preincubation step was required. Furthermore, statin did not affect the tumour necrosis factor (TNF)-α secretion by lipopolysaccharide (LPS)-stimulated PBMC or CD14+ cells in CIU patients. In addition, LPS-activated PBMC from CIU patients showed impaired indoleamine 2,3-dioxygenase (IDO) mRNA expression compared to healthy control, which remained at decreased levels with statin treatment. Statins exhibited a marked down-regulatory effect in T cell functions, but were not able to control TLR-4 activation in CIU patients. The unbalanced regulatory SOCS3 and IDO expressions in CIU may contribute to the pathogenesis of the disease.

Effect of water flow rate and feed training on "pacamã" (Siluriforme: Pseudopimelodidae) juvenile production / Efeito do fluxo de água e do condicionamento alimentar na produção de juvenis de pacamã (Siluriforme: Pseudopimelodidae)

The effects of different water flow rates and feed training on the production of "pacamã" Lophiosilurus alexandri juveniles were evaluated. In the first experiment, nine day post-hatch larvae (n= 2,400) were stocked at a density of 5 larvae/L. Different water flow (F) rates were tested: F1 = 180; F2 = 600; F3 = 1,300; and F4 = 2,600mL/min. Artemia nauplii were offered as food during the first 15 days of active feeding. In the second experiment for feed training, 720 juveniles (total length of 22.2mm) were stocked at a density of 1.5 juveniles/L. A water flow rate similar to F1 was used. The use of extruded dry diet was tested, and feed training was done with and without other enhanced flavors (Artemia nauplii or Scott emulsion). The water flow rates did not influence the survival or growth of L. alexandri. Cannibalism occurred during feed training. The worst survival, specific growth rate and high mortality were found with the use of extruded dry diet, while similar values were registered with the different feed training diets used. Reduced water flow rate can be used to lower water consumption during larviculture and feed training of L. alexandri.

Avaliaram-se os efeitos de diferentes fluxos de água e do condicionamento alimentar sobre a produção de juvenis de pacamã Lophiosilurus alexandri. Larvas com nove dias pós-eclosão (n=2.400) foram estocadas na densidade de 5 larvas/L. Diferentes fluxos (F) de água foram testados: F1 = 180; F2 = 600; F3 = 1.300; e F4 = 2.600mL/min. Náuplios de Artemia foram usados como alimento nos primeiros 15 dias de alimentação ativa. No segundo experimento, para o condicionamento alimentar, 720 juvenis (comprimento total de 22,2mm) foram estocados na densidade de 1,5 juvenis/L. Fluxo de água similar a F1 foi utilizado. Foram testados o uso de dieta extrusada e o condicionamento alimentar adicionado ou não de náuplios de Artemia ou emulsão Scott. Os diferentes fluxos de água não afetaram a sobrevivência e o crescimento de L. alexandri. Durante o condicionamento alimentar foi registrada a ocorrência de canibalismo. Pior sobrevivência, taxa de crescimento específica e maior mortalidade foram registradas para o uso da dieta comercial, enquanto valores similares foram verificados para as diferentes dietas usadas no condicionamento alimentar. Fluxo de água reduzido pode ser empregado durante a larvicultura e condicionamento alimentar de L. alexandri.

Diversity of gall-inducing insects in the high altitude wetland forests in Pernambuco, Northeastern Brazil.

We report on the richness of galling insects in the altitudinal wetland forests of Pernambuco State, Northeastern Brazil. We found 80 distinct types of insect galls on 49 species of host plants belonging to 28 families and 35 genera. Most of the galled plant species belong to Nyctaginaceae, Fabaceae, Meliaceae, Sapindaceae and Myrtaceae. The most common gall were spheroid and globoid; most galls were glabrous, predominantly green and with one chamber, and on the leaves. Most galls were induced by Cecidomyiidae (Diptera). The results of this study contribute to existing knowledge richness of galling insects and host-plant diversity in the altitudinal wetland forests of Northeastern Brazil.

Plant Vigor Hypothesis refuted: preference-performance linkage of a gall-inducing weevil on small-sized host plant resources.

The Plant Vigor Hypothesis (PVH) predicts an oviposition preference of females and higher offspring performance for insect herbivores on longer and fast-growing plant modules. We tested the PVH predictions by investigating the effects of leaf size of Miconia prasina (Sw.) DC. (Melastomataceae) on the oviposition preference and on the offspring survival of the gall-inducing weevil Prospoliata bicolorata (Coleoptera: Curculionidae). Additionally, we analysed the effects of top-down mortality force on this system. Approximately 83% of the developed galls resulted in adults of P. bicolorata, whereas 17% of the galls successfully induced were killed by natural enemies (top-down effect). Leaves of intermediate size were more abundant while smaller and longer leaves were rare. Nevertheless, the percentage of P. bicolorata galls was higher on the smallest leaves of M. prasina, refuting the preference prediction of the PVH. Our results also refuted the performance prediction: the ratio of survival per leaf was negatively related to the leaf length. Thus, we found a link between female preference and larval performance of P. bicolorata on small-sized leaves of M. prasina. The next goal is to understand the mechanisms involved in the selection of gall-inducing weevil on short leaves of its host plant.

