Development and validation of a clinical score for identifying patients with high risk of latent autoimmune adult diabetes (LADA): The LADA primary care-protocol study.

BACKGROUND: Latent autoimmune diabetes in adults (LADA) is a type of diabetes mellitus showing overlapping characteristics between type 1 Diabetes Mellitus and type 2 Diabetes Mellitus (T2DM), and autoimmunity against insulin-producing pancreatic cells. For its diagnosis, at least one type of anti-pancreatic islet antibody (GADAb is the most common) is required. Many authors recommend performing this measure in all newly diagnosed patients with DM, but it is not possible in Primary Health Care (PHC) due to its high cost. Currently, a relevant proportion of patients diagnosed as T2DM could be LADA. Confusing LADA with T2DM has clinical and safety implications, given its different therapeutic approach. The main objective of the study is to develop and validate a clinical score for identifying adult patients with DM at high risk of LADA in PHC. METHODS: This is an observational, descriptive, cross-sectional study carried out in Primary Care Health Centers with a centralized laboratory. All people over 30 years of age diagnosed with diabetes within a minimum of 6 months and a maximum of 4 years before the start of the study will be recruited. Individuals will be recruited by consecutive sampling. The study variables will be obtained through clinical interviews, physical examinations, and electronic medical records. The following variables will be recorded: those related to Diabetes Mellitus, sociodemographic, anthropometric, lifestyle habits, laboratory parameters, presence of comorbidities, additional treatments, personal or family autoimmune disorders, self-perceived health status, Fourlanos criteria, and LADA diagnosis (as main variable) according to current criteria. DISCUSSION: The study will provide an effective method for identifying patients at increased risk of LADA and, therefore, candidates for antibody testing. However, a slight participation bias is to be expected. Differences between participants and non-participants will be studied to quantify this potential bias.

Influenza vaccination in people with type 2 diabetes, coverage, predictors of uptake, and perceptions. Result of the MADIABETES cohort a 7years follow up study.

OBJECTIVES: We aim to determine influenza vaccination uptake among people with diabetes included in the MADIABETES cohort study in order to identify predictors of uptake and to analyze reasons for adherence and non-adherence with vaccination. METHODS: Using data from the MADIABETES Study we conducted a retrospective case record form based study without controls. We included outpatients with type 2 diabetes mellitus. Information was obtained from computerized clinical records and by telephone survey. The main dependent variables were influenza vaccination uptake in the year 2013 and the reason for receiving or refusing vaccination. RESULTS: Overall, 65.7% had received the influenza vaccine in 2013. The mean number of influenza vaccines received from 2007 to 2013 was 3.24 (SD1.15), although 19.23% had not received any influenza vaccine and 23.3% had been vaccinated against pneumococcus. The variables that increased the probability of being vaccinated were inclusion in the age-based recommendation (⩾60years), having a chronic respiratory disease, previous pneumococcal vaccination, higher number of visits to the general practitioner, higher number of influenza vaccines, and longer time since diabetes diagnosis. A higher mean glycated haemoglobin value in 2013 was associated with a reduced probability of vaccination. Most patients (90%) agreed to be vaccinated following their physician's advice because of their age or their chronic conditions. The most common reason for refusal among men was the belief that they were not at risk (41.6% vs. 29.79% in women); the most common reason for refusal among women was fear of adverse reactions (32.53% vs. 20.23% in men). CONCLUSIONS: The uptake of influenza vaccination among diabetic patients in the present study was below desirable levels. The main barrier to vaccination was lack of knowledge regarding the need for and risks and advantages of influenza vaccination. Healthcare professionals should educate and encourage influenza vaccination among people with diabetes.

Cardiovascular and all-cause mortality in patients with type 2 diabetes mellitus in the MADIABETES Cohort Study: Association with chronic kidney disease.

