Cross-mapping medical records to NANDA-I to identify nursing diagnoses in a vulnerable population.

PURPOSE: To assess the association between vulnerable populations and nursing care needs, using NANDA-I diagnostics, in the population of the Canary Islands, Spain. METHODS: Nursing social epidemiology study. Cross Mapping of Medical Records to NANDA-I to Identify Nursing Diagnoses in a Population usinga medical, epidemiological follow-up study of a cohort of 7,190 people. The level of vulnerability of the participants was assigned, among those who were also assigned nursing diagnoses, using the "ICE index" to calculate the expected associations. FINDINGS: The most prevalent nursing diagnosis in our sample was Sedentary lifestyle (60.5%), followed by Ineffective health self-management (33.8%) and Risk-prone health behaviour (28.7%). Significant differences were found by sex, age group and social class, with the nursing diagnoses included in the study being more prevalent among the most socio-economically disadvantaged social class. CONCLUSIONS: The cross-mapping method is useful to generate diagnostic information in terms of care needs, using the NANDA-I classification. The expected associations between high social vulnerability and care needs have been verified in a comprehensive and representative sample of the Canarian population (Spain). IMPLICATIONS FOR NURSING PRACTICE: From an epidemiological perspective, identifying nursing diagnoses at the population level allows us to find the most prevalent needs in the different community groups and to focus appropriate nursing interventions for their implementation and impact assessment.

OBJETIVO: Evaluar la asociación entre las poblaciones vulnerables y las necesidades de cuidados de enfermería, utilizando la clasificación diagnóstica NANDA-I, en la población de las Islas Canarias, España. MÉTODOS: Estudio de epidemiología social enfermera. Mapeo cruzado de registros médicos con la clasificación NANDA-I para identificar los diagnósticos de enfermería en una población mediante un estudio de seguimiento médico y epidemiológico de una cohorte de 7.190 personas. Se asignó el nivel de vulnerabilidad de los participantes, entre los que también se asignaron diagnósticos de enfermería, utilizando el "índice REI" para calcular las asociaciones esperadas. RESULTADOS: El diagnóstico de enfermería más prevalente en nuestra muestra fue Estilo de vida sedentario (60,5%), seguido de Autogestión ineficaz de la salud (33,8%) y Tendencia a adoptar conductas de riesgo para la salud (28,7%). Se encontraron diferencias significativas por sexo, grupo de edad y clase social, siendo los diagnósticos de enfermería incluidos en el estudio más prevalentes entre la clase social más desfavorecida socioeconómicamente. CONCLUSIONES: El método de mapeo cruzado es útil para generar información diagnóstica en términos de necesidades de cuidados, utilizando la clasificación NANDA-I. Se han verificado las asociaciones esperadas entre alta vulnerabilidad social y necesidades de cuidados en una muestra amplia y representativa de la población canaria (España). IMPLICACIONES PARA LA PRÁCTICA ENFERMERA: Desde una perspectiva epidemiológica, la identificación de los diagnósticos de enfermería a nivel poblacional permite encontrar las necesidades más prevalentes en los diferentes grupos de la comunidad y focalizar las intervenciones enfermeras adecuadas para su implementación y evaluación de impacto.

[Evolution of Smoking According to Social Class in the Adult Population of the Canary Islands During 2000-2015: Follow-up of the CDC-Canary Cohort]. / Evolución del tabaquismo según clase social en la población adulta de las Islas Canarias durante el periodo 2000-2015: seguimiento de la cohorte CDC-Canarias.

OBJECTIVE: To determine the status of tobacco consumption in the Canary Islands during 2000-2015, according to social class. LOCATION: Canary Islands. PARTICIPANTS: General population cohort, with contacts in 2000 (n=6,729), 2008 (n=6,171) and 2015 (n=4,705). MAIN MEASUREMENTS: Smoking, gender, age, and social class. RESULTS: Consumption decreased by 6% (5-7%, P<.001) in general, being more accentuated in the period 2000-2008 (5%). The decrease was greater in men, although they continued to smoke more than women, with a prevalence of 25% (24-26%) compared to 18% (17-19%, P<.001). A decrease in consumption was only observed in the younger groups (6% [3-5%], P=.011) and intermediate ages (7% [6-8%], P<.001). A similar decrease was observed in all the social classes, but there was a higher prevalence of smoking in the upper class: 24% (23-25%) in 2015 (P<.001). By jointly assessing gender, age, and social class, younger and middle age men had the greatest decreases in consumption: 8% (7-9%) low and upper classes, 10% (9-11%) middle class. In the lower social class, younger women continue to smoke more (27%) although more of them quit smoking (14%), a phenomenon that occurred in the middle class at intermediate ages. CONCLUSIONS: The evolution of tobacco consumption in the Canary Islands follows a pattern similar to that of mainland Spain. The abandonment of tobacco consumption has slowed down in the period 2008-2015, especially in men, and middle and upper social classes.

