Health Outcomes for Older Patients with Chronic Diseases During the First Pandemic Year.

Background: Worldwide, chronic diseases are prevalent among the older adults, significantly affecting their health and healthcare system. The COVID-19 pandemic exacerbated these challenges, disrupting healthcare services. Our study assesses the impact on older individuals with chronic diseases who were not infected with COVID-19, analyzing comorbidities, medication use, mortality rates, and resource utilization using real data from Aragon, Spain. Methods: A retrospective observational study, conducted in Aragon, Spain, focused on individuals aged 75 and older with at least one chronic disease, who were not infected of COVID-19. The research used actual data collected during three distinct periods: the first covered the six months prior to the pandemic, the second the six months after the lockdown, and the third the period between six and twelve months. Key variables included socio-demographics, comorbidities, clinical parameters, medication use, and health services utilization. Results: We included 128.130 older adults. Mean age was 82.88 years, with 60.3% being women. The most common chronic diseases were hypertension (73.2%), dyslipidemia (52.5%), and dorsopathies (31.5%). More than 90% had more than 2 conditions. A notable decline in new chronic disease diagnoses was observed, particularly pronounced in the six to twelve months period after lockdown. Although statistically significant differences were observed in all clinical variables analyzed, they were considered clinically irrelevant. Furthermore, a decrease in healthcare services utilization and medication prescriptions was reported. Conclusion: Our study highlights a decrease in new chronic disease diagnoses, ongoing reductions in healthcare utilization, and medication prescriptions for older adults with pre-existing chronic conditions, unaffected by COVID-19.

Efectividad de las intervenciones basadas en telemedicina sobre resultados en salud en pacientes con multimorbilidad en atención primaria: revisión sistemática / Effectiveness of interventions based on telemedicine on health outcomes in patients with multimorbidity in Primary Care: A systematic review

OBJETIVO: Evaluar la efectividad de intervenciones basadas en telemedicina para mejorar resultados en salud en pacientes con multimorbilidad en atención primaria. DISEÑO: Revisión sistemática. Fuentes de datos: INAHTA, Guía Salud, NICE, Cochrane Library, Medline/PubMed y EMBASE hasta abril de 2018. Selección de estudios: CRITERIOS DE INCLUSIÓN: pacientes (adultos con 2 o más enfermedades crónicas o índice de Charlson mayor de 3); intervención (programa de telemedicina desarrollada en atención primaria); comparador (práctica habitual); resultados (mortalidad, ingresos hospitalarios, consultas a urgencias, calidad de vida relacionada con la salud y satisfacción); diseño (guía de práctica clínica, revisión sistemática, metaanálisis, ensayo clínico controlado aleatorizado o cuasiexperimental). Publicación en inglés o español. Se localizaron 236 referencias. Extracción de datos: Exclusión de duplicados; valoración de criterios de selección sobre título, resumen y texto completo; valoración crítica; extracción y análisis cualitativo. Dos revisores y un tercero para discrepancias. RESULTADOS: Se incluyeron 5 artículos de 3 estudios, 2 ensayos clínicos controlados aleatorizados y en cuasiexperimental. No se observaron resultados significativos en la reducción de la mortalidad o mejora de la calidad de vida relacionada con la salud. La efectividad de la telemedicina sobre el número de ingresos hospitalarios o consultas a urgencias mostró resultados contradictorios. La satisfacción no fue medida en los estudios incluidos. CONCLUSIONES: El escaso número de estudios, la relativa heterogeneidad y limitaciones metodológicas no permiten confirmar la efectividad de las intervenciones basadas en telemedicina en pacientes con multimorbilidad en atención primaria, sobre la mejora de la mortalidad, el número de ingresos hospitalarios o consultas a urgencias y calidad de vida relacionada con la salud, respecto a la práctica habitual

