Factors associated with implementation of the 5A's smoking cessation model.

BACKGROUND: Several health organizations have adopted the 5A's brief intervention model (Ask, Advise, Assess, Assist, Arrange), based on evidence-based guidelines for smoking cessation. We examine individual, cognitive, behavioral, and organizational factors associated with the 5A's performance among clinical healthcare workers in Catalonia. We also investigate how these factors interact and potentially predict the implementation of each component of the 5A's. METHODS: A cross-sectional survey was conducted among clinical health workers enrolled in an online smoking cessation training course (n = 580). The survey included questions about individual characteristics as well as cognitive, behavioral, and organizational factors previously identified in research. We assessed self-reported performance of the 5A's, assessed on a scale from 0 to 10, and used Multivariate regression to examine factors associated with its performance. RESULTS: The performance means (standard deviation) were moderate for the first 3A's [Ask: 6.4 (3.1); Advise: 7.1 (2.7); Assess: 6.3 (2.8)] and low for the last 2A's [Assist: 4.4 (2.9); Arrange: 3.2 (3.3)]. We observed a high correlation between Assist and Arrange (r = 0.704, p < 0.001). Having positive experiences and feeling competent were positively associated with performing the 5A's model and having organizational support with Assist and Arrange. Personal tobacco use among healthcare workers was negatively associated with Advice and Arrange. CONCLUSIONS: Our study found that clinical healthcare workers do not perform the 5A's completely. The main barriers identified suggest the need of training and making available practical guidelines in healthcare services. Organizational support is essential for moving towards the implementation of Assist and Arrange.

Macrodenoma hipofisario productor de TSH y GH tratado con dosis mensuales del análogo de somatostatina lanreotide. Caso clínico / Pituitary macroadenoma cosecreting thyrotropin and somatotropin treated with monthly doses of the somatostatin analog lanreotide. A case report

Los tirotropinomas son una causa rara de hipertiroidismo, con una prevalencia de un caso por millón de habitantes. Representanmenos del 2% de todos los adenomas pituitarios. Se caracterizan por la secreción autónoma de tirotrofina (TSH) y la refractariedada la retroalimentación negativa de las hormonas tiroideas. Los adenomas mixtos se diferencian por la hipersecreción concomitantede otra hormona de la hipófisis anterior, y se encuentran hasta un 25% de los pacientes, siendo el 15% productoresde somatotrofina (GH).Debido a su infrecuencia, presentamos el caso de una mujer de 62 años, con antecedente de enfermedad de Graves diagnosticadaa los 28 años de edad, tratada con dos dosis de iodo radioactivo. Es derivada a nuestro servicio a la edad de 62 años conel siguiente laboratorio: TSH 38 µUI/ml (0,3-4,2), T4 12.8 µg/ml (4,5-12,5) e IGF-1 445 ng/ml (81-230) y una resonanciamagnética nuclear (RMI) que informaba un macroadenoma hipofisario invasivo. Tras la actualización de los estudios y laconfirmación diagnóstica se inició tratamiento médico con lanreotide intramuscular, 120 mg cada 28 días, obteniendo buenarespuesta bioquímica.

Thyrotropin secreting pituitary adenomas (TSH-omas) are a rare cause of hyperthyroidism with a prevalence of about one case permillion. They account for less than 2% of all pituitary adenomas. TSH secretion is autonomous and refractory to the negative feedbackof thyroid hormones. Mixed adenomas are characterized by concomitant hypersecretion of other anterior pituitary hormones, and arefound in about 25% of patients; approximately 15% secrete somatotropin (GH).Because of their rarity, we report the case of a 62 year old women with a history of Graves’ disease diagnosed at 28 years of age,treated with two doses of I-131, and referred to our service with the following laboratory: TSH 38 µIU/ml (0.3-4.2), T4 12.8 µg/ml(4.5-12.5) and IGF-1 445 ng/ml (81-230). RMI showed an invasive pituitary macroadenoma. After updating and confirming thecomplementary studies, medical treatment was started with the somatostatin analog lanreotide, 120 mg i.m. every 28 days; there wasgood biochemical response.