Austerity Policies and Mortality in Spain After the Financial Crisis of 2008.

OBJECTIVES: To analyze mortality in Spain and the United States before and after these countries implemented divergent policies in response to the financial crisis of 2008. METHODS: We examined mortality statistics in both countries in the years 2000 to 2015. Spain started austerity policies in 2010. We compared differences in mortality ratios, on the basis of trends and effect size analysis. RESULTS: During 2000 to 2010, overall mortality rates (r = 0.98; P < .001; Cohen's d = -0.228) decreased in both countries. In 2011, this trend changed abruptly in Spain, where observed mortality surpassed expected mortality by 29% in 2011 and by 41% in 2015. By contrast, observed mortality surpassed expected mortality in the United States by only 8% in 2015. As the mortality statistics diverged, the effect size greatly increased (d = 7.531). During this 5-year period, there were 505 559 more deaths in Spain than the expected number, while in the United States the difference was 431 501 more deaths despite the 7-fold larger population in the United States compared with Spain. CONCLUSIONS: The marked excess mortality in 2011 to 2015 in Spain is attributable to austerity policies.

Clinical applicability and cost-effectiveness of DIABSCORE in screening for type 2 diabetes in primary care.

AIMS: To evaluate the applicability and cost-effectiveness of a clinical risk score (DIABSCORE) to screen for type 2 diabetes in primary care patients. METHODS: Multicenter cross-sectional study of 10,508 adult no previously diagnosed with diabetes, in 2 Spanish regions (Canary Islands and Valencian Community). The variables comprising DIABSCORE were age, waist to height ratio, family history of diabetes and gestational diabetes. ROC curves were obtained; the diabetes prevalences odds ratios (HbA1c ≥6.5%) between patients exposed and not exposed to DIABSCORE ≥100, and to fasting blood glucose ≥126mg/dL were calculated. The opinions of both the professionals and the patients concerning DIABSCORE were collected, and a cost-effectiveness analysis was performed. RESULTS: In both regions, the valid cut-off point for diabetes (DIABSCORE=100), showed an area under the curve >0.80. The prevalences odds ratio of diabetes for DIABSCORE ≥100 was 9.5 (3.7-31.5) in Canarian and 18.3 (8.0-51.1) in Valencian; and for glucose ≥126mg/dL it was, respectively, 123.0 (58.8-259.2) and 303.1 (162.5-583.8). However, glucose ≥126mg/dL showed a low sensitivity (below 48% in both communities) as opposed to DIABSCORE ≥100 (above 90% in both regions). Professionals (100%) and patients (75%) satisfaction was greater when using DIABSCORE rather than glucose measurement for diabetes screening. The cost of each case of diabetes identified was lower with DIABSCORE ≥100 (7.6 € in Canarian and 8.3 € in Valencian) than glucose ≥126mg/dL (10.8 € and 10.5 €, respectively). CONCLUSIONS: DIABSCORE is an applicable and cost-effective screening method for type 2 diabetes in primary care.

Social class and metabolic syndrome in populations from Tunisia and Spain.

BACKGROUND: There is an increasing prevalence of obesity and metabolic syndrome (MS) in developing countries. It has been shown the relationship between social class and MS in developed countries. The objective of our study was to compare the association of social class with the prevalence of MS in a developing country (Tunisia, region of Cap-Bon) and a developed one (Spain, Canary Islands). METHODS: Cross-sectional study of 6729 Canarian and 393 Tunisian individuals. Social class was measured with the income, crowding and education (ICE) model, which includes family income, household crowding and education level. Logistic regression models adjusted by age estimated the risk by odds ratio (OR) and confidence interval (CI 95 %) of MS according to social class. RESULTS: MS prevalence was higher in Tunisian (50 %) than in Canarian women (29 %; p = 0.002), with no significant differences between men. For Canarian women, being in the highest social class was a protective factor against MS (OR = 0.39; CI 95 % 0.29-0.53) and all its components. The Canarian population and the Tunisian women, showed a significant linear trend (p < 0.001) of MS to decrease when social class increased. CONCLUSION: High social class is a protective factor from MS and its components within the Canarian population and the Tunisian women. Our results suggest that the socioeconomic transition in a developing country like Tunisia can improve the population health in a sex-specific manner.