OBJECTIVE: To evaluate the effectiveness of telemedicine interventions to improve health outcomes in patients with multiple morbidities in Primary Health Care. DESIGN: A systematic review. Data sources: INAHTA, Health Guidelines, NICE, Cochrane Library, Medline/PubMed and EMBASE up to April 2018. Study selection: Inclusion criteria: patients (adults with 2 or more chronic diseases or a Charlson index greater than three); intervention (telemedicine intervention developed entirely in Primary Health Care); comparator (usual care); health outcomes (mortality, hospital admissions, emergency department visits, health-related quality of life, and satisfaction); study design(clinical practice guideline, systematic review, meta-analysis, randomised controlled clinical trial),and quasi-experimental design). English and Spanish language publication. A total of236 references were located. Data extraction: Duplicated articles were removed. Titles, abstracts, and full text of references identified were assessed using the selection criteria; methodological quality assessment; data extraction, and qualitative analysis. RESULTS: Five articles, corresponding to 3 studies, were included, with 2 randomised controlled clinical trials and one quasi-experimental design. No significant results were observed in reducing mortality or improving health-related quality of life. The effectiveness of telemedicine on the number of hospital admissions or emergency visits showed contradictory results. Satisfaction was not measured in the studies included. CONCLUSIONS: The relatively small number of studies, heterogeneity characteristics, and methodological limitations did not confirm the effectiveness of telemedicine intervention on the improvement of mortality, number of hospital admissions, emergency department visits, and health-related quality of life, compared to usual care

Successful improvement of antibiotic prescribing at Primary Care in Andalusia following the implementation of an antimicrobial guide through multifaceted interventions: An interrupted time-series analysis.

BACKGROUND: Most effective strategies designed to improve antimicrobial prescribing have multiple approaches. We assessed the impact of the implementation of a rigorous antimicrobial guide and subsequent multifaceted interventions aimed at improving antimicrobial use in Primary Care. METHODS: A quasi-experimental study was designed. Interventions aimed at achieving a good implementation of the guide consisted of the development of electronic decision support tools, local training meetings, regional workshops, conferences, targets for rates of antibiotic prescribing linked to financial incentives, feedback on antibiotic prescribing, and the implementation of a structured educational antimicrobial stewardship program. Interventions started in 2011, and continued until 2018. Outcomes: rates of antibiotics use, calculated into defined daily doses per 1,000 inhabitants-day (DID). An interrupted time-series analysis was conducted. The study ran from January 2004 until December 2018. RESULTS: Overall annual antibiotic prescribing rates showed increasing trends in the pre-intervention period. Interventions were followed by significant changes on trends with a decline over time in antibiotic prescribing. Overall antibiotic rates dropped by 28% in the Aljarafe Area and 22% in Andalusia between 2011 and 2018, at rates of -0.90 DID per year (95%CI:-1.05 to -0.75) in Aljarafe, and -0.78 DID (95%CI:-0.95 to -0.60) in Andalusia. Reductions occurred at the expense of the strong decline of penicillins use (33% in Aljarafe, 25% in Andalusia), and more precisely, amoxicillin clavulanate, whose prescription plummeted by around 50%. Quinolones rates decreased before interventions, and continued to decline following interventions with more pronounced downward trends. Decreasing cephalosporins trends continued to decline, at a lesser extent, following interventions in Andalusia. Trends of macrolides rates went from a downward trend to an upward trend from 2011 to 2018. CONCLUSIONS: Multifaceted interventions following the delivering of a rigorous antimicrobial guide, maintained in long-term, with strong institutional support, could led to sustained reductions in antibiotic prescribing in Primary Care.

[Effectiveness of interventions based on telemedicine on health outcomes in patients with multimorbidity in Primary Care: A systematic review]. / Efectividad de las intervenciones basadas en telemedicina sobre resultados en salud en pacientes con multimorbilidad en atención primaria: revisión sistemática.

OBJECTIVE: To evaluate the effectiveness of telemedicine interventions to improve health outcomes in patients with multiple morbidities in Primary Health Care. DESIGN: A systematic review. DATA SOURCES: INAHTA, Health Guidelines, NICE, Cochrane Library, Medline/PubMed and EMBASE up to April 2018. STUDY SELECTION: Inclusion criteria: patients (adults with 2 or more chronic diseases or a Charlson index greater than three); intervention (telemedicine intervention developed entirely in Primary Health Care); comparator (usual care); health outcomes (mortality, hospital admissions, emergency department visits, health-related quality of life, and satisfaction); study design(clinical practice guideline, systematic review, meta-analysis, randomised controlled clinical trial),and quasi-experimental design). English and Spanish language publication. A total of236 references were located. DATA EXTRACTION: Duplicated articles were removed. Titles, abstracts, and full text of references identified were assessed using the selection criteria; methodological quality assessment; data extraction, and qualitative analysis. RESULTS: Five articles, corresponding to 3 studies, were included, with 2 randomised controlled clinical trials and one quasi-experimental design. No significant results were observed in reducing mortality or improving health-related quality of life. The effectiveness of telemedicine on the number of hospital admissions or emergency visits showed contradictory results. Satisfaction was not measured in the studies included. CONCLUSIONS: The relatively small number of studies, heterogeneity characteristics, and methodological limitations did not confirm the effectiveness of telemedicine intervention on the improvement of mortality, number of hospital admissions, emergency department visits, and health-related quality of life, compared to usual care.