Diabetes MODY 2: reporte de dos casos con nueva mutación en el gen de glucokinasa / MODY 2: report of two cases with a new gene mutation in GCK

La diabetes MODY (Maturity Onset Diabetes of the Young) comprende un grupo heterogéneo de enfermedades monogénicasque se caracterizan por la disfunción de las células β. Se estima que ellas son responsables de 2-5% de los casos de diabetes. Seconocen más de 200 mutaciones en el gen de la glucoquinasa (GCK). En este trabajo se expone el caso de dos hermanas enlas cuales se realizó el diagnóstico de MODY 2 a través del estudio genético, hallándose una mutación del gen de la GCK nodescripto previamente en la bibliografía.

MODY (maturity onset diabetes of the young) includes a heterogeneous group of monogenic diseases which are characterized bydysfunction of beta cells. It accounts for 2-5% of all cases of diabetes. Over 200 mutations in the glucokinase (GCK) gene are known.In this paper we discuss the cases of two sisters in which the diagnosis of MODY 2 was performed by genetic studies, and report thefinding of a mutation in the GCK gene not previously described in the literature.

Hábitos dietarios en niños obesos / Dietary habits in obese children

La obesidad y el sobrepeso infantil son problemas con tendencia creciente; los factores condicionantes de esta epidemia son principalmente el deterioro de los hábitos dietarios y un estilo de vida sedentario. Objetivos: Describir y evaluar hábitos alimenticios y actividad física en niños con diagnóstico de obesidad. Resultados: Se encuestaron un total de 55 pacientes con una edad media de 9,5±3,2 años (rango 3,1-15,4); la media del índice de masa corporal (IMC) fue de 26,8±3,5(rango 20,0-26,8). Del total de los pacientes estudiados 43,6% se clasificó como obesidad grave. En relación a las hortalizas la mayoría de los niños (65,4%) presentó como primera elección la papa. El porcentaje de pacientes que refirió consumir arroz más de 3 veces por semana fue de 81,9 % (n= 45). La mayoría de los niños (n= 33, 75%) consumía jugos y/o gaseosas azucarados. Conclusión: la edad escolar y la adolescencia son etapas de vital importancia para corregir hábitos alimenticios y estilo de vida que persistirán en etapas posteriores...

Obesity and overweight children are problems with growing trend, the conditions of this epidemic factors are mainly a deterioration of dietary habits and a sedentary life. Objectives: To describe and evaluate eating habits and physical activity in children diagnosed with obesity. Results: A total of 55 patients were surveyed with an average age of 9.5±3.2 years (range 3.1-15.4), mean BMI was 26.8±3.5 (range 20.0-26.8). Of all the patients studied 43.6% were classified as severely obese. With regard to vegetables most children (65.4%) referred potato as their first choice. The majority of patients referred eating rice more than 3 times per week (81.9%,n= 45). Most children (75%, n= 33) ingested sugary juices or soft drinks. Conclusion: school age and adolescence are critical periods for correcting dietary habits and lifestyle that will persist in later stages...

Complicaciones endocrinometabólicas de la obesidad en niños y adolescentes / Endocrine and cardiovascular complications of obesity in children and adolescents

La obesidad es la causa más común de insulinorresistencia en niños y adolescentes. La misma presenta un aumento de su prevalencia involucrando a todos los grupos etarios. La insulinorresistencia determina disturbios metabólicos que son deletéreos para el árbol vascular y otros tejidos. Además se demostró una asociación entre insulinorresistencia e hiperinsulinemia con mayor prevalencia de nódulos tiroideos y aumento del tamaño de la tiroides, que estaría relacionado a la acción bociógena de la insulina y el IGF-1. El objetivo fue evaluar la prevalencia de factores de riesgo cardiovasculares, la presencia de esteatosis hepática y su asociación con hiperinsulinismo. Realizamos un estudio transversal descriptivo de 75 niños entre 2 y 14 años que consultaron al Servicio de Endocrinología en un lapso de 14 meses. Se analizaron las siguientes variables: peso, talla, índice de masa corporal (IMC), glucemia, insulinemia, índice HOMA, acantosis nigricans, transaminasas hepáticas, perfil lipídico, cortisol 8 hs, perfil tiroideocon anticuerpos, ecografía tiroidea y abdominal. Encontramos que 60% de la población presentó niveles de insulina elevados (>15 μUI/ml) con aumento progresivo de la prevalencia de acantosis nigricans, el 12,3% tuvo glucemias alteradas de ayuno y 66,6% índice HOMA >3. El 90% de los pacientes con ecografía tiroidea heterogénea presentó hiperinsulinismo (p <0,05), hallándose nódulos tiroideos en 5 (9,8%) de ellos. Evaluamos la posible relación entre nódulos tiroideos e hiperinsulinismo, y encontramos una asociación positiva en el 80%. La obesidad infantil de beser considerada un problema de salud pública.