[Patients' characteristics and clinical management of atrial fibrillation in primary healthcare in Spain: FIATE Study]. / Características de los pacientes y abordaje terapéutico de la fibrilación auricular en atención primaria en España: Estudio FIATE.

BACKGROUND AND OBJECTIVES: The main therapeutic objective in atrial fibrillation (AF) patients is stroke prevention. This study is aimed to determine whether the anticoagulant therapy may be appropriate regarding to the Guidelines and patients' profile in primary healthcare in Spain. PATIENTS AND METHODS: A national, multicenter, cross-sectional study of AF patients attended in primary healthcare in Spain has been conducted. The study involved 185 family physicians whose patients were randomized. RESULTS: A total of 3,759 AF patients were randomized from the clinical records, and 2,070 were included in the study, at an average age of 74 (11) years old (50.7% female). Most of them (78%) had permanent AF and high comorbidity rates (hypertension 75%, obesity 30%, diabetes 27%, heart failure 20%, coronary heart disease 17%, and social risk 15%). Patients diagnosed in primary healthcare were more frequently asymptomatic than in hospital setting (36%; P<.001). The therapeutic strategy was based on the heart rate control in 4 out of 5 patients. Anticoagulation therapy was widely used (84%), more frequently in patients with permanent vs. non-permanent AF (91 vs. 60%, P<.001). Follow-up and monitoring was mainly performed in primary care (72%). The anticoagulation control was suboptimal, with a 66% of the international normalized ratio (INR) in therapeutic range, dropping to 33% when the last 3 available INR were included (P<.001). CONCLUSIONS: A high rate of patients with anticoagulant therapy in primary healthcare has been found in this research. INR control, however, remains suboptimal. Heart rate control is the most commonly used strategy. The decision about the anticoagulation should be based on the thromboembolic risk rather than in the arrhytmia type.

Riesgo cardiovascular: valoración inicial de la cohorte “CDC de Canarias en Venezuela” / Cardiovascular risk: initial estimation in the study cohort “CDC of the Canary Islands in Venezuela”

En Venezuela como en Canarias (España), la enfermedad cardiovascular es causa importante de morbilidad y de mortalidad. Para estimar el riesgo cardiovascular en adultos de origen canario residentes en Venezuela, reclutamos la cohorte “CDC de Canarias en Venezuela” entre Junio 2.008 y Agosto 2.009. En 452 individuos (54,9% mujeres), entre 18 y 93 años se realizó una encuesta de datos y se midió su talla, peso, presión arterial, circunferencias de abdomen y cadera; previo ayuno de 12 horas, se determinó glucemia y perfil lipídico. 40,5% de los sujetos era mayor de 65 años mientras el grupo joven (18-30 años) era el 8%. En los varones la edad fue 57,69±18,17 años y el índice de masa corporal 29,39±5,71 Kg/m²; en las mujeres 56,50±16,91 años y 28,20±5,57 Kg/m², respectivamente. La prevalencia de síndrome metabólico fue de 49,1%, la suma de sobrepeso y obesidad 75,2%, obesidad abdominal 85,4%, diabetes 17,4%, glucemia alterada en ayunas (GAA) 12,2%, presión arterial elevada 52,9%, HDL-colesterol bajo 53,8% y trigliceridemia elevada 31%. Un tercio de los participantes sin diabetes ni GAA, mostró un índice triglicéridos/HDL-colesterol alto, lo que indica insulino-resistencia. Se concluye que la comunidad de canarios residentes en Venezuela presenta alta prevalencia de factores de riesgo cardiovascular (malnutrición por exceso, obesidad abdominal, dislipemia y diabetes). Respecto a la actual población de Canarias presentan menor frecuencia de GAA y mayor de HDL Colesterol bajo. Respecto a Venezuela presentan menor frecuencia de GAA, de HDL colesterol bajo y de trigliceridemia elevada que los descritos en el estado Zulia.

