Problemas sociales: mucha frecuencia, poca formación / Social problems: high frequency, low training

Introducción: la patología social pediátrica en relación con inequidades socioeconómicas, relaciones disfuncionales familiares, inmigración, adicciones, violencia hacia la infancia, etc. va en aumento. El objetivo de este trabajo es analizar su peso en la labor asistencial del pediatra, la descripción de la formación y los conocimientos en ese ámbito, y las razones que dificultan su implicación en estos temas. Metodología: estudio multicéntrico a través de encuesta online cumplimentada por 407 profesionales médicos. Se analizaron 11 problemas en relación con el entorno familiar, escolar, pobreza, inmigración, adicciones y violencia. Resultados: los problemas del entorno familiar o escolar fueron señalados como frecuentes o muy frecuentes por alrededor del 50% de los profesionales; los relacionados con inmigración, acoso y pobreza, por el 20-30%; y los referidos a violencia o adicciones, por menos del 10%. Sin embargo, los porcentajes de formación recibida (y de conocimientos) fueron muy bajos en todos los temas (la mayor formación se aprecia en violencia de género y abuso). Se desglosan los resultados según el ámbito profesional de trabajo (hospitalario o Atención Primaria), el entorno (urbano o rural) y la edad. La mayor dificultad que alegan los profesionales para el abordaje de estos problemas es precisamente la falta de formación. Conclusiones: la patología social infantil está muy presente en la labor diaria del pediatra. Por ello, se precisa una adecuada formación y actualización en esta materia que permita detectar y atender esta patología como el resto de los problemas de la infancia. Se proponen acciones de mejora. (AU)

Introduction: paediatric social disease in relation to socioeconomic inequities, dysfunctional family relationships, immigration, addiction, violence towards children, etc has been increasing. The aim of this paper is to analyse the importance of social disease in paediatric practice and describe the training and knowledge of providers on this subject and the perceived barriers to their involvement in these issues. Methodology: multicentre study by means of an online survey with participation by 407 medical professionals. We analysed 11 social problems related to the family and school environment, poverty, immigration, substance use and violence. Results: problems in the family or school environment were reported as frequent or highly frequent by approximately 50% of the respondents; problems related to immigration, bullying and poverty, by 20-30%; and problems related to violence or addiction by less than 10%. However, the percentage of respondents that reported receiving training (and having knowledge) were very low for all topics (the frequency of training was highest for gender violence and abuse). We analysed the results based on the care setting (hospital or primary care), geographical setting (urban or rural) and age of the provider. The greatest barrier reported by professionals in tackling these problems was precisely the lack of training. Conclusions: paediatricians encounter social disease frequently in their everyday practice. For this reason, adequate and up-to-date training on the subject is required to detect and treat social disease like any other childhood problems. Some improvement strategies are proposed. (AU)

Impacto de la pandemia por SARS-CoV-2 en la atención a los problemas sociales. El punto de vista de los pediatras / Impact of the SARS-CoV-2 pandemic on social problems care. The perspective of paediatricians

Objetivos: valorar el impacto de la pandemia por SARS-CoV-2 en la atención a los problemas sociales, así como los cambios en la comunicación interprofesional y con las familias, que tuvieron lugar. Métodos: se usó un cuestionario validado para recopilar los datos y se recibieron respuestas de 407 profesionales. Se usó el contraste binomial para valorar las respuestas a las hipótesis. Se usó el coeficiente de correlación de Pearson para ver si las respuestas estaban influenciadas por la edad y la U de Mann-Whitney para valorar si las respuestas fueron influenciadas por el sexo, el nivel de atención, el entorno del centro, el perfil profesional o el grado de especialización. Resultados: el confinamiento no mejoró las relaciones familiares, aumentó el número de familias que consultaban por problemas sociales y por problemas relacionados con las nuevas tecnologías. Mejoró la comunicación entre los profesionales. En la muestra global la mejoría de comunicación con las familias no alcanzó significación estadística, aunque sí lo hizo en el subgrupo de profesiones que trabajan en el ámbito rural, en la Atención Primaria y los de mayor edad. También resultó significativo el impacto en los programas de prevención y concienciación sobre la violencia de género. Conclusiones: la pandemia por SARS-CoV-2 ha supuesto un impacto considerable en la atención de los problemas sociales. Desde el punto de vista de los profesionales, no hemos podido constatar mejoría de las relaciones en el núcleo familiar. Las medidas puestas en marcha para enfrentarla han mejorado la comunicación entre profesionales (AU)