AIMS: To assess the prevalence of stage 3-5 chronic kidney disease (CKD) at baseline and to identify associated risk factors. To determine the effect of CKD and CKD stage according to estimated glomerular filtration rate (eGFR) and albuminuria categories on all-cause and cardiovascular mortality after a 5-year follow-up. METHODS: Prospective cohort study of 3443 outpatients with type 2 diabetes mellitus. RESULTS: The prevalence of CKD was 28.32% (95% CI, 26.84-29.86); and variables most strongly associated were: age >74 years (OR, 19.88; 95% CI, 12.89-30.68) and albuminuria (OR, 2.27; 95% CI, 1.72-3.00). During follow-up, 221 CKD patients (22.90%) died compared with 203 non-CKD patients (8.31%) (p<0.01). The adjusted HR of CKD for cardiovascular and all-cause mortality was 1.82 (95% CI, 1.36-2.44) and 2.11 (95% CI, 1.61-2.76) for those with LDL cholesterol =135 mg/dl, respectively. The adjusted HR of very-high-risk CKD for all-cause mortality was 4.44 (95% CI, 2.31-8.53) in aged <75 years and 1.80 (95% CI, 1.19-2.72) in aged ≥75 years. CONCLUSIONS: CKD at baseline is an independent risk factor for all-cause and cardiovascular mortality in the overall cohort, men and women, or in primary and secondary prevention of coronary heart disease. Albuminuria is an independent risk factor for all-cause and cardiovascular mortality only in primary prevention.

Validating prediction scales of type 2 diabetes mellitus in Spain: the SPREDIA-2 population-based prospective cohort study protocol.

INTRODUCTION: The incidence of type 2 diabetes mellitus (T2DM) is increasing worldwide. When diagnosed, many patients already have organ damage or advance subclinical atherosclerosis. An early diagnosis could allow the implementation of lifestyle changes and treatment options aimed at delaying the progression of the disease and to avoid cardiovascular complications. Different scores for identifying undiagnosed diabetes have been reported, however, their performance in populations of southern Europe has not been sufficiently evaluated. The main objectives of our study are: to evaluate the screening performance and cut-off points of the main scores that identify the risk of undiagnosed T2DM and prediabetes in a Spanish population, and to develop and validate our own predictive models of undiagnosed T2DM (screening model), and future T2DM (prediction risk model) after 5-year follow-up. As a secondary objective, we will evaluate the atherosclerotic burden of the population with undiagnosed T2DM. METHODS AND ANALYSIS: Population-based prospective cohort study with baseline screening, to evaluate the performance of the FINDRISC, DANISH, DESIR, ARIC and QDScore, against the gold standard tests: Fasting plasma glucose, oral glucose tolerance and/or HbA1c. The sample size will include 1352 participants between the ages of 45 and 74 years. ANALYSIS: sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio positive, likelihood ratio negative and receiver operating characteristic curves and area under curve. Binary logistic regression for the first 700 individuals (derivation) and last 652 (validation) will be performed. All analyses will be calculated with their 95% CI; statistical significance will be p<0.05. ETHICS AND DISSEMINATION: The study protocol has been approved by the Research Ethics Committee of the Carlos III Hospital (Madrid). The score performance and predictive model will be presented in medical conferences, workshops, seminars and round table discussions. Furthermore, the predictive model will be published in a peer-reviewed medical journal to further increase the exposure of the scores.

Health-related quality of life of latin-american immigrants and spanish-born attended in spanish primary health care: socio-demographic and psychosocial factors.

BACKGROUND: This study compares the health-related quality of life of Spanish-born and Latin American-born individuals settled in Spain. Socio-demographic and psychosocial factors associated with health-related quality of life are analyzed. METHODS: A cross-sectional Primary Health Care multi center-based study of Latin American-born (n = 691) and Spanish-born (n = 903) outpatients from 15 Primary Health Care Centers (Madrid, Spain). The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) was used to assess health-related quality of life. Socio-demographic, psychosocial, and specific migration data were also collected. RESULTS: Compared to Spanish-born participants, Latin American-born participants reported higher health-related quality of life in the physical functioning and vitality dimensions. Across the entire sample, Latin American-born participants, younger participants, men and those with high social support reported significantly higher levels of physical health. Men with higher social support and a higher income reported significantly higher mental health. When stratified by gender, data show that for men physical health was only positively associated with younger age. For women, in addition to age, social support and marital status were significantly related. Both men and women with higher social support and income had significantly better mental health. Finally, for immigrants, the physical and mental health components of health-related quality of life were not found to be significantly associated with any of the pre-migration factors or conditions of migration. Only the variable "exposure to political violence" was significantly associated with the mental health component (p = 0.014). CONCLUSIONS: The key factors to understanding HRQoL among Latin American-born immigrants settled in Spain are age, sex and social support. Therefore, strategies to maintain optimal health outcomes in these immigrant communities should include public policies on social inclusion in the host society and focus on improving social support networks in order to foster and maintain the health and HRQoL of this group.

