Barriers associated with poor control in Spanish diabetic patients. A consensus study.

BACKGROUND: Delphi technique allows developing a multidisciplinary consensus to establish solutions. AIM: To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2). METHODS: An observational study using the 2-round Delphi technique (June-August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square). RESULTS: Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7-78.1%) in medicine, and 78.1% (95% CI 65.4-90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ(2) = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve. CONCLUSION: The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.

Análisis Bibliométrico de la producción Científica Internacional sobre atención primaria / Bibliometric analysis of International Scientific production on Primary Care

Objetivos: Describir la producción científica internacional en el ámbito de la atención primaria en el período 1985-2004.DiseñoAnálisis bibliométrico. Emplazamiento: Base de datos Medline. Acceso mediante WebSPIRS versión 4,3. Se analizan 2 períodos: 2000-2004 (transversal) y 1985-2004 (evolutivo). Búsqueda basada en MesH Major con los descriptores: Primary Care o Primary Health Care, Family Practice, Physicians Family, Nurse Practitioners y los Entry Terms relacionados con ellos. Mediciones principales: Se analizaron los indicadores bibliométricos de producción, circulación, dispersión y visibilidad. Criterios de inclusión: se consideró aquel registro (documento citable) indexado en Medline. Se incluyeron documentos originales y revisiones. Resultados: En 2000-2004 se publicaron 20.911 artículos, el 0,73% de la producción total. Con una tasa de crecimiento (1985-2004) del 221%, 2,4 veces más que la media. La tasa de transitoriedad fue 83,17%. El idioma inglés es el predominante (88,81%) sobre 34 idiomas, siendo el español el siguiente (2,6%). Dieciséis países producen el 95,67% de los artículos. España ocupa el séptimo lugar. Las universidades (52%) son la institución más productiva. Existen 1.074 revistas diferentes siendo las 10 más productoras: Br J Gen Pract, Adv Nurse Pract, Aust Fam Physician, Fam Pract, Fam Med, BMJ, Aten Primaria, Health Serv J, Can Fam Physician, J Fam Pract. La proporción de ensayos clínicos (5,43%) en atención primaria (AP) es similar a la del resto de disciplinas y ha aumentado el 453% (1985-2004). Conclusiones: La producción de AP supone cerca del 1% del total de la producción científica, con un crecimiento notorio y mayor que la media en 20 años. La proporción de ensayos clínicos es similar a otras disciplinas. Aunque los países y revistas anglosajones son los más productores, España y la revista Aten Primaria se encuentra entre los destacados(AU)

Objective: To present an international view of the scientific production in the field of primary care in the period 1985-2004.DesignRetrospective, observational study. Bibliometric analysis. Location: Medline database. WebSPIRS access through version 4.3. We analysed two periods: 2000-2004 (cross-sectional) and 1985-2004 (developmental). Search based on "MeSH Major" with descriptors: Primary Care or Primary Health Care, Family Practice, Family Physicians, Nurse Practitioners, and Entry Terms associated with these. Key Measures: We analysed the bibliometric indicators of production, circulation, dispersion, and visibility. Results: In 2000-2004, published 20911 articles were published, 0.73% of total production. There was a growth rate (1985-2004) of 221%, which was 2.4 times more than average. Transience rate was 83.17%. The English language is predominant (88.81%) over 34 languages, with Spanish being the next (2.6%). Sixteen countries produce 95.67% of the articles. Spain occupies the 7th place. Universities (52%) are the most productive institutions. There are 1074 different journals with the 10 most productive being: Br J Gen Pract, Adv Nurse Pract, Aust Fam Physician, Fam Pract, Fam Med, BMJ, Aten Primary Health Serv J, Can Fam Physician, J Fam Pract. The proportion of trials (5.43%) in PC is similar to other disciplines and has increased by 453% (1985-2004). Conclusions: The production of Primary care is about 1% of the total scientific output, with a noticeable and higher than average growth over 20 years. The proportion of clinical trials is similar to other disciplines. Although Anglo-Saxon countries and journals are the highest producers, Spain and the journal Aten Primaria is among those highlighted(AU)

[Bibliometric analysis of International Scientific production on primary care]. / Análisis Bibliométrico de la producción Científica Internacional sobre atención primaria.

OBJECTIVE: To present an international view of the scientific production in the field of primary care in the period 1985-2004. DESIGN: Retrospective, observational study. Bibliometric analysis. LOCATION: Medline database. WebSPIRS access through version 4.3. We analysed two periods: 2000-2004 (cross-sectional) and 1985-2004 (developmental). Search based on "MeSH Major" with descriptors: Primary Care or Primary Health Care, Family Practice, Family Physicians, Nurse Practitioners, and Entry Terms associated with these. KEY MEASURES: We analysed the bibliometric indicators of production, circulation, dispersion, and visibility. RESULTS: In 2000-2004, published 20911 articles were published, 0.73% of total production. There was a growth rate (1985-2004) of 221%, which was 2.4 times more than average. Transience rate was 83.17%. The English language is predominant (88.81%) over 34 languages, with Spanish being the next (2.6%). Sixteen countries produce 95.67% of the articles. Spain occupies the 7th place. Universities (52%) are the most productive institutions. There are 1074 different journals with the 10 most productive being: Br J Gen Pract, Adv Nurse Pract, Aust Fam Physician, Fam Pract, Fam Med, BMJ, Aten Primary Health Serv J, Can Fam Physician, J Fam Pract. The proportion of trials (5.43%) in PC is similar to other disciplines and has increased by 453% (1985-2004). CONCLUSIONS: The production of Primary care is about 1% of the total scientific output, with a noticeable and higher than average growth over 20 years. The proportion of clinical trials is similar to other disciplines. Although Anglo-Saxon countries and journals are the highest producers, Spain and the journal Aten Primaria is among those highlighted.