Impact of a soy drink on climacteric symptoms: an open-label, crossover, randomized clinical trial.

OBJECTIVES: The objective of this study is to evaluate the effects of a soy drink with a high concentration of isoflavones (ViveSoy®) on climacteric symptoms. METHODS: An open-label, controlled, crossover clinical trial was conducted in 147 peri- and postmenopausal women. Eligible women were recruited from 13 Spanish health centers and randomly assigned to one of the two sequence groups (control or ViveSoy®, 500 mL per day, 15 g of protein and 50 mg of isoflavones). Each intervention phase lasted for 12 weeks with a 6-week washout period. Changes on the Menopause Rating Scale and quality of life questionnaires, as well as lipid profile, cardiovascular risk and carbohydrate and bone metabolism were assessed. Statistical analysis was performed using a mixed-effects model. RESULTS: A sample of 147 female volunteers was recruited of which 90 were evaluable. In both sequence groups, adherence to the intervention was high. Regular consumption of ViveSoy® reduced climacteric symptoms by 20.4% (p = 0.001) and symptoms in the urogenital domain by 21.3% (p < 0.05). It also improved health-related quality life by 18.1%, as per the MRS questionnaire (p <0.05). CONCLUSION: Regular consumption of ViveSoy® improves both the somatic and urogenital domain symptoms of menopause, as well as health-related quality of life in peri- and postmenopausal women.

Cumplimiento de indicadores de proceso en personas con diabetes tipo 2 y la vinculación a incentivos en Atención Primaria / Compliance with process indicators in people with type 2 diabetes and linking incentives in Primary Care

OBJETIVO: Los programas de pago por desempeño para mejorar la calidad de la atención sanitaria se están extendiendo de forma progresiva, en particular para en Atención Primaria. Nuestro objetivo fue explorar la relación entre el grado de cumplimiento de los indicadores de proceso (IPr) de la diabetes mellitus tipo 2 (DM2) en Atención Primaria y la vinculación a incentivos económicos. DISEÑO: Estudio descriptivo observacional, descriptivo y transversal. Emplazamiento: Seis centros de salud del Distrito Aljarafe, Sevilla, seleccionados de forma aleatoria y estratificada por tamaño poblacional. PARTICIPANTES: De un total de 3.647 sujetos incluidos en el Proceso Asistencial Integrado de DM2 durante el 2008, se incluyó a 366 pacientes, según cálculo de tamaño muestral, mediante muestreo aleatorio estratificado. Mediciones: IPr: exploración de fondo de ojo y pies, hemoglobina glucosilada (HbA1c), perfil lipídico, microalbuminuria y electrocardiograma. Variables potencialmente confusoras: edad, género, característica de zona de residencia en pacientes y variables de los médicos. RESULTADOS: La edad media fue de 66,36 (desviación estándar -DE- 11,56 años); el 48,9% eran mujeres. Los IPr con mejor cumplimiento fueron la exploración de pies, HbA1c y perfil lipídico (59,6, 44,3 y 44, respectivamente). El 2,7% de los pacientes presentaban cumplimiento simultáneo de los 6 IPr y el 11,74% de los 3 IPr vinculados a incentivos. El cumplimiento de IPr vinculado y no a incentivos mostró asociación significativa (p = 0,001). CONCLUSIONES: El cumplimiento de los IPr para el cribado de complicaciones crónicas de la DM2 es en su mayoría bajo, aunque este fue superior en los indicadores vinculados a incentivos