Prevalencia de los trastornos mentales en inmigrantes latinoamericanos atendidos en centros de atención primaria: diferencias a lo largo del tiempo / Prevalence of common mental disorders in Latin American-born immigrants seen in Primary Health Care: Differences over time

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Cluster randomized trial to evaluate the effect of a multimodal hand hygiene improvement strategy in primary care.

OBJECTIVE: To evaluate the effectiveness of a multimodal intervention in primary care health professionals for improved compliance with hand hygiene practice, based on the World Health Organization's 5 Moments for Health Hygiene. DESIGN: Cluster randomized trial, parallel 2-group study (intervention and control). SETTING: Primary healthcare centers in Madrid, Spain. PARTICIPANTS: Eleven healthcare centers with 198 healthcare workers (general practitioners, nurses, pediatricians, auxiliary nurses, midwives, odontostomatologists, and dental hygienists). Methods. The multimodal hand hygiene improvement strategy consisted of training of healthcare workers by teaching sessions, implementation of hydroalcoholic solutions, and installation of reminder posters. The hand hygiene compliance level was evaluated by observation during regular care activities in the office visit setting, at the baseline moment, and 6 months after the intervention, all by a single external observer. RESULTS: The overall baseline compliance level was 8.1% (95% confidence interval [CI], 6.2-10.1), and the healthcare workers of the intervention group increased their hand hygiene compliance level by 21.6% (95% CI, 13.83-28.48) compared with the control group. CONCLUSIONS: This study has demonstrated that hand hygiene compliance in primary healthcare workers can be improved with a multimodal hand hygiene improvement strategy.

Evaluación del cumplimiento de higiene de las manos en un área de atención primaria de Madrid / Evaluation of hand hygiene compliance in a Primary Health care area of Madrid

Introducción La higiene de las manos (HM) es la medida más eficiente para la prevención de infecciones nosocomiales. Nuestro estudio pretende estimar su cumplimiento en atención primaria. Métodos Estudio transversal en el que se ha recogido información sociodemográfica de 198 profesionales. Se evaluó el cumplimiento de HM según los criterios de la Organización Mundial de la Salud. Resultados El cumplimiento de HM fue del 8,1% (intervalo de confianza al 95%: 6,2–10,1). La experiencia laboral de más de 20 años se asoció significativamente a muy bajos niveles de cumplimiento. Conclusión La atención primaria presenta un cumplimiento de HM excesivamente bajo. Es necesario desarrollar programas formativos que aumenten el cumplimiento así como facilitar el acceso a las soluciones hidroalcohólicas (AU)

Introduction Hand hygiene is the most effective measure for preventing infections related to healthcare. This study aims to evaluate the Hand hygiene compliance in Primary Health Care. Methods A cross-sectional study was carried out, collecting socio-demographic data and the hand hygiene compliance from 198 Primary Health Care workers. Their hand hygiene compliance was evaluated according to WHO criteria. Results The level of hand hygiene compliance was 8.1% (95% CI 6.2–10.1). Employment experience of over 20 years was significantly associated with low levels of compliance .Conclusion Primary Health Care workers have a low hand hygiene compliance. Training programs need to be introduced to increase compliance and facilitate access to hydro-alcoholic solutions (AU)

[Evaluation of hand hygiene compliance in a Primary Health Care area of Madrid]. / Evaluación del cumplimiento de higiene de las manos en un área de atención primaria de Madrid.

INTRODUCTION: Hand hygiene is the most effective measure for preventing infections related to healthcare. This study aims to evaluate the Hand hygiene compliance in Primary Health Care. METHODS: A cross-sectional study was carried out, collecting socio-demographic data and the hand hygiene compliance from 198 Primary Health Care workers. Their hand hygiene compliance was evaluated according to WHO criteria. RESULTS: The level of hand hygiene compliance was 8.1% (95% CI 6.2-10.1). Employment experience of over 20 years was significantly associated with low levels of compliance. CONCLUSION: Primary Health Care workers have a low hand hygiene compliance. Training programs need to be introduced to increase compliance and facilitate access to hydro-alcoholic solutions.