[Is breast-feeding a protective factor for infectious diseases? A case-control study]. / Es la lactancia materna un factor de protección ante los procesos infecciosos? Estudio de casos y controles.

AIM: To analyze if breast-feeding (BF) is a protective factor against infectious diseases. DESIGN: Case-control study. Retrospective study during 1998. SETTING: Primary care. Teaching health center. Population of 22,500 inhabitants. PATIENTS: We consider an alpha risk of .05 and a beta risk of .20, unilateral hypothesis. We estimated a sample of 48 children in the "case" group and 144 in the "control" group. Random sample. MEASURES: Cases were children with 3 or more acute respiratory or digestive infectious episodes during the first year of age. Controls were children with less than 3 episodes. We analyze exposure to breast feeding (BF) and we consider it if the child had at least 3 months of BF. In other case we define as a non-exposure child. We have calculated odds ratio (OR) and its 95% confidence intervals. RESULTS: 60.4% of the children were BF after birth. But only 28.5% lasted 3 months, and only 13.9% lasted 1 year. The median of BF was 3.3 months (SD 4.2). 79.2% of the children have a respiratory infectious disease in the first year and 14.6% diarrhea. In children less than 1 year old the OR was 0.81 (95% CI, 0.40-1.63). In the period 3-6 months old we have found an OR of 0.346 (95% CI 0.161-0.744). CONCLUSIONS: In children aged less than 1 year, we have not found protective effects of breast-feeding against acute respiratory infectious diseases. Only in the period 3-6 months old, we have found that BF protects against these diseases.

¿Es la lactancia materna un factor de protección ante los procesos infecciosos? Estudio de casos y controles / Is breast-feeding a protective factor for infectious disease? A case-control study

Objetivo. Analizar si la lactancia natural (materna) (LM) se asocia con una mayor protección ante infecciones respiratorias (IR) y digestivas (ID) en niños de 0-12 meses. Diseño. Observacional analítico, retrospectivo. Estudio de casos y controles. Emplazamiento. Atención primaria. Centro de salud docente. Población de 22.500 habitantes. Participantes. Participaron 48 casos y 96 controles (n = 144). Se consideraron un riesgo alfa de 0,05 y beta de 0,20 como hipótesis unilateral. La selección se realizó por muestreo aleatorio simple. Mediciones principales. En el grupo de casos se incluyó a niños con 3 o más episodios registrados de IR o ID en el primer año de vida. En el grupo control se incluyó a los niños con menos de 3 episodios en el mismo período. Se consideraron como expuestos los niños que habían recibido LM durante al menos 3 meses, y como no expuestos los que habían recibido LM menos de 3 meses. La asociación epidemiológica se ha estimado mediante la odds ratio (OR) y sus intervalos de confianza (IC) del 95%. Resultados. El 60,4% de las madres inician LM, el 28,5% la mantiene al menos 3 meses y el 13,9% todo el primer año. La media ± desviación estándar con LM exclusiva es de 3,3 ± 4,2 meses. El 79,2% de los niños padeció alguna IR en el primer año y el 14,6% alguna ID. Al analizar la asociación entre enfermedad y LM se observa una OR de 0,81 (IC del 95%, 0,40-1,63). En el análisis por trimestres el segundo trimestre presenta una OR de 0,346 (IC del 95%, 0,161-0,744). Conclusiones. No se ha observado una asociación entre la LM y las infecciones respiratorias en el primer año de vida de forma global. Sólo en el segundo trimestre de vida hay una asociación protectora frente a las infecciones respiratorias

Aim. To analyze if breast-feeding (BF) is a protective factor against infectious diseases. Design. Case-control study. Retrospective study during 1998. Setting. Primary care. Teaching health center. Population of 22,500 inhabitants. Patients. We consider an alpha risk of .05 and a beta risk of .20, unilateral hypothesis. We estimated a sample of 48 children in the «case» group and 144 in the «control» group. Random sample. Measures. Cases were children with 3 or more acute respiratory or digestive infectious episodes during the first year of age. Controls were children with less than 3 episodes. We analyze exposure to breast feeding (BF) and we consider it if the child had at least 3 months of BF. In other case we define as a non-exposure child.We have calculated odds ratio (OR) and its 95% confidence intervals. Results. 60.4% of the children were BF after birth. But only 28.5% lasted 3 months, and only 13.9% lasted 1 year. The median of BF was 3.3 months (SD 4.2). 79.2% of the children have a respiratory infectious disease in the first year and 14.6% diarrhea. In children less than 1 year old the OR was 0.81 (95% CI, 0.40-1.63). In the period 3-6 months old we have found an OR of 0.346 (95% CI 0.161-0.744).Conclusions. In children aged less than 1 year, we have not found protective effects of breastfeeding against acute respiratory infectious diseases. Only in the period 3-6 months old, we have found that BF protects against these diseases