Control de diabetes y consultas al médico de familia durante la pandemia de COVID-19: estudio multicéntrico en atención primaria / Diabetes control and visits to the family doctor during the COVID-19 pandemic: a multicenter study in primary care

Objetivos: Determinar los cambios de frecuentación de consultas presenciales (CP) y telemáticas (CT) a su médico de familia en pacientes con diabetes tipo 2 (DM2) durante la pandemia de COVID-19 y su relación con el control de su enfermedad. Diseño: Estudio multicéntrico de seguimiento retrospectivo. Emplazamiento: Siete centros de salud en Tenerife, España. Participantes: Un total de 3.543 pacientes con DM2. Mediciones: Sexo, edad, CP, CT y control de DM2 mediante hemoglobina glicosilada (A1c) durante el periodo 2019-2021. Se ajustaron modelos de regresión logística con el control de DM2 como efecto, y con las demás mediciones como variables independientes. Resultados: El 50% eran mujeres. El 38% tenía 65 años o menos. Se midió la A1c al 84% de los pacientes en 2019, 68% en 2020, y 77% en 2021. Presentaron buen control el 58,4% en 2019, 46,1% en 2020 y 50,3% en 2021. Las CP fueron 7 en 2019, 4 en 2020 y 5 en 2021 (p<0,001). Las razones de ventaja (IC95%) de buen control en 2019 fueron 1,04 (1,04-1,05) por cada año más de edad y 1,03 (1,01-1,04) por cada CP más; en 2020 fueron 1,04 (1,03-1,05) por cada año más de edad, 1,05 (1,04-1,07) por cada CP más y 1,04 (1,02-1,07) por cada CT más; en 2021 fueron 1,04 (1,04-1,05) por cada año más de edad, 1,05 (1,03-1,06) por cada CP más y 1,02 (1,00-1,04) por cada CT más. Conclusiones: El control de pacientes con DM2 durante 2019-2021 tuvo una relación directa con el cambio de frecuentación al centro de salud, con diferencias según el tipo de consulta y la edad.(AU)

Objectives: To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease. Design: Multicentric study of retrospective follow-up. Setting: Seven health centers in Tenerife, Spain. Participants: 3543 patients with DM2. Main measurements: Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables. Results: 50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC. Conclusions: The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.(AU)

[Diabetes control and visits to the family doctor during the COVID-19 pandemic: a multicenter study in primary care]. / Control de diabetes y consultas al médico de familia durante la pandemia de COVID-19: estudio multicéntrico en atención primaria.

OBJECTIVES: To determine whether in patients with type 2 diabetes (DM2) the changes in their relationship with family doctors during the COVID-19 pandemic, in-person (iPC) and telematic (TC) consultations, were associated with control of their disease. DESIGN: Multicentric study of retrospective follow-up. SETTING: Seven health centers in Tenerife, Spain. PARTICIPANTS: 3543 patients with DM2. MAIN MEASUREMENTS: Sex, age, iPC, TC and DM2 control using glycosylated hemoglobin (A1c) during the period 2019-2021. Logistic regression models were fitted with DM2 control as an effect, and with the other measurements as independent variables. RESULTS: 50% were women. 38% were less than 65 years old. A1c was measured in 84% of patients in 2019, 68% in 2020, and 77% in 2021. 58.4% had good control in 2019, 46.1% in 2020, and 50.3% in 2021. Median iPC were 7 in 2019, 4 in 2020 and 5 in 2021 (p<0.001). The OR(95%CI) of good control in 2019 were 1.04(1.04-1.05) per year of age and 1.03(1.01-1.04) for each iPC; In 2020 they were 1.04 (1.03-1.05) per year of age, 1.05 (1.04-1.07) for each iPC and 1.04 (1.02-1.07) for each TC; in 2021 they were 1.04 (1.04-1.05) per year of age, 1.05 (1.03-1.06) for each iPC and 1.02 (1.00-1.04) for each TC. CONCLUSIONS: The control of patients with DM2 during the period 2019-2021 had a direct relationship with the change in the frequency of consultations at the health center, with differences depending on the type of consultation and the age of the patient.