In Venezuela as in the Canary Islands (Spain), cardiovascular disease is a major cause of morbidity and mortality. The purpose of this research is to estimate the cardiovascular risk in the Canary Islands migrants living in Venezuela and participating in the study cohort “CDC of the Canary Islands in Venezuela”. 452 individuals, aged 18 to 93 years (54.9% women), were enrolled between June 2008 and August 2009. A data survey was performed and their weight, height, abdomen and hip circumferences, and blood pressure were measured. After a 12-hour fasting period, a blood sample was obtained for glucose and lipid profile determinations. 40.5% of the subjects were over 65 years of age and 8% corresponded to the younger group (18-30 years). In men, the average age was 57.69±18.17 years and the body mass index 29.39 ± 5.71 kg/m², whereas women were 56.50±16.91 years and 28.20±5.57 kg/m², respectively. The prevalence of metabolic syndrome was 49.1%, overweight and obesity together 75,2%, abdominal obesity 85.4%, diabetes 17.4%, impaired fasting glucose (IFG) 12.2%, elevated blood pressure 52.9%, low HDL-cholesterol 53,8% and elevated serum triglycerides 31%. Among subjects without diabetes or IFG, a third showed a high triglycerides/HDL-cholesterol ratio, indicating insulin resistance. We conclude that the Canarian-Venezuelan community suffers high prevalence of cardiovascular risk factors (obesity, abdominal obesity, dyslipidemia, diabetes). In relation to the current population of the Canary Islands, they show a lower frequency of IFG and a higher frequency of low HDL-cholesterol. In comparison to the Venezuelan population (Zulia), they showed to have lower prevalence of IFG, low HDL cholesterol and elevated triglycerides.

[Cardiovascular risk: initial estimation in the study cohort "CDC of the Canary Islands in Venezuela"]. / Riesgo cardiovascular: valoración inicial de la cohorte "CDC de Canarias en Venezuela".

In Venezuela as in the Canary Islands (Spain), cardiovascular disease is a major cause of morbidity and mortality. The purpose of this research is to estimate the cardiovascular risk in the Canary Islands migrants living in Venezuela and participating in the study cohort "CDC of the Canary Islands in Venezuela". 452 individuals, aged 18 to 93 years (54.9% women), were enrolled between June 2008 and August 2009. A data survey was performed and their weight, height, abdomen and hip circumferences, and blood pressure were measured. After a 12-hour fasting period, a blood sample was obtained for glucose and lipid profile determinations. 40.5% of the subjects were over 65 years of age and 8% corresponded to the younger group (18-30 years). In men, the average age was 57.69 +/- 18.17 years and the body mass index 29.39 +/- 5.71 kg/m2, whereas women were 56.50 +/- 16.91 years and 28.20 +/- 5.57 kg/m2, respectively. The prevalence of metabolic syndrome was 49.1%, overweight and obesity together 75,2%, abdominal obesity 85.4%, diabetes 17.4%, impaired fasting glucose (IFG) 12.2%, elevated blood pressure 52.9%, low HDL-cholesterol 53,8% and elevated serum triglycerides 31%. Among subjects without diabetes or IFG, a third showed a high triglycerides/HDL-cholesterol ratio, indicating insulin resistance. We conclude that the Canarian-Venezuelan community suffers high prevalence of cardiovascular risk factors (obesity, abdominal obesity, dyslipidemia, diabetes). In relation to the current population of the Canary Islands, they show a lower frequency of IFG and a higher frequency of low HDL-cholesterol. In comparison to the Venezuelan population (Zulia), they showed to have lower prevalence of IFG, low HDL cholesterol and elevated triglycerides.

Efficiency of different strategies to detect autoantibodies to extractable nuclear antigens.

