Alfabetización en salud en pacientes con diabetes tipo 2: un estudio transversal con el cuestionario HLS-EU-Q47 / Health literacy in patients with type 2 diabetes: A cross-sectional study using the HLS-EU-Q47 questionnaire

OBJETIVO: Determinar el grado de alfabetización en salud de pacientes diabéticos de Ourense, de 50 a 75 años de edad, y su relación con la concentración de hemoglobina glicada y el riesgo cardiovascular. MATERIALES Y MÉTODOS: Estudio transversal mediante cuestionario autocumplimentado. A partir de muestreo polietápico fueron incluidos aleatorizadamente pacientes diabéticos de tipo 2 pertenecientes a cupos urbanos de la ciudad de Ourense. Se analizó a un total de 103 pacientes. Se determinaron: grado de alfabetización en salud utilizando el cuestionario HLS-EU-Q47, último valor de hemoglobina glicada y el riesgo cardiovascular se calculó con el algoritmo UKPDS. Edad, sexo, nivel educativo, grado de apoyo social, clase social y comorbilidad se utilizaron como covariables. RESULTADOS: El 81,5% (84) tenía un nivel de alfabetización en salud inconveniente (el 29,1% nivel inadecuado y el 52,4% nivel problemático). Se observó asociación entre mayores grados de alfabetización en salud y niveles más altos de educación (p < 0,001). El nivel de hemoglobina glicada estaba relacionado de forma negativa con el grado de alfabetización en salud, de tal forma que un mayor grado de alfabetización implicaba un menor valor de hemoglobina glicada (p = 0,03). No se encontró asociación con el riesgo cardiovascular (p = 0,3). CONCLUSIONES: El grado de alfabetización en salud de la población analizada fue insuficiente y su incremento podría suponer mejores resultados clínicos en el tratamiento de los pacientes diabéticos

OBJECTIVE: The aim of this study was to determine the level of health literacy of diabetic patients aged 50 to 75 years, from Ourense, Spain, as well as its relationship with the glycated haemoglobin (HbA1c) concentration and cardiovascular risk of the patient. MATERIAL AND METHODS: Cross-sectional study using a self-completed questionnaire. From a multi-stage sampling, urban, type 2 diabetic patients were randomly included. The level of health literacy, using the HLS-EU-Q47 questionnaire, the last concentration of HbA1c, and both total and fatal cardiovascular risk at 10 year follow-up, measured using the UKPDS (U.K. Prospective Diabetes Study) algorithm, were determined. The age, gender, level of education, level of social support, social class, and comorbidities were used as covariates. RESULTS: A total of 103 patients were analysed. Out of all the patients, 81.5% (84) had an unsuitable health literacy level (29.1% had an inadequate level and 52.4% had a problematic level). A clear association was seen between a higher level of health literacy and higher levels of education. Moreover, the level of health literacy was seen to be inversely related to the level of control of the patients' diabetes measured on the basis of their HbA1c (P = .03) concentration. However, no such association was found with the cardiovascular risk (P = .3). CONCLUSIONS: The results of the present study show that the level of literacy of the analysed population was insufficient, and that its improvement could result in a better outcome in the treatment of diabetic patients

[Health literacy in patients with type 2 diabetes: A cross-sectional study using the HLS-EU-Q47 questionnaire]. / Alfabetización en salud en pacientes con diabetes tipo 2: un estudio transversal con el cuestionario HLS-EU-Q47.

OBJECTIVE: The aim of this study was to determine the level of health literacy of diabetic patients aged 50 to 75 years, from Ourense, Spain, as well as its relationship with the glycated haemoglobin (HbA1c) concentration and cardiovascular risk of the patient. MATERIAL AND METHODS: Cross-sectional study using a self-completed questionnaire. From a multi-stage sampling, urban, type 2 diabetic patients were randomly included. The level of health literacy, using the HLS-EU-Q47 questionnaire, the last concentration of HbA1c, and both total and fatal cardiovascular risk at 10 year follow-up, measured using the UKPDS (U.K. Prospective Diabetes Study) algorithm, were determined. The age, gender, level of education, level of social support, social class, and comorbidities were used as covariates. RESULTS: A total of 103 patients were analysed. Out of all the patients, 81.5% (84) had an unsuitable health literacy level (29.1% had an inadequate level and 52.4% had a problematic level). A clear association was seen between a higher level of health literacy and higher levels of education. Moreover, the level of health literacy was seen to be inversely related to the level of control of the patients' diabetes measured on the basis of their HbA1c (P=.03) concentration. However, no such association was found with the cardiovascular risk (P=.3). CONCLUSIONS: The results of the present study show that the level of literacy of the analysed population was insufficient, and that its improvement could result in a better outcome in the treatment of diabetic patients.