Seguimiento de los pacientes con diabetes tipo 2 durante la pandemia por COVID-19: un estudio multicéntrico en Atención Primaria / Follow-up of patients with type 2 diabetes during the COVID-19 pandemic: A multicentre study in Primary Care

Antecedentes La pandemia de COVID-19 obligó a tomar medidas que implicaban la desatención a los pacientes con diabetes tipo 2 (DM2). Objetivos Explorar la repercusión de la discontinuidad asistencial sobre los pacientes con DM2. Diseño Estudio observacional retrospectivo multicéntrico. Emplazamiento Cinco centros de atención primaria (AP), que no tenían protocolo de actuación específica para ellos, durante 2020 y 2021. Participantes Pacientes con DM2 en Tenerife, Islas Canarias, España. Mediciones principales De las historias clínicas se extrajeron el sexo y la edad, las variables de seguimiento del programa de detección y control de la enfermedad vascular ateroesclerótica (pEVA), de cumplimiento de los objetivos de control y frecuentación al médico de familia y enfermera comunitaria. Resultados Se incluyó a 3.543 pacientes, 1.772 (50%) mujeres, de ellos 2.204 (62%) mayores de 65 años. La gran mayoría de actividades registradas y objetivos de control disminuyeron en 2020, recuperándose en 2021 sin alcanzar los niveles de 2019. En 2020 aumentaron las consultas telefónicas y disminuyeron las presenciales, tendencia mantenida en 2021 para las telefónicas. Las mujeres y los mayores de 65 años presentaron mayor frecuentación, más registros de actividades y logros de objetivos de control en la mayoría de los parámetros. Conclusiones La pandemia supuso una sobrecarga de la AP que ha afectado a la atención de los pacientes con DM2, que no ha logrado restablecerse a los niveles prepandémicos. Los hombres jóvenes conforman la diana de priorización de esta atención. Las medidas antipandémicas han aumentado la consulta telefónica, un recurso que debe potenciarse (AU)

Background The COVID-19 pandemic meant measures had to be taken that implied the neglect of patients with type 2 diabetes (T2D). Objectives to explore the impact of care discontinuity on patients with T2D in Primary Care (PC) centres, who did not have a specific action protocol for them, during 2020 and 2021. Design Multicenter retrospective observational study. Participants Patients with T2D in Tenerife, Canary Islands, Spain. Main Measurements Sex and age, follow-up variables of atherosclerotic vascular disease detection and control programme (pEVA), compliance with the control objectives and visits to the family practitioner and community nurse were extracted from their medical records. Results 3,543 participants took part in the study, 1,772 (50%) women, 2,204 (62%) of whom were older than 65 years of age. The vast majority of registered activities and control objectives decreased in 2020, recovering in 2021 without reaching 2019 levels. In 2020, telephone consultations increased and in-person consultations decreased, a trend that remained unchanged in 2021 for telephone consultations. Women and those over 65 years of age presented higher frequentation, more activity records and achievement of control objectives in most of the parameters. Conclusions The pandemic caused an overload in the PCs that affected the care of patients with T2D, which has not returned to pre-pandemic levels. Young men are the target for prioritization of this care. Anti-pandemic measures have led to an increase in telephone consultations, a resource that should be strengthened (AU)

The Impact of MRSA Colonization on Healthcare-Associated Infections in Long-Term Care Facility Residents: A Whole-Genome Sequencing-Based Study.

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been considered a risk factor for the development of infection, however, there are no studies that have compared the colonizing and infecting strains using whole-genome sequencing (WGS). The aim of this study is to determine the prevalence of and risk factors for MRSA colonization among long-term care facilities (LTCF) residents of Tenerife (Spain), and to analyze the epidemiological relationship between the colonizing and infecting strains using WGS. A point-prevalence study was carried out at 14 LTCFs in Tenerife from October 2020 to May 2021. Nasal swabs were cultured for MRSA. Colonized residents were followed up for two years. A phylogenetic comparison between colonization and infection strains was performed using WGS. A total of 764 residents were included. The prevalence of colonization by MRSA was 28.1% (n = 215), of which 12 (5.6%) subsequently developed infection. A close genetic relationship between colonization and infection isolates was found in three of the four (75%) residents studied. Our study confirms that colonized residents can develop serious MRSA infections from the same nasal colonization strain. Given the high prevalence of MRSA colonization in these centers, it is necessary to implement strategies with preventive measures to avoid the development of infection and the transmission of MRSA.