Objectives: to assess the impact of the SARS-CoV-2 pandemic on the management of social problems and the changes that took place in the communication with families and between professionals.Methods: we collected data from 407 providers using a validated questionnaire. We used the binomial test to analyse the responses to the hypotheses, the Pearson correlation coefficient to see if the responses were influenced by age and the Mann-Whitney U test to assess whether the responses were influenced by sex, level of care, the setting of the centre, the professional category or the degree of specialisation.Results: the confinement did not improve family relationships, but did increase the number of consultations from families for social problems and problems with new technology. There was an improvement in interprofessional communication. The improvement in the communication with families was not statistically significant in the overall sample, but it was significant in providers working in rural areas, primary care providers and older providers. There was also a significant impact on gender-based violence prevention and awareness programmes.Conclusions: the SARS-CoV-2 pandemic had a significant impact on the management of social problems. From the point of view of providers, there was no improvement in family relationships. The measures taken to deal with the pandemic have improved communication between professionals. (AU)

Creación y validación de un instrumento para cuantificar actitudes, conocimientos y dificultades en el abordaje de los problemas sociales / Creation and validation of an instrument to quantify attitudes, knowledge and difficulties in the approach to social problems

Objetivos: Este estudio tiene como objetivo desarrollar y validar un cuestionario para evaluar actitudes, conocimientos y dificultades en el manejo de problemas sociales por parte de los profesionales de pediatría. Métodos: El desarrollo de la herramienta comenzó con una fase de conceptualización, seguida del diseño, prueba piloto y evaluación de las propiedades psicométricas del cuestionario tras obtener respuestas de 407 profesionales. Se realizaron análisis factoriales exploratorios (AFE) y análisis factoriales confirmatorios (AFC) para explorar la validez de constructo del cuestionario. El índice de ajuste normado (IAN), el error cuadrático medio de aproximación (ECMA), la prueba de chi-cuadrado (χ2) y el índice de ajuste comparativo (IAC) se utilizaron para probar la bondad del ajuste. La confiabilidad se exploró a través del alfa de Cronbach para la consistencia interna. Resultados: La AFE identificó doce factores. Todos los factores mostraron buena consistencia interna (alfa de Cronbach 0,8434). El AFC mostró un buen ajuste al modelo (ECMA=0,037). Los valores de IAN y IAC fueron 0,742 y 0,797, respectivamente. Todos los análisis cuantitativos se llevaron a cabo con el software STATA/SE v.16.1. Conclusiones: Este cuestionario de 138 ítems distribuidos en doce factores es un instrumento fiable y válido para analizar actitudes, conocimientos y dificultades en el abordaje de problemas sociales en la infancia por parte de los pediatras, que permitirá diseñar intervenciones, de acuerdo con las necesidades y las carencias identificadas a través del mismo. (AU)

Objectives: The aim of the study was to develop and validate a questionnaire to assess attitudes, knowledge and difficulties in the management of social problems by paediatric care providers. Methods: The development of the tool started with a conceptualization phase, followed by the design, pilot testing and psychometric evaluation of the questionnaire based on the responses obtained from 407 professionals. We performed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the construct validity of the questionnaire. We used the normed fit index (NFI), the root mean square error of approximation (RMSEA), the χ2 test and the comparative fit index (CFI) to test the goodness of fit. We assessed reliability through the Cronbach's α coefficient of internal consistency. All quantitative analyses were performed with the Stata/SE software, version 16.1. Results: The EFA identified 12 factors. All factors exhibited a good internal consistency (Cronbach's α, .8434). The CFA showed the model was a good fit (RMSEA=.037). The NAI and CAI values were .742 and .797, respectively. Conclusions: This questionnaire comprising 138 items distributed in 12 factors is a reliable and valid instrument to analyse the attitudes, knowledge and difficulties in the approach to social problems in children by paediatricians, which will allow the design of interventions according to the needs and deficiencies identified through it. (AU)

Creation and validation of an instrument to quantify attitudes, knowledge and difficulties in the approach to social problems.

OBJECTIVES: The aim of the study was to develop and validate a questionnaire to assess attitudes, knowledge and difficulties in the management of social problems by paediatric care providers. METHODS: The development of the tool started with a conceptualization phase, followed by the design, pilot testing and psychometric evaluation of the questionnaire based on the responses obtained from 407 professionals. We performed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to assess the construct validity of the questionnaire. We used the normed fit index (NFI), the root mean square error of approximation (RMSEA), the χ2 test and the comparative fit index (CFI) to test the goodness of fit. We assessed reliability through the Cronbach's α coefficient of internal consistency. All quantitative analyses were performed with the Stata/SE software, version16.1. RESULTS: The EFA identified twelve factors. All factors exhibited a good internal consistency (Cronbach's α, 0.8434). The CFA showed the model was a good fit (RMSEA=0.037). The NAI and CAI values were 0.742 and 0.797, respectively. CONCLUSIONS: This questionnaire comprising 138 items distributed in twelve factors is a reliable and valid instrument to analyse the attitudes, knowledge and difficulties in the approach to social problems in children by paediatricians, which will allow the design of interventions according to the needs and deficiencies identified through it.

