[Effectiveness of the TG/HDL-C ratio to improve GLP-1 prescription in patients with type 2 diabetes in primary care]. / Efectividad de la ratio TG/c-HDL en la mejora de la prescripción de GLP-1 en pacientes con diabetes tipo 2 en atención primaria.

AIMS: Check the usefulness of ratio TG/HDL-C≥2.5 to improve the effectiveness of GLP-1 prescribing in patients with type 2 diabetes (DM2) in primary care, and determine whether any patient profile would higher benefit. DESIGN: Descriptive cross-sectional study. LOCATION: Barranco Grande Health Center, Tenerife. PARTICIPANTS: Random selection of patients with DM2 attended by 12 family doctors and 12 nurses. MAIN MEASUREMENTS: Poor control according to the current criteria was compared to poor control according to the proposed rule. To determine who would benefit, the sociodemographic, clinical, therapeutic and follow-up characteristics were analyzed. Descriptive, bivariate and multivariate statistical analysis was performed. RESULTS: No predominant characteristics were found in the patients who would be prescribed GLP-1 according to the proposed rule, but those that reached a significance P<.20 were included as potential explanatory factors in a multivariate binary logistic regression model. The adjustment of the model retained the factors of therapeutic non-compliance (OR 3.40 [1.58-5.02]; P=.003), evolution of DM2 less than 15 years (OR 2.74 [1.10-4.89]; P=.031), number of prescribed anti-diabetes drugs (OR 2.30 [1.88-2.81]; P<.001) and age under 65 years (OR 1.67 [1.08-2.58]; P=.021). CONCLUSIONS: The use of the rule that we propose for the prescription of GLP-1 (2018 recommendations of the GDPS network combined with the TG/HDL-C ratio≥2.5 or BMI≥30kg/m2), instead of the current criterion adopted by the National Health System, would allow to broaden the spectrum of application of the drug in patients with poor control of their DM2.

[Evolution of antimicrobial resistance and mortality in Staphylococcus aureus endocarditis during 15 years in a university hospital]. / Evolución de la resistencia antimicrobiana y mortalidad en la endocarditis por Staphylococcus aureus durante 15 años en un hospital universitario.

OBJECTIVE: One of the most aggressive microorganisms in infective endocarditis (IE) is Staphylococcus aureus. We analyse the resistance of S. aureus to antibiotics and its impact on the clinical course of IE in a recent 15-year period. METHODS: Retrospective study of patients with IE in a university hospital from 2005 to 2019. Bivariate and multivariate analysis of severity at admission, comorbidities, minimum inhibitory concentrations (MIC) and mortality. RESULTS: Of the 293 IE cases, 66 (22.5%) were due to S. aureus, and 21 (7.2%) were methicillin-resistant S. aureus (MRSA). The prevalence of strains with a MIC to vancomycin ≥ 1mg/L increased from 4.8% to 63.6% (p <0.001) and the cases of MRSA from 38 to 27.3% (p = 0.045). Older age (p= 0.02), comorbidity (p <0.01) and nosohusial origin (p = 0.01), were factors associated with MRSA. But the antimicrobial resistance and severity on admission were not associated with exitus; predictive factors were the right-sided IE (OR = 0.08; 95% CI: 0.01-0.51), comorbidities (OR per Charlson index point = 1.30; 95% CI: 1.01-1.69) and creatinine on admission (OR per mg / dL = 1.56; 95% CI = 1.01- 2.35; p = 0.04). CONCLUSIONS: We have experienced an increase in IE cases with MIC to vancomycin ≥ 1mg/L, without significant variation in infections due to MRSA. Antimicrobial resistance was not associated with mortality, but comorbidity and left involvement were predictive factors.

Calibrated prevalence of infertility in 30- to 49-year-old women according to different approaches: a cross-sectional population-based study.