OBJECTIVE: Pay-for-performance programs to improve the quality of health care are extending gradually, particularly en Primary Health Care. Our aim was to explore the relationship between the degree of compliance with the process indicators (PrI) of type 2 diabetes (T2DM) in Primary Care and linkage to incentives. DESIGN: Cross-sectional, descriptive, observational study. SETTING: Six Primary Health Care centers in Seville Aljarafe District randomly selected and stratified by population size. PARTICIPANTS: From 3.647 adults included in Integrated Healthcare Process of T2DM during 2008, 366 patients were included according sample size calculation by stratified random sampling. Measurements: PrI: eye and feet examination, glycated hemoglobin, lipid profile, microalbuminuria and electrocardiogram. Confounding: Age, gender, characteristics town for patients and professional variables. RESULTS: The mean age was 66.36 years (standard deviation [DE]: 11,56); 48.9% were women. PrI with better compliance were feet examination, glycated hemoglobin and lipid profile (59.6%, 44.3% and 44%, respectively). 2.7% of patients had simultaneous compliance of the six PrI and 11.74% of patients three PrI linkage to incentives. Statistical association was observed in the compliance of the PrI incentives linked or not (P = .001). CONCLUSIONS: The degree of compliance with the PrI for screening chronic complications of T2DM is mostly low but this was higher on indicators linked to incentives

[Compliance with process indicators in people with type 2 diabetes and linking incentives in Primary Care]. / Cumplimiento de indicadores de proceso en personas con diabetes tipo 2 y la vinculación a incentivos en Atención Primaria.

OBJECTIVE: Pay-for-performance programs to improve the quality of health care are extending gradually, particularly en Primary Health Care. Our aim was to explore the relationship between the degree of compliance with the process indicators (PrI) of type 2 diabetes (T2DM) in Primary Care and linkage to incentives. DESIGN: Cross-sectional, descriptive, observational study. SETTING: Six Primary Health Care centers in Seville Aljarafe District randomly selected and stratified by population size. PARTICIPANTS: From 3.647 adults included in Integrated Healthcare Process of T2DM during 2008, 366 patients were included according sample size calculation by stratified random sampling. MEASUREMENTS: PrI: eye and feet examination, glycated hemoglobin, lipid profile, microalbuminuria and electrocardiogram. Confounding: Age, gender, characteristics town for patients and professional variables. RESULTS: The mean age was 66.36 years (standard deviation [DE]: 11,56); 48.9% were women. PrI with better compliance were feet examination, glycated hemoglobin and lipid profile (59.6%, 44.3% and 44%, respectively). 2.7% of patients had simultaneous compliance of the six PrI and 11.74% of patients three PrI linkage to incentives. Statistical association was observed in the compliance of the PrI incentives linked or not (P=.001). CONCLUSIONS: The degree of compliance with the PrI for screening chronic complications of T2DM is mostly low but this was higher on indicators linked to incentives.

[Validation of a prognostic model for polypathological patients (PP) in Primary Health Care: "PROFUND STUDY-AP"]. / Validación de un modelo pronóstico para pacientes pluripatológicos en atención primaria: Estudio PROFUND en atención primaria.

AIMS: to validate the PROFUND index in PP in Primary Health Care (PHC). DESIGN: two-year prospective multicenter study. LOCATION: three health care centers in Seville Province (Spain). SUBJECTS OF THE ASSESSMENT: PP with signed informed consent. SAMPLE: n=446 (p=20%; α=5%; ß=99%); consecutive sampling. MEASUREMENT: Dependent variable: mortality (2 years). INDEPENDENT VARIABLES: socio-demography, clinic, anthropometric, laboratory, pharmacologic prescriptions, functional, cognitive and socio-familiar evaluation and the use of health resources. INFORMATION SOURCE: interview with patients and clinical charts. STATISTICAL ANALYSIS: uni and multivariate analysis according to the variables; Accuracy was assessed in the cohort by risk terciles calibration, and discrimination power, by ROC curves. Finally, accuracy of the index was compared with that of the Charlson index. RESULTS: 446 subjects were included (53.8% men); average age was 75.44yr (Confidence interval 95% 74.58-76.31). Average of diagnostic categories was 2.37 (Confidence interval 95% 2.30-2.44). Prevalent categories were: A (64.1%), F (41.7%) and E (33.5%). Mortality within 2 years was 24.1%. Calibration in predicted/observed mortality along the three established risk strata was 16%/16.7% for PP with 0-2 points, 22%/19.5% for PP with 3-6, and 34%/36% for PP with 7 or more points (Hosmer-Lemeshow test with p=0.119). Discrimination power of PHC PROFUND's by area under the curve was (AUC) ROC was 0.622 (Confidence interval 95% 0.556-0.689; p<0.001), and that of Charlson index 0.510 (Confidence interval 95% 0.446 - 0.575; p>0.005). CONCLUSIONS: The PROFUND index is a good indicative tool in the stratification of 2-year mortality risk polypathological patients in PHC.