Autoantibodies to extractable nuclear antigens (anti-ENA) are identified mainly in samples positive for antinuclear antibodies (ANA). Although the method of choice for ANA screening is indirect immunofluorescence (IIF), several techniques are available to detect anti-ENA. The aim of this study was to compare the efficiency of five different strategies to determine anti-ENA. During a 2-year period we screened ANA in 30375 samples with IIF, and the 4475 samples ANA positive were tested for anti-ENA by double immune diffusion screening or fluoroenzymeimmunoassay (Screening FI); anti-ENA specificities were then determined by line immunoassay (LIA) or fluoroenzymeimmunoassay (FI). We compared five strategies that involved FI or LIA identification of anti-ENA with or without prior screening, or an algorithm that combined fluorescence pattern, number of anti-ENA specificities requested by the clinician and ANA dilution titer. One cost unit (CU) was defined as the cost of 1 test of ANA determination. We detected 553 anti-ENA positive samples. The most efficient strategy was the algorithm, at a cost of 3.3 CU per sample processed, the second most efficient strategy was screening plus FI identification (cost=3.8 CU), and the third most efficient strategy was screening plus LIA identification (cost=3.9 CU). The fourth most efficient strategy was FI identification without prior screening (13.3 CU per sample) and the least efficient was LIA identification without prior screening (13.6 CU per sample). In conclusion, an algorithm that combined techniques for detection, ANA titer, fluorescence pattern and number of specificities requested was the most efficient strategy for determining anti-ENA.

[Validation of the ICE model to assess social class in the adult population]. / Validación del modelo REI para medir la clase social en población adulta.

BACKGROUND: Social class has commonly been defined by the type of employment and it is assessed as a categorical variable. However, this approach has a number of drawbacks. The objective of this article is to develop and validate a readily standardizable quantitative indicator of social class and to show its ability to measure the impact of social class as a health determinant. METHODS: In 6729 individuals we measured income, crowding index, education, occupation and employment status. Two models were adjusted to study the neighborhood, dietary pattern and health problems. RESULTS: The model that included only income, crowding index and education (ICE) yielded an indicator that correlated with age (r = -0.28; p < 0.001) and consumption of potatoes (r = -0.17; p < 0.001) and salads (r = 0.10; p < 0.001). This indicator estimated that poor social classes were at significant risk for unemployment (OR = 5,), blue collar jobs (OR = 40,9), residing in poor neighborhoods (OR = 30.2), low salad consumption (OR = 2.2) and high consumption of potatoes (OR = 4.5). They also had, especially in women, a higher risk of sedentarism (OR = 1.8), obesity (OR = 4.4), metabolic syndrome (OR = 3.4) and diabetes mellitus (OR = 2.0). CONCLUSIONS: The ICE index was valid, not based on occupation or employment status, readily standardizable, and suitable for measuring social class and its impact of on health.

[Sedentary lifestyle: physical activity duration versus percentage of energy expenditure]. / Sedentarismo: tiempo de ocio activo frente a porcentaje del gasto energético.

INTRODUCTION AND OBJECTIVES: To compare different definitions of a sedentary lifestyle and to determine which is the most appropriate for demonstrating its relationship with the metabolic syndrome and other cardiovascular risk factors. METHODS: A cross-sectional study of 5814 individuals was carried out. Comparisons were made between two definitions of a sedentary lifestyle: one based on active energy expenditure being less than 10% of total energy expenditure, and the other, on performing less than 25-30 minutes of physical activity per day. Reported levels of physical activity, anthropometric measurements, and biochemical markers of cardiovascular risk were recorded. The associations between a sedentary lifestyle and metabolic syndrome and other risk factors were adjusted for gender, age and tobacco use. RESULTS: The prevalence of a sedentary lifestyle was higher in women (70%) than in men (45-60%, according to the definition used). The definitions based on physical activity duration and on energy expenditure were equally useful: there were direct associations between a sedentary lifestyle and metabolic syndrome, body mass index, abdominal and pelvic circumferences, systolic blood pressure, heart rate, apolipoprotein B, and triglycerides, and inverse associations with high-density lipoprotein cholesterol and paraoxonase activity, which demonstrated the greatest percentage difference between sedentary and active individuals. An incidental finding was that both definitions of a sedentary lifestyle were more strongly associated with the metabolic syndrome as defined by International Diabetes Federation criteria than by Adult Treatment Panel III criteria. CONCLUSIONS: Given that it is relatively easy to determine whether a patient performs less than 25 minutes of physical activity per day, use of this definition of a sedentary lifestyle is recommended for clinical practice. The serum paraoxonase activity level could provide a useful marker for studying sedentary lifestyles.