[Follow-up of patients with type 2 diabetes during the COVID-19 pandemic: A multicentre study in Primary Care]. / Seguimiento de los pacientes con diabetes tipo 2 durante la pandemia por COVID-19: un estudio multicéntrico en Atención Primaria.

BACKGROUND: The COVID-19 pandemic meant measures had to be taken that implied the neglect of patients with type 2 diabetes (T2D). OBJECTIVES: to explore the impact of care discontinuity on patients with T2D in Primary Care (PC) centres, who did not have a specific action protocol for them, during 2020 and 2021. DESIGN: Multicenter retrospective observational study. PARTICIPANTS: Patients with T2D in Tenerife, Canary Islands, Spain. MAIN MEASUREMENTS: Sex and age, follow-up variables of atherosclerotic vascular disease detection and control programme (pEVA), compliance with the control objectives and visits to the family practitioner and community nurse were extracted from their medical records. RESULTS: 3,543 participants took part in the study, 1,772 (50%) women, 2,204 (62%) of whom were older than 65 years of age. The vast majority of registered activities and control objectives decreased in 2020, recovering in 2021 without reaching 2019 levels. In 2020, telephone consultations increased and in-person consultations decreased, a trend that remained unchanged in 2021 for telephone consultations. Women and those over 65 years of age presented higher frequentation, more activity records and achievement of control objectives in most of the parameters. CONCLUSIONS: The pandemic caused an overload in the PCs that affected the care of patients with T2D, which has not returned to pre-pandemic levels. Young men are the target for prioritization of this care. Anti-pandemic measures have led to an increase in telephone consultations, a resource that should be strengthened.

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.

Risk factors for colonization by carbapenemase-producing bacteria in Spanish long-term care facilities: a multicentre point-prevalence study.

BACKGROUND: The emergence of carbapenemase-producing bacteria (CPB) has become a major public health concern. Long-term care facilities (LTCF) are potential reservoirs for multidrug-resistant micro-organisms (MDRO). However, data on CPB is limited. The study aims to determine the prevalence of MDRO and risk factors for CPB colonization among residents of LTCFs. METHODS: A point-prevalence study was conducted at 14 LTCFs in Tenerife (Spain) between October 2020 and May 2021. Nasal and rectal swabs were cultured for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), carbapenemase-producing Enterobacterales, MDR Acinetobacter baumannii (MDR-Ab) and MDR Pseudomonas aeruginosa. Antimicrobial susceptibility testing and molecular detection of resistance genes were performed. Risk factors for colonization by carbapenemase-producing bacteria (CPB) were determined by univariate and multivariate analysis. RESULTS: A total of 760 LTCF residents were recruited. The prevalence of colonization by CPB was 9.3% (n = 71) with the following distribution: 35 (49.3%) K. pneumoniae, 26 (36.6%) MDR-Ab, 17 (23.9%) E. coli, and 1 (1.4%) C. koseri. In addition, the prevalence of colonization by MRSA was 28.1% (n = 215) and only one case of VRE was isolated. Multivariate analysis identified male sex (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.86-3.11; P = 0.01), having a high health requirement (OR, 6.32; 95% CI, 1.91-20.92; P = 0.003) and previous hospitalization (OR, 3.60; 95% CI, 1.59-8.15 P = 0.002) as independent risk factors for CPB rectal carriage. CONCLUSIONS: LTCFs are an important reservoir for MDRO, including CPB. We have identified some predictors of colonization by CPB, which enable a more targeted management of high-risk residents. Antimicrobial stewardship programmes and infection control preventive measures are needed to stop acquisition and transmission of MDRO.

Humoral response to SARS-CoV-2 after vaccination and booster effect in patients undergoing dialysis.

OBJECTIVE: The aim of this study was to determine and evaluate the postvaccination variation in immunoglobulin G (IgG) receptor-binding domain (RBD) produced in non-SARS-CoV-2-infected patients with nephropathy and renal replacement therapy. METHODS: This is a follow-up study of the humoral response to the BNT162b2 messenger ribonucleic acid COVID-19 vaccine in patients with nephropathy, comparing it with itself at different times and with the healthy population. RESULTS: In patients with nephropathy, a very striking decrease in IgG RBD was observed compared with the healthy population (P<0.001) at three months after the second dose. In patients with nephropathy, the response rate ≥590 binding antibody units/ml (4154 AU/ml) was detected in 45% of patients, 15 days after the second dose, whereas at 3 months, this decreased to 9% (P<0.05) and then increased to 86% after the third dose (P<0.001). CONCLUSION: In patients with nephropathy and renal replacement therapy, it is necessary to administer a third-dose vaccination within 3 months after the second dose. It is important to continue monitoring the humoral response to obtain a better SARS-CoV-2 vaccination schedule.