besity is the most common cause of insulin resistance in children and adolescents. It has increasing prevalence and involves all age groups. Insulin resistance determines metabolic disturbances that are deleterious to the vasculature and other tissues. An association between insulin resistance and hyperinsulinemia on the one side and increased prevalence of thyroid nodules and enlargement of the thyroid gland on the other has been demonstrated, which could be related to the goitrogenic action of insulin and IGF-1. The aim of this study was to evaluate the prevalence of cardiovascular risk factors, the presence of hepatic steatosis and its association with hyperinsulinism. We performed a cross sectional study of 75 children between 2 and 14 years (mean 10 years) who visited the Department of Endocrinology during a span of 14 months. We analyzed the following variables: weight, height, body mass index (BMI), glucose, insulin, HOMA, acanthosis nigricans,liver transaminases, lipid profile, cortisol at 8 AM, thyroid function tests and thyroid antibodies, thyroid and abdominal ultrasonography. In our study we found that 60% of the population showed elevated insulin levels (>15 μIU/ml) with progressive increase in the prevalence of acanthosis nigricans, and 12.3% showed inappropriate glucose levels...

Complicaciones endocrinometabólicas de la obesidad en niños y adolescentes / Endocrine and cardiovascular complications of obesity in children and adolescents

La obesidad es la causa más común de insulinorresistencia en niños y adolescentes. La misma presenta un aumento de su prevalencia involucrando a todos los grupos etarios. La insulinorresistencia determina disturbios metabólicos que son deletéreos para el árbol vascular y otros tejidos. Además se demostró una asociación entre insulinorresistencia e hiperinsulinemia con mayor prevalencia de nódulos tiroideos y aumento del tamaño de la tiroides, que estaría relacionado a la acción bociógena de la insulina y el IGF-1. El objetivo fue evaluar la prevalencia de factores de riesgo cardiovasculares, la presencia de esteatosis hepática y su asociación con hiperinsulinismo. Realizamos un estudio transversal descriptivo de 75 niños entre 2 y 14 años que consultaron al Servicio de Endocrinología en un lapso de 14 meses. Se analizaron las siguientes variables: peso, talla, índice de masa corporal (IMC), glucemia, insulinemia, índice HOMA, acantosis nigricans, transaminasas hepáticas, perfil lipídico, cortisol 8 hs, perfil tiroideocon anticuerpos, ecografía tiroidea y abdominal. Encontramos que 60% de la población presentó niveles de insulina elevados (>15 μUI/ml) con aumento progresivo de la prevalencia de acantosis nigricans, el 12,3% tuvo glucemias alteradas de ayuno y 66,6% índice HOMA >3. El 90% de los pacientes con ecografía tiroidea heterogénea presentó hiperinsulinismo (p <0,05), hallándose nódulos tiroideos en 5 (9,8%) de ellos. Evaluamos la posible relación entre nódulos tiroideos e hiperinsulinismo, y encontramos una asociación positiva en el 80%. La obesidad infantil de beser considerada un problema de salud pública. (AU)

besity is the most common cause of insulin resistance in children and adolescents. It has increasing prevalence and involves all age groups. Insulin resistance determines metabolic disturbances that are deleterious to the vasculature and other tissues. An association between insulin resistance and hyperinsulinemia on the one side and increased prevalence of thyroid nodules and enlargement of the thyroid gland on the other has been demonstrated, which could be related to the goitrogenic action of insulin and IGF-1. The aim of this study was to evaluate the prevalence of cardiovascular risk factors, the presence of hepatic steatosis and its association with hyperinsulinism. We performed a cross sectional study of 75 children between 2 and 14 years (mean 10 years) who visited the Department of Endocrinology during a span of 14 months. We analyzed the following variables: weight, height, body mass index (BMI), glucose, insulin, HOMA, acanthosis nigricans,liver transaminases, lipid profile, cortisol at 8 AM, thyroid function tests and thyroid antibodies, thyroid and abdominal ultrasonography. In our study we found that 60% of the population showed elevated insulin levels (>15 μIU/ml) with progressive increase in the prevalence of acanthosis nigricans, and 12.3% showed inappropriate glucose levels...(AU)