The ins and outs of population relationships in west-Mediterranean islands: data from autosomal Alu polymorphisms and Alu/STR compound systems.

The islands of the West Mediterranean have played a central role in numerous archaeological, historical and anthropological studies due to their active participation in the history of main Mediterranean civilisations. However, genetic data failed to fit in both their degree of internal differentiation and relationships. A set of 18 Alu markers and three short tandem repeats (STRs) closely linked to the CD4, F13B and DM Alu have been analysed in seven samples from Majorca, Corsica, Sardinia and Sicily to explore some of these issues. Our samples show a high genetic heterogeneity inside and among islands for the Alu data. Global differentiation among islands (F(ST) 2.2%) is slightly higher than that described for Europeans and North Africans. Both the estimated divergence times among samples and the high population heterogeneity revealed by Alu data are compatible with population differences since the first islands' settlement in the Paleolithic period. However, the high within-population diversities and the remarkable homogeneity observed in both STR and Alu/STR haplotype variation indicated that, at least since Neolithic times, gene flow has been acting in west Mediterranean. Genetic drift in west-coast Sardinia and gene flow in west Sicily have contributed to their general differentiation, whereas Corsica, Majorca and east Sicily seem to reflect more recent historical relationships from continental south Europe.

How many populations set foot through the Patagonian door? Genetic composition of the current population of Bahía Blanca (Argentina) based on data from 19 Alu polymorphisms.

The city of Bahía Blanca occupies a strategic place in Argentina south of the Pampean region in the north-east corner of the Patagonia. Since 1828, this city has been the historical and political border between Amerindian lands in the south, and the lands of European colonists. Nowadays, Bahía Blanca is an urban population mainly composed by descendents of immigrants from Spain and other European countries with apparently low admixture with Amerindians. In view of the unexpectedly high Amerindian admixture levels (about 46.7%) suggested by mtDNA data, and protein markers (19.5%), we analyzed a set of 19 Alu polymorphisms (18 autosomal, 1 of Chromosome Y) in a well-documented genealogical sample from Bahía Blanca. The genotyped sample was made up of 119 unrelated healthy individuals whose birth place and grandparent origins were fully documented. According to available genealogical records, the total sample has been subdivided into two groups: Bahía Blanca Original (64 individuals with all 4 gandparents born in Argentina) and Bahía Blanca Mix (55 individuals with one to three grandparents born out of Argentina). Allele frequencies and gene diversity values in Bahía Blanca fit well into the European ranges. Population relationships have been tested for 8 Alu markers, whose variation has been described in several Amerindian and European samples. Reynolds genetic distances underline the significant genetic similarity of Bahía Blanca to Europeans (mean distance 0.044) and their differentiation from Amerindians (0.146). Interestingly enough, when the general sample is divided, Bahía Blanca Original appears slightly closer to Amerindians (0.127) in contrast to Bahía Blanca Mix (0.161). Furthermore, the genetic relationships depicted through a principal components analysis emphasize the relative similarity of Bahía Blanca Original to Amerindians. A thorough knowledge of the sample origins has allowed us to make a subtle distinction of the genetic composition of Bahía Blanca.

Genetic change in the polynesian population of Easter Island: evidence from Alu insertion polymorphisms.

The origin of Pacific islanders is still an open issue in human population genetics. To address this topic we analyzed a set of 18 Alu insertion polymorphisms in a total of 176 chromosomes from native Easter Island inhabitants (Rapanui). Available genealogical records allowed us to subdivide the total island sample into two groups, representative of the native population living in the island around 1900, and another formed by individuals with some ancestors of non-Rapanui origin. Significant genetic differentiation was found between these groups, allowing us to make some biodemographic and historical inferences about the origin and evolution of this geographically isolated island population. Our data are consistent with equivalent and recent contributions from Amerindian and European migrants to the 1900s Rapanui population, with an accelerated increase in the European gene flow during the 20(th) century, especially since the 1960s. Comparative analysis of our results with other available Alu variation data on neighbouring populations supports the "Voyaging Corridor" model of Polynesian human settlement, which indicates that pre-Polynesians are mainly derived from Southeast Asian and Wallacean populations rather than from Taiwan or the Philippines. This study underlines the importance of sampling and taking into account historical information in genetic studies to unravel the recent evolution of human populations.