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 / 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

OBJETIVO: Conocer la evolución del consumo de tabaco en Canarias durante 2000-2015 según clase social. Emplazamiento: Comunidad Autónoma de Canarias. PARTICIPANTES: Cohorte CDC-Canarias con cortes en 2000 (n = 6.729), 2008 (n = 6.171) y 2015 (n = 4.705). Mediciones principales: Tabaquismo, sexo, edad y clase social. RESULTADOS: El consumo disminuyó un 6% (5-7%, p < 0,001) en general, siendo más acentuado en el periodo 2000-2008 (5%). La disminución fue mayor en hombres, aunque siguieron fumando más que las mujeres, con una prevalencia del 25% (24-26%) frente al 18% (17-19%, p < 0,001). Solo hubo una disminución del consumo en los grupos jóvenes (6% [3-5%]; p = 0,011) y de edades intermedias (7% [6-8%]; p < 0,001). En todas las clases sociales se observó una disminución similar, con mayor prevalencia de tabaquismo en la clase alta: 24% (23-25%) en 2015 (p < 0,001). Al valorar conjuntamente sexo, edad y clase social, los hombres más jóvenes y de edad intermedia presentaron los mayores descensos de consumo: 8% (7-9%) clase baja y alta, 10% (9-11%) clase media. En la clase social baja, las mujeres más jóvenes continúan fumando más (27%) aunque abandonaron más el consumo (14%), fenómeno que en las de clase media se produjo en edades intermedias. CONCLUSIONES: La evolución del consumo de tabaco en Canarias sigue un patrón similar al conjunto de España. El abandono del consumo de tabaco se ha frenado en el periodo 2008-2015, especialmente en hombres y en clases sociales medias y altas

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

Sistema informatizado de Valoración Enfermera de la Urgencia Pediátrica en Atención Primaria VEUPAP y su enlace a la historia clínica informatizada de atención primaria / Computerized Nurse Assessment System for Pediatric Emergency in Primary Care VEUPAP and its link to the computerized medical record of primary care

OBJETIVO: Implementación informática del sistema de Valoración Enfermera de la Urgencia Pediátrica en Atención Primaria (VEUPAP). DISEÑO: El desarrollo de la aplicación informática de VEUPAP siguió las siguientes fases: 1. Diseño de salidas y entradas al sistema necesarias para asegurar esas salidas. 2. Programación de los algoritmos y vínculos de enlace a partir de las entradas de datos para obtener las salidas de información esperadas. 3. Obtención de versión tentativa del VEUPAP informatizado, puesta a punto y prueba piloto de su funcionamiento con las modificaciones y ajustes hasta lograr su versión definitiva. RESULTADOS: VEUPAP en versión informática para ordenador personal en entorno operativo Windows Microsoft NT Professional, con la visión general de los campos de valoración que lo conforman, especificidades de entradas de cada campo e informe clínico tipo de salida. CONCLUSIONES: VEUPAP computarizado con incorporación a la historia clínica informatizada de Atención Primaria hace transparentes y accesibles todos los datos del proceso de la actividad clínica enfermera en cuidados pediátricos urgentes, permitiendo que sean conocidos y puedan ser empleados por todos los profesionales de la atención primaria. La huella de información generada por VEUPAP permite seguir su evolución y valorar su impacto en el manejo enfermero de las urgencias pediátricas en atención primaria, con la consiguiente evaluación de la posibilidad de su extensión a nuevos campos. La implementación de VEUPAP automatizado en la práctica diaria permitiría protocolizar y desarrollar áreas de atención enfermera finalista e incorporar sistemas taxonómicos enfermeros que, en función de la prioridad asignada y considerando el diagnóstico concreto del paciente, posibiliten gradar las intervenciones específicas que permitan alcanzar los resultados óptimos en cuidados enfermeros esperados