STUDY QUESTION: How does the estimated prevalence of infertility among 30- to 49-year-old women vary when using different approaches to its measurement? SUMMARY ANSWER: The prevalence of women with difficulties in conceiving differed widely according to the measurement approach adopted. WHAT IS KNOWN ALREADY: Establishing the true magnitude of infertility as a public health problem is challenging, given that it is not categorized as a disability or chronic condition and may be largely unreported. The time required to conceive is an increasingly frequent concern among couples of reproductive age. Population-based studies do not consider multiple approaches to infertility measurement in the same sample. STUDY DESIGN, SIZE, DURATION: A face-to-face cross-sectional population-based survey of 443 women aged between 30 and 49 years residing in Huelva, southern Spain, was carried out. The sample size estimation was based on an assumed prevalence of infertility of 19%, a sampling error of ±4.84 percentage points, a design effect of 1.8 and a 95% confidence level. The information was collected in 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS: Self-reported information was gathered on socio-demographic data, pregnancy history, time required to become pregnant and perception of difficulties in becoming pregnant. Eight approaches to the estimation of infertility prevalence were considered: diagnosed infertility, subjective infertility, 1-year infertility, primary infertility, secondary infertility and subfertility based on the time taken to conceive (6, 12 or 24 months). Calibration estimators (indirect estimation techniques) were used to extrapolate the infertility prevalences to the whole of Spain. MAIN RESULTS AND THE ROLE OF CHANCE: The response rate was 61.05%. Among 30- to 49-year-old Spanish women, 1.26% had a clinical diagnosis of infertility, 17.58% did not achieve pregnancy in 1 year (1-year infertility), 8.22% perceived difficulties in procreation (subjective infertility), 6.12% had not succeeded in having biological children (primary infertility) and 11.33% had not been able to have another biological child (secondary infertility). Finally, pregnancy was not achieved within 6, 12 and 24 months of starting to attempt conception in 19.98, 11.21 and 4.36% of women, respectively. These approaches to estimate the prevalence of infertility show similar socio-demographic patterns except for educational level. Calibration adjustments allowed extrapolation of these prevalences to Spain and a reduction of from 3.7 to 90.4% in their variances. LIMITATIONS, REASONS FOR CAUTION: The response rate was moderate but acceptable in comparison to similar studies. We only asked whether the women had practiced intercourse without contraceptive methods for >1 year. Hence, we could only calculate the time for which a couple were trying to become pregnant when the woman became pregnant, and we do not know whether it was longer than 1 year for the women failing to conceive. Future research should avoid this study weakness by gathering quantitative data on the months during which vaginal sexual intercourse was practiced, with no time limit. The only prevalence with a high coefficient of variation was that for diagnosed infertility, and our estimation for this prevalence should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS: Despite major differences according to the approach adopted, the prevalences of infertility estimated in our study are comparable with those obtained in other similar studies. A set of categories to measure infertility including subjective infertility, 1-year infertility and subfertility have been proposed here, which may be useful for cross-disciplinary comparisons of infertility in clinical and population-based studies. These measures may also assist health managers to tailor fertility resources and services to the real needs of the population and provide a more rapid and effective response to couples. Finally, the calibration adjustments (indirect estimation techniques) applied to the infertility prevalences help to maximize their generalization and improve accuracy. This technique may be considered as a model for application in other epidemiological studies.

An Internet-based programme to promote adequate UV exposure behaviour in adolescents in Spain.

BACKGROUND: The exponential rise in the incidence of cutaneous cancers underscores the need to promote primary prevention. Adolescents are highly familiar with the use of Internet, and new technologies and Internet systems have proven especially useful to educate this age group in other health problems. To date, there have been no reports of Internet-based primary prevention campaigns for adolescents against skin cancer. OBJECTIVES: To determine the knowledge and behaviour of a Spanish adolescent population in relation to sun exposure through an Internet-based system and to describe the use of an Internet-based school intervention programme to improve the sun exposure knowledge and behaviour in adolescents. METHODS: The cross-sectional study included 2170 school pupils aged between 12 and 16 years from public secondary schools. Pupils in the participating centres completed the survey via the website, which contained a total of 35 questions and three information blocks. For the intervention programme, a sub-sample of 12 secondary schools (total of 1290 pupils) was randomly selected. RESULTS: About 56.7% of the female pupils and 52.6% of the male pupils reported having suffered from sunburn in the previous summer. Sunburn risk increased with the frequency of sun exposure between 12 and 6 pm (OR of 3.59), null knowledge of the negative effects of sun exposure (OR of 2.102), the use of sun protection cream (OR of 0.695 for non-use) and physical sun protection measures (OR of 2.21 for 0-1 physical measures). A significant reduction in self-reported sunburns was observed in the quasi-experimental group in comparison with controls after adjusting for sex and inland or coastal location of the centre (OR = 0.45, 95% CI = 0.23-0.87, P = 0.018). Adjusted OR showed that there was a significant improvement in the use of physical measures, use of sun cream, frequency of sun cream application every 2 h and use of protection on cloudy days. CONCLUSIONS: This is the first study to demonstrate that a programme entirely conducted via Internet significantly reduces by half self-reported sunburn risk in an adolescent population achieving very high satisfaction rates.

Prevalence of melanocytic nevi in 8- to 10-year-old children in Southern Spain and analysis of associated factors.

