Impacto del confinamiento domiciliario por COVID-19 en población con diabetes tipo 2 de una zona rural / Impact of home confinement due to COVID-19 in the population with Type 2 diabetes of a rural area

Objetivo: determinar el impacto del confinamiento domiciliario por la pandemia de COVID-19 sobre el control de la hemoglobina glicosilada (Hb1Ac) y el riesgo cardiovascular de personas diabéticas residentes en una zona rural de Cataluña, así como su autopercepción del control de la enfermedad.Método: estudio descriptivo longitudinal retrospectivo con personas diagnosticadas de DM2 usuarias de los servicios de Atención Primaria del Institut Català de la Salut, en el área rural del Ripollés (Cataluña, España). Se recogieron datos de la historia clínica sobre: Hb1Ac, riesgo cardiovascular (según la ecuación Framingham-REGICOR), edad, sexo, tabaquismo, tensión arterial, peso, índice de masa corporal y variables bioquímicas; tanto antes como después del confinamiento y se compararon. Además, se les administró un cuestionario ad hoc sobre salud autopercibida.Resultados: participaron N= 233 personas con una edad media de 69,8 (DE: 10) años, mayoritariamente hombres (56,2%) y no fumadores (90,3%). El 46,3% tenía un buen control de Hb1Ac preconfinamiento que aumentó al 48,1% (p= 0,555). No se detectaron diferencias significativas entre el promedio de HbA1c antes (7,26; DE: 1,17) y después (7,28; DE:1,23) del confinamiento. La mayoría de los participantes tenía un riesgo cardiovascular medio (51,4%) o alto (25,7%) y aumentó 0,11 puntos posconfinamiento (p= 0,307). El 18% de los encuestados (N= 42) percibió un empeoramiento del control de la DM2 tras el confinamiento, principalmente debido al sedentarismo (42,8%) y a cambios en la dieta (21,4%).Conclusiones: el confinamiento no generó impacto en los niveles de Hb1Ac en el riesgo cardiovascular, ni en la autopercepción del manejo de la DM2 de los pacientes con diabetes de un área rural.(AU)

Objective: to determine the impact of home confinement due to the COVID-19 pandemic on the control of glycosylated hemoglobin (Hb1Ac) and cardiovascular risk in diabetic persons living in a rural area of Catalonia, as well as their self-perception of disease controlMethod: a descriptive longitudinal retrospective study with persons diagnosed with T2D and users of the Primary Care services of the Institut Català de la Salut, in the rural area of Ripollés (Catalonia, Spain). Data were collected from clinical records about: Hb1Ac, cardiovascular risk (according to the Framingham-REGICOR equation), age, gender, smoking, blood pressure, weight, body mass index and biochemical variables, both before and after lockdown; and they were compared. Besides, an ad hoc questionnaire on self-perceived health was administered.Results: the study included N= 233 persons with a mean age of 69.8 (SD: 10) years, mostly male (56.2%) and non-smoking (90.3%). Of these, 46.3% had good control of their Hb1Ac before the confinement, which increased to 48.1% (p= 0.555). No significant differences were detected between the average HbA1c before (7.26; SD: 1.17) and after the confinement (7.28; SD:1.23). The majority of participants had medium (51.4%) or high cardiovascular risk (25.7%), and this increased by 0.11 points post-confinement (p= 0.307). There was a perception of worsening in their T2D after the confinement by 18% of participants (N= 42), mainly due to sedentarism (42.8%) and changes in their diet (21.4%).Conclusions: lockdown did not generate any impact on Hb1Ac levels in cardiovascular risk, or in the self-perception of T2D management of patients with diabetes in a rural area.(AU)

Facilitators, Barriers, and Solutions in Pain Management for Older Adults with Dementia.

BACKGROUND: Although qualitative studies have been conducted to identify barriers and facilitators that influence the pain management of older adults with dementia, as far as we know, only a very recent study (Andrews et al., 2019) has used participatory action research (PAR) as a methodology for studying pain management. It allows nurses to examine and improve their practice based on their realities and within their context. AIM: To reflect on nursing practice and identify facilitators and barriers in the management of pain in older adults with dementia and to propose actions for improvement. DESIGN: We used qualitative participatory action research. PARTICIPANTS/SETTINGS: Ten nurses from the geriatric acute care unit of a university hospital in Spain were recruited through convenience sampling. METHODS: Data were generated through a written questionnaire and three focus groups. RESULTS: One of the main facilitators the participants identified was professional experience. The main barriers they identified were lack of knowledge and skills and lack of time. The participants proposed two main improvements: (1) a training program consisting of three courses (pain evaluation and management, dementia and pain, and pharmacology) and (2) the creation of a specific register for nurses to record patients' pain. CONCLUSIONS: Involving nurses directly in research on their practices can result in precise proposals for improvements based on their needs and oriented toward improving the quality of care. Moreover, our results confirm previous findings in other countries.