OBJECTIVE: Design of the informatic version of the VEUPAP system (Nurse Pediatric Emergency Assessment of Primary Care). DESIGN: The development of computer application VEUPAP followed three stages: 1. Design outputs and inputs necessary to the system to ensure those outings. 2. Data entry procedures and their programming algorithms to obtain the expected outputs. 3 Getting initial computerized version for VEUPAP, its set-up and pilot proof with modifications and adjustments to achieve final version. RESULTS: Automatized VEUPAP on personal computer with Microsoft Windows NT Professional operating system, with a general overview of the fields that comprise valuation, specificities of entries in each field and clinical report type output. CONCLUSIONS: Computerized VEUPAP linked with clinical history of primary care allows that all data process of nurse clinical activity in urgent pediatric care be transparent and accessible, allowing be known and be used by all professionals in primary care. The footprint of information generated by VEUPAP allows monitor progress and assess their impact on the nursing management of pediatric emergencies in primary care, with subsequent evaluation of the possibility of its extension to new fields. The implementation of automated VEUPAP in daily practice allows to develop areas of care nurse finalist and incorporate nursing taxonomic systems, depending on the assigned priority and considering the specific diagnosis of the patient, enable to graduate specific interventions to achieve optimal results in nursing care

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.

Valoración del riesgo de neuropatía periférica diabética: diseño y validación del procedimiento para cribado enfermero NeuDiaCan / Evaluation of the risk of diabetic peripheral neuropathy: Design and validation of the NeuDiaCan nursing screening procedure

Objetivo: Diseñar y validar un procedimiento enfermero de cribado de la neuropatía periférica diabética en atención primaria. Método: El estudio se llevó a cabo en tres fases. 1) Construcción de un banco de ítems para conformar el procedimiento con una puntuación de salida que describiera la situación clínica del paciente. 2) Prueba y reducción del procedimiento tentativo inicial sobre una muestra de 50 pacientes usuarios de consultas enfermeras comunitarias, eliminando los componentes con baja fiabilidad inter-intra enfermeras. 3) Validación de la versión del procedimiento obtenida en el paso anterior sobre una muestra de 106 pacientes. Cálculo de validez y fiabilidad eliminando componentes con baja validez de criterio respecto a los resultados de la electromiografía diagnóstica utilizada como patrón de referencia. Se estimaron puntos de corte para el empleo del procedimiento como herramienta de cribado, valores predictivos, rendimiento, consistencia interna y fiabilidad inter-intra enfermera. Resultados: El procedimiento tentativo inicial constó de 12 componentes que fueron reducidos a 10. En el proceso de validación de esta segunda versión el procedimiento se simplificó nuevamente, quedando conformado por 6 componentes, con un punto de corte de 2,5 en su escala de salida, punto en el que alcanza valores adecuados de sensibilidad y predictivos negativos para emplearlo como instrumento de cribado. Para este punto de corte la fiabilidad inter-intra enfermeras, la validez de criterio y la validez predictiva alcanzaron valores aceptables. Conclusiones: NeuDiaCan como procedimiento de cribado enfermero de la neuropatía periférica diabética en atención primaria resulta válido, fiable y de fácil empleo

Objective: To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care. Methods: The study was carried out in three phases. 1) Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation. 2) Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability. 3) Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability. Results: The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values. Conclusions: NeuDiaCan as a nursing screening procedure for diabetic peripheral neuropathy in primary care is valid, reliable and easy to use

Evaluation of the risk of diabetic peripheral neuropathy: Design and validation of the NeuDiaCan nursing screening procedure. / Valoración del riesgo de neuropatía periférica diabética: diseño y validación del procedimiento para cribado enfermero NeuDiaCan.

OBJECTIVE: To design and validate a nursing screening procedure for diabetic peripheral neuropathy in primary care. METHODS: The study was carried out in three phases. 1)Construction of an item bank to form the procedure with an exit score describing the patient's clinical situation. 2)Test and reduction of the initial tentative procedure on a sample of 50 patients using community nurse consultations, eliminating the components with low inter-intra nurse reliability. 3)Validation of the version of the procedure obtained in the previous step on a sample of 106 patients. Calculation of validity and reliability by eliminating components with low criterion validity with respect to the results of the diagnostic electromyography used as a reference standard. Cut-off points were estimated for the use of the procedure as a screening tool, predictive values, performance, internal consistency and inter-nurse reliability. RESULTS: The initial tentative procedure consisted of 12 components that were reduced to 10. In the process of validation of this second version the procedure was simplified again, eventually comprising 6 components, with a cut-off point of 2.5 in its output scale, the point at which it reaches adequate values of sensitivity and negative predictors to be used as a screening instrument. For this cut-off point the inter-intra nurse reliability, criterion validity and predictive validity reached acceptable values. CONCLUSIONS: NeuDiaCan as a nursing screening procedure for diabetic peripheral neuropathy in primary care is valid, reliable and easy to use.