Effectiveness of a training programme to improve hand hygiene compliance in primary healthcare.

BACKGROUND: Hand hygiene is the most effective measure for preventing infections related to healthcare, and its impact on the reduction of these infections is estimated at 50%. Non-compliance has been highlighted in several studies in hospitals, although none have been carried out in primary healthcare. MAIN OBJECTIVE: To evaluated the effect of a "Hand Hygiene for the reduction of healthcare-associated infections" training program for primary healthcare workers, measured by variation from correct hand hygiene compliance, according to regulatory and specific criteria, 6 months after the baseline, in the intervention group (group receiving a training program) and in the control group (a usual clinical practice). SECONDARY OBJECTIVES: -To describe knowledges, attitudes and behaviors as regards hand hygiene among the professionals, and their possible association with "professional burnout", stratifying the results by type of group (intervention and usual clinical practice).-To estimate the logistic regression model that best explains hand hygiene compliance. METHODS/DESIGN: Experimental study of parallel groups, with a control group, and random assignment by Health Center.Area of study.- Health centers in north-eastern Madrid (Spain).Sample studied.- Healthcare workers (physicians, odontostomatologists, pediatricians, nurses, dental hygienists, midwife and nursing auxiliaries).Intervention.- A hand hygiene training program, including a theoretical-practical workshop, provision of alcohol-based solutions and a reminder strategy in the workplace.Other variables: sociodemographic and professional knowledges, attitudes, and behaviors with regard to hand hygiene. STATISTICAL ANALYSIS: descriptive and inferential, using multivariate methods (covariance analysis and logistic regression). DISCUSSION: This study will provide valuable information on the prevalence of hand hygiene non-compliance, and improve healthcare.

Factores asociados a mal estado de salud percibido o a mala calidad de vida en personas mayores de 65 años / Factors Related to Perceived Poor Health Condition or Poor Quality of Life among those over Age 65

Fundamento: Hoy en día, en los países desarrollados, llegar a una edad avanzada ha dejado de ser algo excepcional, sin embargo muchas personas no logran envejecer con una buena calidad de vida. El presente trabajo tiene como objetivos, contribuir a un mejor conocimiento de los principales factores que influyen en la calidad de vida y la percepción de la salud de los mayores de 65 años, así como determinar qué ventajas y desventajas presenta cada uno de los tres instrumentos de medida de la salud y la calidad de vida frente a los otros dos instrumentos utilizados. Métodos: A partir de 911 encuestas a personas mayores de 65 años no institucionalizadas, realizadas a domicilio, se hizo un análisis multivariante mediante regresión logística, poniendo en relación los resultados obtenidos en el Perfil de Salud de Nottingham (PSN), el Euroqol y el EAS con las caracterísiticas sociodemográficas, el nivel de recursos económicos, el grado de apoyo sociofamiliar, el estado de salud física y mental y la capacidad funcional. Resultados: Los principales factores que se asocian con la percepción de un mal estado de salud y mala calidad de vida en el Euroqol y el PSN son los trastornos de ansiedad (Odd Ratios entre 1,8 (IC:1,2-2,8) para movilidad y 7,9 (IC:4,5-13,9) para perfil distinto de 11111), trastornos depresivos (OR:1,8 (IC:1,3-2,6) para dolor/malestar -3,3 (IC:2,1-5,1) para aislamiento social), falta de ejercicio (OR:1,4 (IC:1-2,1) para ansiedad/depresión -3,9 (IC:2,5-6,2) para actividades cotidianas), dependencia para las actividades básicas de la vida diaria (OR:0,5 (IC:0,3-0,9) para reacción emocional -4,8 (IC:3-7,6) para actividades cotidianas) y dependencia para las actividades instrumentales de la vida diaria (OR:1,5 (IC:1,1-2,1) para Escala Visual Analógica < 70 - 7,1 (IC:2,9-17,2) para cuidado personal). Conclusiones: La salud mental y la capacidad funcional son los factores que más influyen en la percepción del estado de salud y la calidad de vida de las personas mayores. Dado que los tres instrumentos utilizados han obtenido resultados semejantes, el Euroqol ofrece ventajas por su brevedad, incluyendo una valoración global y por dimensiones (AU)