Validación de un modelo pronóstico para pacientes pluripatológicos en atención primaria: Estudio PROFUND en atención primaria / Validation of a prognostic model for polypathological patients (PP) in Primary Health Care: "PROFUND STUDY-AP"

OBJETIVO: Validar el índice PROFUND, en pacientes pluripatológicos (PP) en atención primaria. DISEÑO: Estudio longitudinal prospectivo multicéntrico, seguimiento 2 años. Emplazamiento: Tres centros de salud de la provincia de Sevilla .Sujetos: Adultos pluripatológicos, con consentimiento a participar; muestreo consecutivo. Mediciones: Variable dependiente: mortalidad (2 años). Variables independientes: sociodemográficas, clínicas, antropométricas, analíticas, prescripción farmacológica, valoración funcional, cognitiva, sociofamiliar y uso de recursos sanitarios. Fuente: entrevista presencial e historia clínica. Análisis estadístico univariado y multivariado según variables. La validación fue desarrollada mediante calibración por terciles de riesgo y análisis del poder discriminativo según curvas ROC. Finalmente la precisión del índice fue comparada con el índice de Charlson. RESULTADOS: se incluyeron 446 sujetos (53,8% hombres); edad media 75,44 (IC 95% 74,58-76,31). Media de categorías diagnósticas 2,37 (IC 95% 2,30-2,44). Categorías más prevalentes: A (64,1%), F (41,7%) y E (33,5%). Mortalidad (2 años) fue 24,1%. La mortalidad pronosticada/observada en los tres estratos de riesgo establecidos fue del 16%/16.7% para los PP con 0-2 puntos, 22%/19.5% para los PP con 3-6, y 34%/36% para los PP con 7 o más puntos (bondad de ajuste de Hosmer-Lemeshow con p = 0,119). El poder de discriminación del PROFUND en AP obtuvo un área bajo la curva ROC de 0,622 (IC 95% 0,556-0,689; p < 0,001), y el índice de Charlson 0,510 (IC 0,446-0,575; p > 0,05). CONCLUSIONES: el índice PROFUND mantiene una buena calibración reagrupado a tres estratos de riesgo, así como una buena precisión en el pronóstico a los dos años para poblaciones de pacientes pluripatológicos de atención primaria

AIMS: to validate the PROFUND index in PP in Primary Health Care (PHC).DESIGN: two-year prospective multicenter study. Location: three health care centers in Seville Province (Spain).Subjects of the assessment: PP with signed informed consent. Sample: n = 446 (p = 20%; a = 5%; b = 99%); consecutive sampling. Measurement: Dependent variable: mortality (2 years). Independent variables: socio-demography, clinic, anthropometric, laboratory, pharmacologic prescriptions, functional, cognitive and socio-familiar evaluation and the use of health resources. Information source: interview with patients and clinical charts. Statistical Analysis: uni and multivariate analysis according to the variables; Accuracy was assessed in the cohort by risk terciles calibration, and discrimination power, by ROC curves. Finally, accuracy of the index was compared with that of the Charlson index. RESULTS: 446 subjects were included (53.8% men); average age was 75.44 yr (Confidence interval95% 74.58-76.31). Average of diagnostic categories was 2.37 (Confidence interval 95% 2.30-2.44). Prevalent categories were: A (64.1%), F (41.7%) and E (33.5%). Mortality within 2 years was 24.1%.Calibration in predicted/observed mortality along the three established risk strata was 16%/16.7% for PP with 0-2 points, 22%/19.5% for PP with 3-6, and 34%/36% for PP with 7 or more points (Hosmer-Leme show test with p = 0.119). Discrimination power of PHC PROFUND's by areaunder the curve was (AUC) ROC was 0.622 (Confidence interval 95% 0.556-0.689; p < 0.001), and that of Charlson index 0.510 (Confidence interval 95% 0.446 - 0.575; p > 0.005). CONCLUSIONS: The PROFUND index is a good indicative tool in the stratification of 2-year mortality risk polypathological patients in PHC

Compliance with quality prescribing indicators in terms of their relationship to financial incentives.