BACKGROUND: There is a known relationship between melanocytic nevi (MN) and cutaneous melanoma. MN are related to genetic and environmental factors, and the latter appear to be more important in childhood. OBJECTIVES: To determine the prevalence of MN and its relationship with phenotypic traits and sun exposure habits in 8- to 10-year-old children. SUBJECTS AND METHODS: We performed a cross-sectional study of 8- to 10-year-old primary school children in the city of Granada (Spain), gathering data on phenotypic traits, sun protection measures, sunburn frequency and the number and density of MN. RESULTS: We detected a mean of 19.38 MN per child, predominantly <2 mm in diameter. MN count was associated with low phototype, and was higher in boys vs. girls with low phototype. MN were more numerous with higher age. The largest number of MN of all sizes was detected in 10-year-old boys. MN were most frequently located on the torso and other sites intermittently exposed to sunlight. CONCLUSIONS: A higher MN count is associated with lower phototype (blonde hair and fair skin) and higher age. The mean number of MN, including those of smaller size (<2 mm), was elevated in our series, especially on intermittently exposed sites.

Prevención de la accidentalidad infantil en Andalucía: aprender a crecer con seguridad / Prevention of childhood accidents in andalusia: To learn to grow up safely

Introducción: La accidentalidad infantil se ha convertido en un ámbito de especial interés para la investigación social y sanitaria ya que se sitúa como una de las primeras causas de muerte en las sociedades desarrolladas. Partiendo de la idea de que los accidentes infantiles se convierten en un riesgo conatural al crecimiento y al aprendizaje de la vida, la prevención ha de ser una de las líneas principales en los programas sobre accidentalidad en promoción de la salud. Métodos: Este artículo presenta los resultados de una encuesta sobre accidentalidad infantil realizada sobre 421 estudiantes de 5° y 6° curso de Educación Primaria de centros públicos de Jaén y que participaron en el programa «Aprende a crecer con seguridad» realizado por la Consejería de Empleo de la Junta de Andalucía. Resultados: A medida que aumenta la edad de los chicos, los accidentes ocurren en mayor medida que en las chicas y es en la calle donde principalmente se producen, mientras que en las chicas el escenario más frecuente de accidentalidad es el hogar. Además, el colegio se presenta como el entorno más seguro. Conclusiones: La accidentalidad infantil observada presenta bastantes similitudes con la de la accidentalidad laboral (caídas, cortes y golpes), justificando la importancia de insistir en que la adquisición de conductas preventivas en edades tempranas pueden derivar en buenos hábitos comportamentales que supongan en la edad adulta una disminución de los riesgos y por lo tanto de la accidentalidad laboral (AU)

Introduction: Childhood accidents have become an area of special interest for social and health research as it is one of the main causes of death in children in developed societies. Starting from the idea that child injuries are an inherent risk of growing up and life learning, prevention has to be one of the main lines in programmes on injury in health promotion. Methods: This article reports the results of a survey of 421 pupils in 5th and 6th year of Primary Education in public schools in Jaen province who participated in the safety first campaign called «Learn to grow with safety»1. This campaign is organised by the Andalusian Government Employment Council. Results: Injuries occur more frequently in boys, as they grow older, than in girls. These injuries occur mainly in the street, while in girls they most frequently occur in the home. Furthermore, school is the most secure place. Conclusions: The type of child injury observed is very similar to job injuries (falls, cuts and knocks) which justifies the importance of insisting learning preventive behaviour at a early age. This would lead to good habits that would involve less risk taking in adult years, and therefore less injuries at work (AU)

[Evaluation of a school intervention program to modify sun exposure behaviour]. / Evaluación de un programa de intervención escolar para la modificación del comportamiento ante la exposición solar.

INTRODUCTION: Nonmelanoma skin cancer is the most prevalent and incident tumor in the world, being sun exposure the most important risk factor. Childhood and adolescence are the periods where sun exposure is greatest. An intervention to modify sun-related behaviours is essential for skin cancer prophylaxis. MATERIAL AND METHODS: We carried out a quasi-experimental study on a school population of Granada with ages ranging from 11-12 years. The control and study groups completed a questionnaire prior to the intervention with educational program and thereafter. We performed a random conglomerate sampling of 628 teenagers. Statistical analysis was carried out using the Mc Nemar and Wilcoxon tests. RESULTS: After the intervention, the study group showed marked improvement in the results concerning knowledge about sun exposure and skin (OR = 2.89), sun exposure and environment (OR = 2.23), and sun exposure and health (OR = 1.4) as well as in attitudes and healthy behaviour regarding sun exposure (OR = 4.2). This difference was statistically significant compared to the control group. CONCLUSIONS: 1. Before planning a campaign for primary prophylaxis of skin cancer it is necessary to know the information and knowledge of the target population. 2. The risk of acute, intermittent sun exposure and the use of different means of photoprotection should be stressed. 3. In our study group the rate of sun burn has decreased.