Background: Nowadays, in the developed countries, a long lifespan is no longer the exception to the rule, however there are still many people who even today do not manage to age with a good quality of life. The objectives of this study are, first of all, to contribute to a better knowledge of the main factors which have an impact on the quality of life and the perceived health condition of those over age 65 and, secondly, to determine what advantages and disadvantages involved in each one of the tools for gauging health and quality of life as compared to the other two tools employed. Methods: Based on 911 home surveys of non-institutionalized individuals over age 65, a multivariate analysis was made using Logistic regression, relating the results obtained in the Nottingham Health Profile (NHP), the EuroQol and the Self Perceived Health Status to the socio-demographic characteristics, the level of economic resources, the degree of social-family support, the physical and mental health condition and the functional capacity. Results: The main factors related to the perception of a poor health condition and a poor quality of life in the EuroQol and the NHP are anxiety disorders (Odds Ratio ranging from 1.8(IC:1.2-2.8) for mobility and 7.9(IC:4.5-13.9) for Profile*11111), depressive disorders (OR:1.8(IC:1.3-2.6) for pain/discomfort- 3.3(IC:2.1-5.1) for social isolation), lack of exercise (OR:1.4 (IC:1-2.1) for anxiety/depression -3.9(IC:2.5-6.2) for everyday activities), dependence for basic everyday living activities (OR:0.5(IC:0.3-0.9) for emotional reaction - 4.8(IC:3-7.6) for everyday activities) and dependence for the instrumental daily living activities (OR:1.5(IC:1.1-2.1) for Analog Visual Scale c<70 - 7.1(IC:2.9-17.2) for personal care). Conclusions: Mental health and functioning capacity are the factors which have the greatest bearing on the perception of health condition and quality of life of individuals over age 65. Given that the three tools used have led to similar results, the EuroQol has advantages to offer due to its short length, including an overall evaluation by dimensions (AU)

[Factors related to perceived poor health condition or poor quality of life among those over 65 years of age]. / Factores asociados a mal estado de salud percibido o a mala calidad de vida en personas mayores de 65 años.

BACKGROUND: Nowadays, in the developed countries, a long lifespan is no longer the exception to the rule, however there are still many people who even today do not manage to age with a good quality of life. The objectives of this study are, first of all, to contribute to a better knowledge of the main factors which have an impact on the quality of life and the perceived health condition of those over age 65 and, secondly, to determine what advantages and disadvantages involved in each one of the tools for gauging health and quality of life as compared to the other two tools employed. METHODS: Based on 911 home surveys of non-institutionalized individuals over age 65, a multivariate analysis was made using Logistic regression, relating the results obtained in the Nottingham Health Profile (NHP), the EuroQol and the Self Perceived Health Status to the socio-demographic characteristics, the level of economic resources, the degree of social-family support, the physical and mental health condition and the functional capacity. RESULTS: The main factors related to the perception of a poor health condition and a poor quality of life in the EuroQol and the NHP are anxiety disorders (Odds Ratio ranging from 1.8(IC:1.2-2.8) for mobility and 7.9(IC:4.5-13.9) for Profile*11111), depressive disorders (OR:1.8(IC:1.3-2.6) for pain/discomfort-3.3(IC:2.1-5.1) for social isolation), lack of exercise (OR:1.4 (IC:1-2.1) for anxiety/depression -3.9(IC:2.5-6.2) for everyday activities), dependence for basic everyday living activities (OR:0.5(IC:0.3-0.9) for emotional reaction -4.8(IC:3-7.6) for everyday activities) and dependence for the instrumental daily living activities (OR:1.5(IC:1.1-2.1) for Analog Visual Scale c < 70-7.1(IC:2.9-17.2) for personal care). CONCLUSIONS: Mental health and functioning capacity are the factors which have the greatest bearing on the perception of health condition and quality of life of individuals over age 65. Given that the three tools used have led to similar results, the EuroQol has advantages to offer due to its short length, including an overall evaluation by dimensions.