Analgesia postoperatoria con tramadol epidural tras histerectomía abdominal / Epidural postoperative analgesia with tramadol after abdominal hysterectomy

Introducción: El dolor postoperatorio es un tipo especial de dolor agudo cuyo control inadecuado conduce a reacciones fisiopatológicas anormales. Objetivos: Evaluar la utilidad del tramadol por vía epidural en la analgesia postoperatoria de las pacientes a quienes se les practicó histerectomía abdominal. Material y método: Se estudiaron 90 pacientes que conformaron tres grupos: Grupo I: recibió 100 mg de tramadol epidural cada 6 h. Grupo II: recibió 1,2 g de metamizol por vía intramuscular cada 6 h. Grupo III: recibió 100 mg de tramadol por vía intramuscular cada 6 h. Se evaluó el comportamiento de la presión arterial media y la frecuencia cardíaca. Evaluamos la intensidad del dolor por medio de una Escala Visual Analógica. Fue utilizado metamizol sódico, 2 g endovenoso, como analgesia de rescate. Resultados: Se presentaron variaciones significativas de la frecuencia cardíaca y presión arterial media en el grupo I (P<0,05), mientras que en los grupos II y III resultaron muy significativas (P<0,01). La intensidad del dolor postoperatorio alcanzó valores más bajos en el grupo I (P>0,05), por lo que sólo 2 pacientes requirieron analgesia de rescate, mientras que el grupo II mostró las mayores variaciones (P<0,01), donde el 100% de los pacientes requirió analgesia de rescate. El grupo III, que recibió tramadol intramuscular, presentó un mayor número de efectos colaterales, fundamentalmente las náuseas, con 23,3%. Conclusiones: El uso de tramadol epidural es una alternativa eficaz para el manejo y tratamiento del dolor agudo postoperatorio, ya que ofrece una analgesia superior con escasos efectos adversos (AU)

Introduction: Postoperative pain is a special type of acute pain whose inadequate control leads to abnormal reactions. Objectives: To evaluate the utility of tramadol by the epidural route in the postoperative analgesia of patients undergoing abdominal hysterectomy. Material and method: 90 patients studied who conformed three groups: Group I: received 100 mg of epidural tramadol every 6 h. Group II: received 1.2 g of intramuscular metamizol every 6 h. Group III: received 100 mg of intramuscular tramadol every 6 h. Blood pressure and heart rate were measured. Pain intensity was evaluated by a visual analogical scale. Metamizol 2 g was used as rescue analgesia. Results: Significant variations of heart rate and mean blood pressure were found in group I (p < 0.05) whereas in group II and III they were very significant (p < 0.01). The intensity of postoperative pain reached lower values in group I (p < 0.05) and therefore only 2 patients required rescue analgesia, whereas group II showed the greater variations (p < 0.01), and 100% of patients required rescue analgesia. Group III receiving intramuscular tramadol showed a greater number of side effects, mainly nausea in 23.3%. Conclusions: Epidural tramadol is an effective alternative for the management and treatment of acute postoperative pain, since it offers superior analgesia with fewer undesired effects (AU)

An unexpected wide population variation of the G1733A polymorphism of the androgen receptor gene: data on the Mediterranean region.

The androgen receptor (AR) has been proposed as a candidate gene for several cancers (breast, prostate, uterine endometrium, colon, and esophagus). Ethnicity is considered an associated risk factor for some of these cancers. Several case-control genetic studies have been focused in samples of the main ethnic groups, but little is known about the distribution of risk polymorphisms in current populations with accurate ethnic and/or geographic origins. The A allele of the G1733A polymorphism of the AR gene has been associated with increased risk of prostate cancer. We provide data from this marker in 12 samples from 7 Mediterranean countries such as Spain, Italy (Sardinia), Greece, Turkey, Morocco, Algeria, and Egypt. A sample from Ivory Coast has also been analyzed. The A allele distribution shows a frequency in the Ivory Coast population (65.17%) that contrasts with the low values found in Northern Mediterraneans (mean average value of 13.98%). North African populations present two-times higher frequencies (average value of 27.19%) than Europeans. The wide population variation range found for the A allele strengthens the potential interest of further screening as a baseline to the design of future preventive and population health programs.

