Abordaje de factores de riesgo de diabetes tipo 2 en adolescentes: estudio PRE-STARt Euskadi / Tackling risk factors for type 2 diabetes in adolescents: PRE-STARt study in Euskadi

Introducción: La obesidad en la población pediátrica y su efecto en la génesis de las enfermedades metabólicas constituye un gran problema de salud pública. Uno de los objetivos del estudio de ámbito europeo PRE-STARt en Euskadi es evaluar la efectividad de un programa de promoción de la salud, dirigido a adolescentes con factores de riesgo asociados al desarrollo de diabetes mellitus tipo 2 (DMT2).Pacientes y métodos: Ensayo clínico con doble grupo aleatorizado de adolescentes de 12 a 14 años con exceso ponderal. El grupo intervención recibió un programa multidisciplinar durante 24 meses, de 11 sesiones grupales (ocho al inicio, tres de refuerzo) junto con sus tutores. El grupo control continuó el seguimiento habitual por los equipos de pediatría de Atención Primaria. Se plantean modelos longitudinales para estudiar la evolución de medidas antropométricas y hábitos de vida desde el momento basal, a los 3, 6, 12 y 24 meses.Resultados: Participaron 92 personas en el estudio, igualmente distribuidas por grupo. Se observaron mejoras estadísticamente significativas en varios resultados: evolución del índice de masa corporal; aumento del consumo de frutas y verduras; disminución del consumo de snacks y de bebidas azucaradas; y aumento del número de días por semana en los que realizan más de una hora de ejercicio físico.Conclusiones: Los resultados confirman la efectividad del programa multidisciplinar, tanto en la evolución del índice de masa corporal como en la mejora de los hábitos alimentarios y de actividad física, todos ellos factores de riesgo en la génesis de enfermedades metabólicas futuras, como la DMT2. (AU)

Introduction: Obesity in the child population and its effect in the development of metabolic diseases are a public health issue. One of the aims of the European Project PRE-STARt in Euskadi, is the evaluation of the effectiveness of a multidisciplinary health promotion program directed at adolescents with risk factors associated with the development of type 2 Diabetes Mellitus (T2DM).Patients and methods: Randomised clinical trial with two groups of 12-14 year-old overweight adolescents. The intervention group took part in a multidisciplinary program for 24 months. This program was based on 11 group sessions (8 main sessions and 3 additional support ones) for adolescents and their guardians. The control group received usual care at primary care level. Longitudinal regression models were adjusted to assess the evolution of anthropometric measures and living habits at baseline, 3, 6, 12, and 24 months in both groups.Results: There were 92 participants, equally distributed by group. Statistically significant differences were observed between intervention and control groups in several results: evolution of the body mass index; increase in the consumption of fruits and vegetables; decrease in the consumption of snacks and sweetened drinks; and increase in the number of days per week with more than one hour of physical activity.Conclusions:The results confirm the effectiveness of this multidisciplinary program, both in the evolution of the body mass index, and in the improvement of the eating and physical activity habits, all of them risk factors for the future development of metabolic diseases, such as T2DM. (AU)

Tackling risk factors for type 2 diabetes in adolescents: PRE-STARt study in Euskadi.

INTRODUCTION: Obesity in the child population and its effect in the development of metabolic diseases are a public health issue. One of the aims of the European Project in a health system, is the evaluation of the effectiveness of a multidisciplinary health promotion program directed at adolescents with risk factors associated with the development of type 2 Diabetes Mellitus (T2DM). PATIENTS AND METHODS: Randomised clinical trial with two groups of 12-14 year-old overweight adolescents. The intervention group took part in a multidisciplinary program for 24 months. This program was based on 11 group sessions (8 main sessions and 3 additional support ones) for adolescents and their guardians. The control group received usual care at primary care level. Longitudinal regression models were adjusted to assess the evolution of anthropometric measures and living habits at baseline, 3, 6, 12, and 24 months in both groups. RESULTS: There were 92 participants, equally distributed by group. Statistically significant differences were observed between intervention and control groups in several results: evolution of the body mass index; increase in the consumption of fruits and vegetables; decrease in the consumption of snacks and sweetened drinks; and increase in the number of days per week with more than one hour of physical activity. CONCLUSIONS: The results confirm the effectiveness of this multidisciplinary program, both in the evolution of the body mass index, and in the improvement of the eating and physical activity habits, all of them risk factors for the future development of metabolic diseases, such as T2DM.

Factors that Influence Treatment Delay for Patients with Breast Cancer.

INTRODUCTION: The diagnosis or treatment of breast cancer is sometimes delayed. A lengthy delay may have a negative psychological impact on patients. The aim of our study was to evaluate the sociodemographic, clinical and pathological factors associated with delay in the provision of surgical treatment for localised breast cancer, in a prospective cohort of patients. METHODS: This observational, prospective, multicentre study was conducted in ten hospitals belonging to the Spanish national public health system, located in four Autonomous Communities (regions). The study included 1236 patients, diagnosed through a screening programme or found to be symptomatic, between April 2013 and May 2015. The study variables analysed included each patient's personal history, care situation, tumour history and data on the surgical intervention, pathological anatomy, hospital admission and follow-up. Treatment delay was defined as more than 30 days elapsed between biopsy and surgery. RESULTS: Over half of the study population experienced surgical treatment delay. This delay was greater for patients with no formal education and among widows, persons not requiring assistance for usual activities, those experiencing anxiety or depression, those who had a high BMI or an above-average number of comorbidities, those who were symptomatic, who did not receive NMR spectroscopy, who presented a histology other than infiltrating ductal carcinoma or who had poorly differentiated carcinomas. CONCLUSIONS: Certain sociodemographic and clinical variables are associated with surgical treatment delay. This study identifies factors that influence surgical delays, highlighting the importance of preventing these factors and of raising awareness among the population at risk and among health personnel.

Gender differences in stage at diagnosis and preoperative radiotherapy in patients with rectal cancer.

BACKGROUND: Few studies have examined gender differences in the clinical management of rectal cancer. We examine differences in stage at diagnosis and preoperative radiotherapy in rectal cancer patients. METHODS: A prospective cohort study was conducted in 22 hospitals in Spain including 770 patients undergoing surgery for rectal cancer. Study outcomes were disseminated disease at diagnosis and receiving preoperative radiotherapy. Age, comorbidity, referral from a screening program, diagnostic delay, distance from the anal verge, and tumor depth were considered as factors that might explain gender differences in these outcomes. RESULTS: Women were more likely to be diagnosed with disseminated disease among those referred from screening (odds ratio, confidence interval 95% (OR, CI = 7.2, 0.9-55.8) and among those with a diagnostic delay greater than 3 months (OR, CI = 5.1, 1.2-21.6). Women were less likely to receive preoperative radiotherapy if they were younger than 65 years of age (OR, CI = 0.6, 0.3-1.0) and if their tumors were cT3 or cT4 (OR, CI = 0.5, 0.4-0.7). CONCLUSIONS: The gender-specific sensitivity of rectal cancer screening tests, gender differences in referrals and clinical reasons for not prescribing preoperative radiotherapy in women should be further examined. If these gender differences are not clinically justifiable, their elimination might enhance survival.