Complicaciones endocrinometabólicas de la obesidad en niños y adolescentes / Endocrine and cardiovascular complications of obesity in children and adolescents

La obesidad es la causa más común de insulinorresistencia en niños y adolescentes. La misma presenta un aumento de su prevalencia involucrando a todos los grupos etarios. La insulinorresistencia determina disturbios metabólicos que son deletéreos para el árbol vascular y otros tejidos. Además se demostró una asociación entre insulinorresistencia e hiperinsulinemia con mayor prevalencia de nódulos tiroideos y aumento del tamaño de la tiroides, que estaría relacionado a la acción bociógena de la insulina y el IGF-1. El objetivo fue evaluar la prevalencia de factores de riesgo cardiovasculares, la presencia de esteatosis hepática y su asociación con hiperinsulinismo. Realizamos un estudio transversal descriptivo de 75 niños entre 2 y 14 años que consultaron al Servicio de Endocrinología en un lapso de 14 meses. Se analizaron las siguientes variables: peso, talla, índice de masa corporal (IMC), glucemia, insulinemia, índice HOMA, acantosis nigricans, transaminasas hepáticas, perfil lipídico, cortisol 8 hs, perfil tiroideo con anticuerpos, ecografía tiroidea y abdominal. Encontramos que 60% de la población presentó niveles de insulina elevados (>15 µUI/ml) con aumento progresivo de la prevalencia de acantosis nigricans, el 12,3% tuvo glucemias alteradas de ayuno y 66,6% índice HOMA >3. El 90% de los pacientes con ecografía tiroidea heterogénea presentó hiperinsulinismo (p <0,05), hallándose nódulos tiroideos en 5 (9,8%) de ellos. Evaluamos la posible relación entrenódulos tiroideos e hiperinsulinismo, y encontramos una asociación positiva en el 80%. La obesidad infantil debeser considerada un problema de salud pública.

Obesity is the most common cause of insulin resistance in children and adolescents. It has increasing prevalence and involves all age groups. Insulin resistance determines metabolic disturbances that are deleterious to the vasculature and other tissues. An association between insulin resistance and hyperinsulinemia on the one side and increased prevalence of thyroidnodules and enlargement of the thyroid gland on the other has been demonstrated, which could be related to the goitrogenic action of insulin and IGF-1. The aim of this study was to evaluate the prevalence of cardiovascular risk factors, the presence of hepatic steatosis and its association with hyperinsulinism. We performed a cross sectional study of 75 childrenbetween 2 and 14 years (mean 10 years) who visited the Department of Endocrinology during a span of 14 months.We analyzed the following variables: weight, height, body mass index (BMI), glucose, insulin, HOMA, acanthosis nigricans, liver transaminases, lipid profile, cortisol at 8 AM, thyroid function tests and thyroid antibodies, thyroid and abdominalultrasonography. In our study we found that 60% of the population showed elevated insulin levels (>15 ìIU/ml) with progressive increase in the prevalence of acanthosis nigricans, and 12.3% showed inappropriate glucose levels. Ninety per cent of patients with heterogeneous thyroid ultrasonography had hyperinsulinemia (p <0.05), and thyroid nodules were found in 5 of them (9.8%). We assessed the possible relationship between thyroid nodules and hyperinsulinism, and founda positive association in 80% of the cases. Childhood obesity should be considered a public health problem.