[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.

Validity and Reliability of the Emergency Severity Index in a Spanish Hospital.

Saturation in hospital emergency departments is one of the main safety problems for the patient, which can generate negative consequences for their health. In response to this issue, triage systems are developed to organize the flow of patients in order to allow the most urgent ones to be treated first. The Emergency Severity Index (ESI) is the most used triage system in the USA and it has been implemented in the General Hospital of La Palma since 2010. The objective of this study is the validation of the ESI adapted to our hospital through the study of its degree of reliability, as well as the criterion validity. The sample consisted of 240 randomly selected cases, with proportional representation of emergencies attended in 2015 and their fraction of urgent ones (Levels 1 and 2). Criterion validity was estimated by sensitivity, specificity, and predictive result values. For reliability, the degree of agreement among the nurses was studied by means of the adapted kappa index kc2. Criterion validity showed a sensitivity of 89% (85-93%) and a specificity of 97% (94-99%), with a positive predictive value of 68% (62-74%) and a negative predictive value of 99% (98-100%) for the discrimination of urgent cases. The reliability analysis showed a kc2 = 0.94 (0.84-0.99) index, a very good agreement according to Landis-Koch criteria. The results of our study have shown adequate validity and reliability in the adaptation and implementation of an ESI triage system suited to the specific conditions of a hospital emergency service in Spain.

Prevalence and characteristics of methicillin-resistant staphylococci in goats on the island of Tenerife, Spain.

The aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus (MRS) in healthy goats on the Island of Tenerife, Spain, as well as to identify the phenotypic and genotypic characteristics of the strains found. A cross-sectional prevalence study was conducted. A total of 158 goats from 15 different farms were sampled between September 2017 and January 2018. The percentage of positive samples of methicillin-resistant Staphylococcus aureus (MRSA) was 15.8% (25/158) and that of methicillin-resistant coagulase-negative staphylococci (MRCoNS) was 6.9% (11/158). All MRSA isolates from goats belonged to one clonal group showing Multi-Locus Sequence type 398. All strains studied (n = 36) were resistant to non-carbapenem beta-lactam antibiotics and susceptible to teicoplanin, linezolid, vancomycin, rifampicin, quinupristin-dalfospristin and mupirocine. In MRSA isolates, the highest percentage of resistance obtained, besides beta-lactam non-carbapenem antibiotics, was to trimethoprim-sulphamethoxazole and, in the case of MRCoNS isolates, to phosphomycin and erythromycin. A total of 12 resistance patterns were obtained, presenting differences between patterns obtained for MRSA and MRCoNS, with 7 different patterns for MRSA and 5 for MRCoNS. We therefore consider it essential to expand the epidemiological study of these strains of animal origin, as well as to increase surveillance and control measures at all stages of the food chain.

Factores de riesgo en bacteriemias nosocomiales secundarias a ITU en un hospital terciario / Risk factors to secondary nosocomial bacteremia to UTI in a tertiary hospital

INTRODUCCIÓN: Las bacteriemias nosocomiales secundarias a infecciones del tracto urinario (BNS-ITU) ocurren en un 1-4% de los episodios y la mortalidad asociada puede aumentar hasta el 33%. Sin embargo, se conoce muy poco sobre la epidemiología de estas infecciones. La determinación de los factores de riesgo modificables para desarrollar este tipo de bacteriemias podría ayudar al control de la infección y reducir el gasto sanitario. MATERIAL Y MÉTODOS: Estudio de casos y controles de las BNS-ITU diagnosticadas en el Hospital Universitario de Canarias entre 2010-2014. Se recogieron las variables clínico-epidemiológicas y los factores de riesgo potenciales intrínsecos y extrínsecos. Se utilizó la regresión logística para estudiar las variables asociadas al desarrollo de BNS-ITU. RESULTADOS: Se estudiaron 178 episodios, 85 casos y 93 controles. La estancia media fue significativamente mayor en los casos; desde el ingreso hasta la bacteriemia (p< 0,003), como desde ésta hasta el alta (p< 0,005). La insuficiencia hepática (p< 0,091), el uso de ventilación mecánica (p < 0,001), de el catéter venoso central (p < 0,043) y la cirugía en el episodio (p< 0,001) se comportaron como factores de riesgo para la adquisición de BNS-ITU. CONCLUSIONES: Los dispositivos invasivos, como el catéter venoso central y la ventilación mecánica, que no había sido estudiada previamente; así como la cirugía en el episodio, que tampoco había sido estudiada, suponen factores de riesgo. Además, la BNS-ITU causa un aumento significativo de la estancia hospitalaria. Por ello, es necesario conocer los factores de riesgo para la aparición de estas infecciones, y así, prevenir su aparición y mejorar la seguridad de los pacientes hospitalizados