OBJECTIVE: To develop quality prescribing indicators for general practitioners (GPs) who are non-monitored and not included in pay-for-performance programs, and to determine compliance with incentivized and non-incentivized indicators. STUDY DESIGN: Descriptive cross sectional study. SETTING: Aljarafe Primary Health Care Area (Andalusian Public Health Care Service, Spain), a rural and suburban area with a population of 323,857 inhabitants. Health assistance in this area is provided by 176 GPs in 37 health centers. Prescribing indicators were developed by a multidisciplinary group using a qualitative technique based on consensus. The members of the consensus group searched for updated recommendations focused on clinical evidence. Prescribing data were obtained from the computerised pharmacy records of reimbursed drugs and clinical data from the electronic clinical databases and hospital admission records. RESULTS: Fourteen indicators based on the selection of drugs of different therapeutic groups or linked to patient´s clinical information were designed. The compliance with indicators based on the selection of drugs linked to financial incentives was higher than that of indicators not linked to financial incentives. The compliance with indicators based on clinical information varied widely. Inappropriate prescribing ranged from 7 %, in the use of long-acting beta-agonists in asthma, to 86 % in the use of drugs for the prevention of osteoporotic fractures in young women. CONCLUSIONS: This study shows better compliance by GPs with indirect and incentivized quality prescribing indicators, included in pay-for-performance programs, compared with not-incentivized indicators based on the relative use of drugs and on the appropriateness prescribing.

[Predictive value of metabolic syndrome in pregnancy for the development of diabetes mellitus and factors of short-term vascular risk for mother and child after birth (gestaMET)]. / Valor predictivo del síndrome metabólico en la gestación para el desarrollo de diabetes mellitus.

OBJECTIVES: To evaluate the presence of diabetes mellitus (DM) or short-term alterations in glucose metabolism, obesity and vascular risk factors after birth in women with pregnancy metabolic syndrome (PMS). To evaluate the incidence of obesity, lipaemia, glucaemia disorder, blood pressure (BP), or lipid figures in the period after birth in children of women with PMS. DESIGN. Cohort study. SETTING. Forty two primary care centres. PARTICIPANTS: Study cohort (SC): women with PMS and their children. Control cohort (CC): women without primary criteria of PMS and their children. SAMPLE SIZE: SC, 980 women and CC, also 980. Consecutive sampling. MEASUREMENTS: Mother: basic data, 75 g oral overload, lipid profile, insulinaemia, toxic habits, nutrition survey, and physical activity. Child: weight, height, BP, nutrition survey, glucaemia, insulinaemia, and lipid profile. Father: basic data, BP, glucaemia, lipid profile, insulinaemia, toxic habits, nutrition survey, and physical activity. We will study genes related to insulin resistance in all subjects. STATISTICAL ANALYSIS: Comparison of proportions with *2 test; ANOVA to measure means. Evaluation of effect of intra-uteral exposure through logistical regression and COX regression, whilst controlling potentially confusing and interactive variables. DISCUSSION: This study will contribute to locating the moment when diabetes and vascular risk start and to finding the optimum moment for starting prevention strategies.

Valor predictivo del síndrome metabólico en la gestación para el desarrollo de diabetes mellitus / Predictive value of metabolic syndrome in pregnancy for the development of diabetes mellitus and factors of short-term vascular risk for mother and child after birth (gestaMET)