Genetic relationships among Berbers and South Spaniards based on CD4 microsatellite/Alu haplotypes.

BACKGROUND: CD4 STR/Alu haplotype diversity, both for its qualitative and quantitative properties, has been widely used in molecular anthropology to clarify the degree of genetic relationships among human populations. AIM: CD4 STR/Alu variation was studied in two West Mediterranean samples, Andalusians from La Alpujarra region on the north side of the Gibraltar Strait and Berbers from the south, to ascertain the pattern of affinities between them. SUBJECTS AND METHODS: Alu and microsatellite alleles were tested in 99 Andalusians from La Alpujarra region (Southeast Spain) and 124 Middle Atlas Berbers (Morocco). RESULTS: Two new combinations of Alu and STR alleles (75(+) and 80(-)) were found in Berbers. The CD4 STR/Alu haplotype distribution in South Spaniards is similar to that of other Europeans, the only special feature is the slight presence of the 90(+) and 130(+) typical Sub-Saharan haplotypes. The Berber sample is characterized by a high number of different haplotypes (18) with intermediate heterozygosity values (0.846) in comparison with other North African groups, and by a high frequency of the 110(-) combination that has been proposed as representative of an ancient Northwest African population. CONCLUSION: A geographical gradient of Sub-Saharan gene contribution has been detected in North Africa. The Middle Atlas Berbers showed an intermediate value in comparison with the high and low values found in Mauritanians and Moroccan Berbers, respectively. The analysis of the CD4 STR/Alu haplotype variation failed to indicate any particular relationship between South Spaniards and North Africans.

Lack of association between methylenetetrahydrofolate reductase (MTHFR) C677T and ischaemic heart disease (IHD): family-based association study in a Spanish population.

The effect of the C677T polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene, traditionally associated with ischaemic heart disease (IHD), was assessed in a Spanish population. The transmission disequilibrium test (TDT) was used to determine a possible association in a sample of 101 trios of IHD patients. The distribution of MTHFR genotypes was similar in the IHD subjects and the parental group; the TT genotype was present in 14.9% of IHD patients, as compared to 15.2% in the parents. The frequency of the T allele was also similar in IHD cases and parents (39.6% vs. 42.4%; p = 0.649). The TDT confirmed that the observed transmission of the T allele did not deviate significantly from the expected one (chi2 = 0.743; p > 0.4). Our TDT analysis clearly demonstrates a lack of association between the T allele of the C677T mutation in MTHFR and cardiovascular artery disease, both for the general group and for different risk subgroups (smokers, hypertension, male sex, overweight and type A behaviour pattern) in the Spanish population.

Cognitive predictors of resistiveness in dementia patients.

Resistiveness to physical care among patients with dementia is a common and burdensome problem. Forty-nine nursing home residents with dementia were administered the Mini-Mental State Exam (MMSE) and the Royall Executive Interview (EXIT), a specific test of frontal-subcortical function. Nurses rated resistiveness on every shift for 3 days. Correlation with resistiveness ratings was stronger for the EXIT (r=0. 73) than for the MMSE (r=-0. 46); logistic modeling found the EXIT to be a strong independent predictor of resistiveness. Executive dysfunction as measured by the EXIT is a major determinant of resistiveness to care in long-term care residents with dementia, possibly as a result of such patients' tendency toward inertia.

[Daily variations in health care in a health area of Cuba]. / Variaciones diarias de asistencia médica en un área de salud de Cuba.

The daily variations of several medical care activities in a health area of Cuba were evaluated during the first semester of 1990. To this end, chronological series of the different activities were set up, and seasonal indexes were calculated from them. The selected method was the mobile mean, using a multiplicative model as a basis. The occurrence of seasonal changes in the behaviour of evaluated activities was found to be higher in the visits of family physicians in their clinics and in the home visits than in on duty staff. Monday was identified as the least used day. The possible reasons for these results are relate with the schedules of medical tasks and also with population habits. These results may be useful to improve the quality of the health area services.