INTRODUCTION: Nosocomial bacteremia secondary to urinary tract infections (NBS-UTI) occur in 1-4% of episodes and the associated mortality can increase up to 33%. However, very little is known about the epidemiology of these infections. The determination of modifiable risk factors to develop this type of bacteremia could help to control the infection and reduce health costs. MATERIAL AND METHODS: Cases-control study of NBS-UTI diagnosed at the University Hospital of Canary Islands between 2010-2014. The clinical-epidemiological variables and the intrinsic and extrinsic potential risk factors were collected. Logistic regression was used to study the variables associated with the development of NBS-UTI. RESULTS: A total of 178 episodes were studied, 85 cases and 93 controls. The average stay was significantly greater in the cases; from admission to bacteremia (p <0.003), as well as from discharge to discharge (p <0.005). Hepatic insufficiency (p <0.091), the use of mechanical ventilation (p <0.001), the central venous catheter (p <0.043) and surgery in the episode (p <0.001) behaved as risk factors for the acquisition of NBS-ITU. CONCLUSION: Invasive devices, such as central venous catheter and mechanical ventilation, that had not previously been studied; as well as the surgery in the episode, which had not been studied either, suppose risk factors. In addition, NBS-ITU causes a significant increase in hospital stay. Therefore, it is necessary to know the risk factors for the appearance of these infections, and thus prevent their appearance and improve the safety of hospitalized patients

Functional physiotherapy method results for the treatment of idiopathic clubfoot.

BACKGROUND: Idiopathic clubfoot is a congenital deformity of multifactorial etiology. The initial treatment is eminently conservative; one of the methods applied is the Functional physiotherapy method (FPM), which includes different approaches: Robert Debré (RD) and Saint-Vincent-de-Paul (SVP) among them. This method is based on manipulations of the foot, bandages, splints and exercises adapted to the motor development of the child aimed to achieve a plantigrade and functional foot. Our hypothesis was that the SVP method could be more efficient than the RD method in correcting deformities, and would decrease the rate of surgeries. AIM: To compare the RD and SVP methods, specifically regarding the improvement accomplished and the frequency of surgery needed to achieve a plantigrade foot. METHODS: Retrospective study of 71 idiopathic clubfeet of 46 children born between February 2004 and January 2012, who were evaluated and classified in our hospital according to severity by the Dimeglio-Bensahel scale. We included moderate, severe and very severe feet. Thirty-four feet were treated with the RD method and 37 feet with the SVP method. The outcomes at a minimum of two years were considered as very good (by physiotherapy), good (by percutaneous heel-cord tenotomy), fair (by limited surgery), and poor (by complete surgery). RESULTS: Complete release was not required in any case; limited posterior release was done in 23 cases (74%) with the RD method and 9 (25%) with the SVP method (P < 0.001). The percutaneous heel-cord tenotomy was done in 2 feet treated with the RD method (7%) and 6 feet (17%) treated with the SVP method (P < 0.001). Six feet in the RD group (19%) and twenty-one feet (58%) in the SVP group did not require any surgery (P < 0.001). CONCLUSION: Our study provides evidence of the superiority of the SVP method over the RD method, as a variation of the FPM, for the treatment of idiopathic clubfoot.