Objetivos. Evaluar la presencia de diabetes mellitus (DM) o alteraciones en el metabolismo de la glucosa, la presencia de obesidad y los factores de riesgo vascular a corto plazo tras el parto en mujeres con síndrome metabólico gestacional (SMG). Evaluar la incidencia de obesidad, dislipidemia, alteraciones en las cifras de glucemia, presión arterial (PA) o lípidos, a corto plazo tras el parto, en los hijos de mujeres con SMG. Diseño. Estudio de cohortes. Emplazamiento. En total, 42 centros de atención primaria. Participantes. Cohorte de estudio (CE): mujeres con SMG y sus hijos. Cohorte control (CC): mujeres sin criterios primarios de SMG y sus hijos. Tamaño muestral: CE: 980 mujeres y CC: 980 mujeres. Muestreo consecutivo. Mediciones. Madre: antropometría, sobrecarga oral de 75 g, perfil lipídico, insulinemia, PA, hábitos tóxicos, encuesta nutricional y actividad física. Niño: peso, talla, PA, encuesta nutricional, determinaciones de glucemia, insulinemia y perfil lipídico. Padre: antropometría, PA, glucemia, perfil lipídico, insulinemia, hábitos tóxicos, encuesta nutricional y actividad física. Estudiaremos genes relacionados con la resistencia insulínica en todos los sujetos. Análisis estadístico. Comparación de proporciones mediante el test de la *2, diferencias de medias mediante el ANOVA. Evaluación del efecto de la exposición intraútero mediante análisis de regresión logística y de regresión de COX, controlando las potenciales variables de confusión y de interacción. Discusión. Con este estudio podremos contribuir al conocimiento sobre el momento de inicio de la diabetes y el riesgo vascular, y sobre el momento óptimo de iniciar estrategias de prevención

Objectives. To evaluate the presence of diabetes mellitus (DM) or short-term alterations in glucose metabolism, obesity and vascular risk factors after birth in women with pregnancy metabolic syndrome (PMS). To evaluate the incidence of obesity, lipaemia, glucaemia disorder, blood pressure (BP), or lipid figures in the period after birth in children of women with PMS. Design. Cohort study. Setting. Forty two primary care centres. Participants. Study cohort (SC): women with PMS and their children. Control cohort (CC): women without primary criteria of PMS and their children. Sample size: SC, 980 women and CC, also 980. Consecutive sampling. Measurements. Mother: basic data, 75 g oral overload, lipid profile, insulinaemia, toxic habits, nutrition survey, and physical activity. Child: weight, height, BP, nutrition survey, glucaemia, insulinaemia, and lipid profile. Father: basic data, BP, glucaemia, lipid profile, insulinaemia, toxic habits, nutrition survey, and physical activity. We will study genes related to insulin resistance in all subjects. Statistical analysis. Comparison of proportions with *2 test; ANOVA to measure means. Evaluation of effect of intra-uteral exposure through logistical regression and COX regression, whilst controlling potentially confusing and interactive variables. Discussion. This study will contribute to locating the moment when diabetes and vascular risk start and to finding the optimum moment for starting prevention strategies

[Usefulness of the third-hour plasma glucose measurement of the oral glucose tolerance test for the diagnosis of gestational diabetes mellitus]. / Utilidad de la determinación de la glucemia a la tercera hora de la sobrecarga oral de glucosa para el diagnóstico de diabetes gestacional.

OBJECTIVES: To value the utility of the third-hour plasma glucose measurement of the oral glucose tolerance test (OGTT) for diagnosis of gestational diabetes mellitus (GDM). To analyse the relation of rate insulin therapy, type of delivery and morbidity and mortality perinatal with the third-hour plasma glucose measurement or not for diagnosis of GDM. METHODS: Historic cohort study. SUBJECTS: Women diagnosed of GDM from 1993 to March of 2002 in Pregnancy Consultation in periurban Primary Care Center in Camas (Seville, Spain) by consecutive sampling design (n=112). INTERVENTION: To apply the screening and diagnosis criteria from Third International Conference of GDM. To value obstetric outcome history, anthropometric parameter before, treatment and delivery type and perinatal complications. Statistic analysis: A chi2 test, with Fisher's correction was used. RESULTS: A 63% of women were diagnosed of GDM with normal third-hour plasma glucose measurement (Group 1). In 21.4% this value was increase (> 145 mg/dL) but it was not necessary to diagnosis (Group 2). In 15.1%, the third-hour plasma glucose measurement was essential to diagnose GDM (Group 3). Insulin therapy was recommended in 17% (Group 3) and 5% (Group 1 and 2). There are not significant difference between groups about perinatal complications and cesarean delivery incidence. DISCUSSION: We suggest it is not recommended the omission of the third-hour plasma glucose measurement of OGTT because a 15.1% were undiagnosed and would be a substantial decrease in sensitivity. In addition, that group was higher rate insulin therapy.