Survey of acarine fauna in dust samplings of curtains in the city of Campinas, Brazil

O intuito deste estudo foi avaliar as espécies acarinas encontradas em amostras de poeira de cortinas presentes em 33 salas e 22 quartos de um total de 41 domicílios na cidade de Campinas, SP. Foram encontrados 148 ácaros. Desse total, 83 foram encontrados na sala de TV (56,1% do total) e 65 nos quartos (43,9%). As principais subordens encontradas foram: Acaridida (n = 79; 53.4%), Actinedida (n = 53; 35.8%), Oribatida (n = 14; 9.5%) e Gamasida (n = 2; 1.3%). As principais famílias observadas foram: Pyroglyphidae (n = 61; 41,2% do total), Eriophyidae (n = 25; 16,9%), Tarsonemidae (n = 15; 10,1%) e Glycyphagidae (n = 13; 8,8%). Não houve diferença significativa no número de ácaros observados nas amostras da sala e do quarto.

Odontoma-producing intraosseous calcifying odontogenic cyst: case report.

The present report describes a case of odontoma-producing intraosseous calcifying odontogenic cyst in a 36-year-old Black male in the right mandibular bicuspid region. The lesion involved an unerupted permanent canine, which was displaced to the mandible base and a calcified mass that was later recognized as an odontoma. The lesion was surgically removed.

Angiotensin-(1-7) increases osmotic water permeability in isolated toad skin

Angiotensin-(1-7) (Ang-(1-7)) increased osmotic water permeability in the isolated toad skin, a tissue with functional properties similar to those of the distal mammalian nephron. Concentrations of 0.1 to 10 ÁM were effective, with a peak at 20 min. This effect was similar in magnitude to that of frog skin angiotensin II (Ang II) and oxytocin but lower than that of human Ang II and arginine-vasotocin. The AT2 angiotensin receptor antagonist PD 123319 (1.0 ÁM) fully inhibited the response to 0.1 ÁM Ang-(1-7) but had no effect on the response to Ang II at the same concentration. The specific receptor antagonist of Ang-(1-7), A-779, was ineffective in blocking the response to Ang-(1-7) and to frog skin Ang II. The AT1 receptor subtype antagonist losartan, which blocked the response to frog skin Ang II, was ineffective in blocking the response to Ang-(1-7). The present results support the view of an antidiuretic action of Ang-(1-7) in the mammalian nephron

[Metabolic control of diabetes mellitus en relation to the quality of the medical records]. / Control metabólico de la diabetes mellitus en relación con la calidad de las historias clínicas.

OBJECTIVE: To investigate whether there is a relationship between the quality of the clinical history (CH) in primary care and metabolic control of patients with diabetes (DM). DESIGN: Retrospective and observational. SETTING: 15 health centres in the Segovia Area. PATIENTS: 315 diabetic patients, selected at random from among those with a record of the type of DM, date and outcome of at least one HbA1c and treatment at the time of the most recent HbA1c. RESULTS: The quality of the clinical histories was measured through the mean of recording of the following items in the 13 months previous to the most recent HbA1c: weight and height, peripheral pulses, sensitivity, foot examination, creatinine, proteinuria, microalbuminuria, glucaemia levels, back of eye, ECG, and diet, tobacco and alcohol counselling. Other variables that could condition the HbA1c, chronic pathologies and those related to DM, were gathered too. Of patients treated with diet or oral diabetic drugs, patients with a clinical history of < or = 49% quality had a mean HbA1c of 7.40%, whereas those with CH of > or = 50% quality had an average of 6.94% (0.46 difference; 95% CI, 0.03-0.90; p = 0.038). This drop was not attributable to age, gender, years of evolution or BMI differences. The risk of having an HbA1c > or = 7.5% is double in patients with a CH of < or = 49% quality than in those with CH of > or = 50% quality (OR = 2.06; 95% CI, 1.14-3.72). In insulin-treated patients, no association between CH quality and HbA1c was found. CONCLUSIONS: Follow-up of the recommendations for clinical action is associated with better metabolic control in diabetics treated with diet--oral diabetic drugs. This association was not found in insulin-treated patients.