Evaluación de un programa de intervención escolar para la modificación del comportamiento ante la exposición solar / Evaluation of a school intervention program to modify sun exposure behaviour

Introducción. El cáncer de piel melanoma y no-melanoma es el tumor más prevalente y más frecuente en el mundo, la exposición solar es el factor de riesgo más importante. La infancia y la adolescencia es el periodo de la vida en el cual la exposición solar es mayor. La intervención para modificar hábitos ante el sol es fundamental para la prevención del cáncer cutáneo. Material y métodos. Realizamos un estudio cuasiexperimental sobre una población escolar de Granada capital de 11 y 12 años con un test previo a casos y controles, intervención con programa educativo a grupo de casos y test posterior a ambos grupos. Muestreo aleatorio por conglomerados. Cuestionario autocumplimentado. Muestra de 628 adolescentes de colegios e institutos de Granada. Estadístico utilizado: Test de Mc Nemar y Wilcoxon. Resultados. Tras la intervención, el grupo de casos mejoraba ampliamente los resultados tanto en conocimientos sobre sol y piel (OR = 2,89), sol y medio ambiente (OR = 2,23) y sol y salud (OR = 1,4) como en actitudes y conductas sanas con respecto al sol, (OR = 4,2), siendo esta diferencia estadísticamente significativa, frente al grupo control. Conclusiones. Antes de planificar una campaña de prevención primaria de cáncer de piel es necesario saber los conocimientos y comportamientos de la población a la que se dirige. En segundo lugar se debe insistir en el riesgo de la exposición solar intermitente aguda y en el uso de los diferentes medios de fotoprotección. Por último hay que señalar que en el grupo de nuestro estudio ha disminuido la frecuencia de quemadura solar

Introduction. Nonmelanoma skin cancer is the most prevalent and incident tumor in the world, being sun exposure the most important risk factor. Childhood and adolescence are the periods where sun exposure is greatest. An intervention to modify sun-related behaviours is essential for skin cancer prophylaxis. Material and methods.We carried out a quasi-experimental study on a school population of Granada with ages ranging from 11-12 years. The control and study groups completed a questionnaire prior to the intervention with educational program and thereafter. We performed a random conglomerate sampling of 628 teenagers. Statistical analysis was carried out using the Mc Nemar and Wilcoxon tests. Results. After the intervention, the study group showed marked improvement in the results concerning knowledge about sun exposure and skin (OR = 2.89), sun exposure and environment (OR = 2.23), and sun exposure and health (OR = 1.4) as well as in attitudes and healthy behaviour regarding sun exposure (OR = 4.2). This difference was statistically significant compared to the control group. Conclusions. 1. Before planning a campaign for primary prophylaxis of skin cancer it is necessary to know the information and knowledge of the target population. 2. The risk of acute, intermittent sun exposure and the use of different means of photoprotection should be stressed. 3. In our study group the rate of sun burn has decreased

Male erectile dysfunction and health-related quality of life.

OBJECTIVE: The purpose of this work was to assess the health-related quality of life factors associated with erectile dysfunction (ED). METHODS: 2476 non-institutionalised Spanish males, age ranging from 25 to 70 years, were interviewed. ED was defined using two instruments: a simple self-assessment question (ED-sq) and the International Index of Erectile Function (IIEF). Health-related quality of life (HRQoL) was measured through the SF-36 questionnaire. RESULTS: The severity of ED (measured both through the ED-sq and with the IIEF) increased as the scores of the scales of the SF-36 decreased (Mantel-Hänszel chi(2)-test statistic range: [26-305]; p<0.001). The two summary components (physical and mental) showed a downward trend, more for the physical than for the mental component. CONCLUSION: We found a clear pattern of negative association between self-perceived erectile dysfunction and HRQoL. This association was clearer when ED-sq (rather than IIEF) was used, and stronger for the physical summary component than for the mental one.

[Conclusions of the Canary Islands Nutrition Survey (1997-98). Foundations for a nutrition policy in Canary Islands]. / Conclusiones de la Encuesta de Nutrición de Canarias (1997-98). Bases para una política de nutrición en Canarias.

The principal findings of the Canary Island Nutrition survey (ENCA). 1997-98 are presented. This survey was realised to obtain the following objectives: to evaluate eating habits and nutritional status utilising dietary, anthropometric and biochemical indicators in the Canary Island population along with determining lifestyle factors and the prevalence of the main cardiovascular risk factors. Additionally, a survey evaluating food-related knowledge and attitudes was also carried out. To attain this end, a cross-sectional study was realised in a representative sample of the Canary Island population aged 6 to 75 years (n = 1,747). This article summarises the key findings related to study objectives as well as study-derived recommendations to be realised within a Canary Island health and nutrition policy framework. For this purpose, the development of food based dietary guidelines addressed to meet target nutrients is needed.