Complicaciones endocrinometabólicas de la obesidad en niños y adolescentes / Endocrine and cardiovascular complications of obesity in children and adolescents

La obesidad es la causa más común de insulinorresistencia en niños y adolescentes. La misma presenta un aumento de su prevalencia involucrando a todos los grupos etarios. La insulinorresistencia determina disturbios metabólicos que son deletéreos para el árbol vascular y otros tejidos. Además se demostró una asociación entre insulinorresistencia e hiperinsulinemia con mayor prevalencia de nódulos tiroideos y aumento del tamaño de la tiroides, que estaría relacionado a la acción bociógena de la insulina y el IGF-1. El objetivo fue evaluar la prevalencia de factores de riesgo cardiovasculares, la presencia de esteatosis hepática y su asociación con hiperinsulinismo. Realizamos un estudio transversal descriptivo de 75 niños entre 2 y 14 años que consultaron al Servicio de Endocrinología en un lapso de 14 meses. Se analizaron las siguientes variables: peso, talla, índice de masa corporal (IMC), glucemia, insulinemia, índice HOMA, acantosis nigricans, transaminasas hepáticas, perfil lipídico, cortisol 8 hs, perfil tiroideo con anticuerpos, ecografía tiroidea y abdominal. Encontramos que 60% de la población presentó niveles de insulina elevados (>15 AUI/ml) con aumento progresivo de la prevalencia de acantosis nigricans, el 12,3% tuvo glucemias alteradas de ayuno y 66,6% índice HOMA >3. El 90% de los pacientes con ecografía tiroidea heterogénea presentó hiperinsulinismo (p <0,05), hallándose nódulos tiroideos en 5 (9,8%) de ellos. Evaluamos la posible relación entrenódulos tiroideos e hiperinsulinismo, y encontramos una asociación positiva en el 80%. La obesidad infantil debeser considerada un problema de salud pública.(AU)

Obesity is the most common cause of insulin resistance in children and adolescents. It has increasing prevalence and involves all age groups. Insulin resistance determines metabolic disturbances that are deleterious to the vasculature and other tissues. An association between insulin resistance and hyperinsulinemia on the one side and increased prevalence of thyroidnodules and enlargement of the thyroid gland on the other has been demonstrated, which could be related to the goitrogenic action of insulin and IGF-1. The aim of this study was to evaluate the prevalence of cardiovascular risk factors, the presence of hepatic steatosis and its association with hyperinsulinism. We performed a cross sectional study of 75 childrenbetween 2 and 14 years (mean 10 years) who visited the Department of Endocrinology during a span of 14 months.We analyzed the following variables: weight, height, body mass index (BMI), glucose, insulin, HOMA, acanthosis nigricans, liver transaminases, lipid profile, cortisol at 8 AM, thyroid function tests and thyroid antibodies, thyroid and abdominalultrasonography. In our study we found that 60% of the population showed elevated insulin levels (>15 ýIU/ml) with progressive increase in the prevalence of acanthosis nigricans, and 12.3% showed inappropriate glucose levels. Ninety per cent of patients with heterogeneous thyroid ultrasonography had hyperinsulinemia (p <0.05), and thyroid nodules were found in 5 of them (9.8%). We assessed the possible relationship between thyroid nodules and hyperinsulinism, and founda positive association in 80% of the cases. Childhood obesity should be considered a public health problem.(AU)

Reassessment of the interaction between a worksite hypertension program and private physicians.

We investigated how nurse practitioners attending at worksite hypertension clinics were perceived as care providers by both patients enrolled in the clinics and their private physicians. This study indicates a very favorable attitude towards nurse practitioners from both patients and private practitioners and gives additional support for the utilization of nurse practitioners as effective health care providers in the management of common and chronic illness.

Predictors of long-term compliance in attending a worksite hypertension programme.

Variables such as patient's anxiety, knowledge, number of medication changes, medication-induced side-effects and programme-derived benefits and conveniences have been reported or theorised to be important determinants of patient's attendance at worksite hypertension programmes. This study investigates whether these variables have predictive value in differentiating compliers from noncompliers attending a union-sponsored worksite hypertension programme for at least five years. Scores were created from a questionnaire distributed to 243 patients with a response rate of 98%. Compliance was defined as missing < or = 25% of scheduled clinic appointments. By discriminant statistical analysis scores for patient's anxiety, knowledge, number of medication changes, medication side-effects, perceived benefits and conveniences failed to show any predictive value for patient's compliance with appointment keeping.