Reduction in the Risk of Peripheral Neuropathy and Lower Decrease in Kidney Function with Metformin, Linagliptin or Their Fixed-Dose Combination Compared to Placebo in Prediabetes: A Randomized Controlled Trial.

OBJECTIVE: To compare the effect of glucose-lowering drugs on peripheral nerve and kidney function in prediabetes. METHODS: Multicenter, randomized, placebo-controlled trial in 658 adults with prediabetes treated for 1 year with metformin, linagliptin, their combination or placebo. Endpoints are small fiber peripheral neuropathy (SFPN) risk estimated by foot electrochemical skin conductance (FESC < 70 µSiemens) and estimated glomerular filtration rate (eGFR). RESULTS: Compared to the placebo, the proportion of SFPN was reduced by 25.1% (95% CI:16.3-33.9) with metformin alone, by 17.3% (95% CI 7.4-27.2) with linagliptin alone, and by 19.5% (95% CI 10.1-29.0) with the combination linagliptin/metformin (p < 0.0001 for all comparisons). eGFR remained +3.3 mL/min (95% CI: 0.38-6.22) higher with the combination linagliptin/metformin than with the placebo (p = 0.03). Fasting plasma glucose (FPG) decreased more with metformin monotherapy -0.3 mmol/L (95%CI: -0.48; 0.12, p = 0.0009) and with the combination metformin/linagliptin -0.2 mmol/L (95% CI: -0.37; -0.03) than with the placebo (p = 0.0219). Body weight (BW) decreased by -2.0 kg (95% CI: -5.65; -1.65, p = 0.0006) with metformin monotherapy, and by -1.9 kg (95% CI: -3.02; -0.97) with the combination metformin/linagliptin as compared to the placebo (p = 0.0002). CONCLUSIONS: in people with prediabetes, a 1 year treatment with metformin and linagliptin, combined or in monotherapy, was associated with a lower risk of SFPN, and with a lower decrease in eGFR, than treatment with placebo.

Early prevention of diabetes microvascular complications in people with hyperglycaemia in Europe. ePREDICE randomized trial. Study protocol, recruitment and selected baseline data.

OBJECTIVES: To assess the effects of early management of hyperglycaemia with antidiabetic drugs plus lifestyle intervention compared with lifestyle alone, on microvascular function in adults with pre-diabetes. METHODS: Trial design: International, multicenter, randomised, partially double-blind, placebo-controlled, clinical trial. PARTICIPANTS: Males and females aged 45-74 years with IFG, IGT or IFG+IGT, recruited from primary care centres in Australia, Austria, Bulgaria, Greece, Kuwait, Poland, Serbia, Spain and Turkey. INTERVENTION: Participants were randomized to placebo; metformin 1.700 mg/day; linagliptin 5 mg/day or fixed-dose combination of linagliptin/metformin. All patients were enrolled in a lifestyle intervention program (diet and physical activity). Drug intervention will last 2 years. Primary Outcome: composite end-point of diabetic retinopathy estimated by the Early Treatment Diabetic Retinopathy Study Score, urinary albumin to creatinine ratio, and skin conductance in feet estimated by the sudomotor index. Secondary outcomes in a subsample include insulin sensitivity, beta-cell function, biomarkers of inflammation and fatty liver disease, quality of life, cognitive function, depressive symptoms and endothelial function. RESULTS: One thousand three hundred ninety one individuals with hyperglycaemia were assessed for eligibility, 424 excluded after screening, 967 allocated to placebo, metformin, linagliptin or to fixed-dose combination of metformin + linagliptin. A total of 809 people (91.1%) accepted and initiated the assigned treatment. Study sample after randomization was well balanced among the four groups. No statistical differences for the main risk factors analysed were observed between those accepting or rejecting treatment initiation. At baseline prevalence of diabetic retinopathy was 4.2%, severe neuropathy 5.3% and nephropathy 5.7%. CONCLUSIONS: ePREDICE is the first -randomized clinical trial with the aim to assess effects of different interventions (lifestyle and pharmacological) on microvascular function in people with pre-diabetes. The trial will provide novel data on lifestyle modification combined with glucose lowering drugs for the prevention of early microvascular complications and diabetes. REGISTRATION: - ClinicalTrials.Gov Identifier: NCT03222765 - EUDRACT Registry Number: 2013-000418-39.