Efecto de la sedación consciente con midazolam y fentanilo sobre la calidad global de la colonoscopia. Estudio prospectivo y aleatorizado / Effect of conscious sedation with midazolam and fentanyl on the overall quality of colonoscopy: a prospective and randomized study

Introducción: estudio prospectivo y aleatorizado para valorar la influencia de la sedación consciente, con midazolam y fentanilo, sobre la calidad global de la colonoscopia, cuantificando simultáneamente su efecto sobre la calidad científica, la calidad percibida y la seguridad del paciente. Método: se incluyeron prospectivamente pacientes remitidos para colonoscopia y se aleatorizaron para recibir o no sedación. Se recogieron datos demográficos, indicación de la colonoscopia, intubación cecal, grado de limpieza colónica, tiempo de introducción y retirada, adenomas resecados y complicaciones durante la exploración y recuperación del paciente. Treinta días después se realizó un cuestionario de satisfacción (GHAA 9-me) y se preguntó por las complicaciones tras la exploración. Resultados: se incluyeron 5.328 pacientes (edad 62 +/- 15,22; 47% varones; 3.734 sedados y 1.594 sin sedación). Los pacientes sedados mostraron menor tiempo de introducción del endoscopio (7'20 +/- 2'15 vs. 6'15 +/- 3'12 minutos; p < 0,019), mayor tasa de intubaciones del ciego (96% vs. 88%; p < 0,05), tiempo de retirada más prolongado (7'20 +/- 2'15 vs. 6'15 +/- 3'12 minutos; p < 0,01) y mayor tasa de adenomas (22% vs. 17; p < 0,05), adenomas avanzados (8% vs. 4,3%; p < 0,05) y pólipos serrados (1,9% vs. 0,6%; p = 0,05). El uso de sedación disminuyó las molestias durante y después de la exploración, sin aumentar las complicaciones. La puntuación del cuestionario de satisfacción fue mayor (23,6 +/- 1,5 vs. 16,6 +/- 4,8; p < 0,001) en los pacientes sedados. Conclusiones: la sedación superficial con midazolam y fentanilo no solo disminuye las molestias de los pacientes, sino que mejora la calidad global de la colonoscopia. Por esto, debemos considerar el uso de sedación como una parte imprescindible de la colonoscopia

Introduction: a prospective, randomized study was performed to assess the influence of conscious sedation on the overall quality of colonoscopy, simultaneously quantifying its effect on the scientific quality, perceived quality and patient safety. Methods: patients referred for a colonoscopy were included in the study and were randomized to receive or not receive sedation. Demographic data, indication for colonoscopy, cecal intubation, introduction and withdrawal time, resected adenomas and complications during the exploration were collected. Thirty days later, a satisfaction questionnaire was performed (GHAA 9-me) and patients were asked about complications after the examination. Results: a total of 5,328 patients were included, the average age was 62 +/- 15.22 years, 47% were male, 3,734 were sedated and 1,594 were not sedated. The sedated patients had a shorter endoscope insertion time (7'20 +/- 2'15 min vs 6'15 +/- 3'12 min, p < 0.019), a higher rate of cecal intubations (96% vs 88%, p < 0.05), longer withdrawal time (7'20 +/- 2'15 min vs 6'15 +/- 3'12 min, p < 0.01) and higher adenoma detection rates (22% vs 17%, p < 0.05). The use of sedation reduced discomfort during and after the exploration, without increasing the complications. The satisfaction questionnaire score was higher (23.6 +/- 1.5 vs 16.6 +/- 4.8, p < 0.001) in the sedated patients. Conclusions: superficial sedation not only reduces patient discomfort but also improves the overall quality of the colonoscopy. Therefore, we must consider the use of sedation as an essential part of colonoscopy

Impact of the Case Management Model through Community Liaison Nurses.

The objective of the present study is to assess the model's impact on patients and their families in terms of outcomes and the efficiency results for the health system in Tenerife, Canary Islands, selecting a period of eight years from the time interval 2002-2018. The employed indicators were collected on a monthly basis. They referred to home care and its impact on clinical outcomes and on the use of resources. The comparison between the indicators' tendencies with and without the liaison nurse model was done with the F-test by Snedecor. All these tests are bilateral, with a level of significance of p < 0.05. In those areas with community liaison nurse (CLN), improvements have been found in indicators that describe: (1) the management of the clinical status of patients, (2) the efficiency of the use of resources, and (3) the quality and compliance with the process that also includes home visits and social risk detection and management. It can be said that in the basic areas of primary health care where the work of the CLN develops there are improvements in the management of the patients' clinical condition as well as in the quality and efficiency of care.