Vitamin D Deficiency and Gestational Diabetes Mellitus in Relation to Body Mass Index.

A relationship between vitamin D deficiency (VDD) and gestational diabetes mellitus (GDM) has been described. Considering that GDM prevalence depends on body mass index (BMI), our main objective was to determine if VDD is associated with GDM, independent of BMI. A cross-sectional study with 886 pregnant women was conducted in Elda (Spain) from September 2019 to June 2020. To assess the association, Poisson regression models with robust variance were used to estimate the prevalence ratio (PR). The observed GDM prevalence was 10.5%, while the VDD prevalence was 55.5%. In the crude model, both VDD and obesity were associated with GDM, but in the adjusted model, only VDD was statistically significant (PR = 1.635, p = 0.038). A secondary event analysis did not detect differences in VDD, but BMI yielded a higher frequency of births by cesarean section and newborns with a >90 percentile weight in the obesity group. In conclusion, VDD is associated with GDM, independent of BMI. Future longitudinal studies could provide information on causality.

Construction, internal validation and implementation in a mobile application of a scoring system to predict nonadherence to proton pump inhibitors.

BACKGROUND: Other studies have assessed nonadherence to proton pump inhibitors (PPIs), but none has developed a screening test for its detection. OBJECTIVES: To construct and internally validate a predictive model for nonadherence to PPIs. METHODS: This prospective observational study with a one-month follow-up was carried out in 2013 in Spain, and included 302 patients with a prescription for PPIs. The primary variable was nonadherence to PPIs (pill count). Secondary variables were gender, age, antidepressants, type of PPI, non-guideline-recommended prescription (NGRP) of PPIs, and total number of drugs. With the secondary variables, a binary logistic regression model to predict nonadherence was constructed and adapted to a points system. The ROC curve, with its area (AUC), was calculated and the optimal cut-off point was established. The points system was internally validated through 1,000 bootstrap samples and implemented in a mobile application (Android). RESULTS: The points system had three prognostic variables: total number of drugs, NGRP of PPIs, and antidepressants. The AUC was 0.87 (95% CI [0.83-0.91], p < 0.001). The test yielded a sensitivity of 0.80 (95% CI [0.70-0.87]) and a specificity of 0.82 (95% CI [0.76-0.87]). The three parameters were very similar in the bootstrap validation. CONCLUSIONS: A points system to predict nonadherence to PPIs has been constructed, internally validated and implemented in a mobile application. Provided similar results are obtained in external validation studies, we will have a screening tool to detect nonadherence to PPIs.

Non-guideline-recommended prescribing of proton pump inhibitors in the general population.

OBJECTIVES: To determine the magnitude of non-guideline-recommended prescribing (NGRP) of proton pump inhibitors (PPIs) in the general population, its associated factors and expense. METHODS: We undertook a cross-sectional observational study in three community pharmacies in a Spanish region in 2013 involving a total of 302 patients with a prescription for PPIs. The main variable was the NGRP of PPIs. Secondary variables were: gender, age, antidepressants, osteoporosis, osteoarthritis, prescription cost per month and total number of chronic diseases. The cost associated with NGRP was calculated. To evaluate the associated factors, a multivariate binary logistic regression model was constructed and the adjusted odds ratios (OR) were obtained. RESULTS: NGRP was observed in 192 cases (63.6%). The average cost associated with NGRP per prescription was 3.24 euros per month. The factors significantly associated with NGRP (p < .05) were: antidepressants (OR = 2.66, p = .001), osteoporosis (OR = 3.53, p = .001), osteoarthritis (OR = 3.57, p < .001) and number of chronic diseases (OR = 0.73, p = .003). CONCLUSION: A novel approach was used to quantify the NGRP of PPIs in a Spanish community, as well as the associated economic costs. Qualitative studies are needed to better understand the causes of NGRP of PPIs. This analysis will aid in designing interventions to minimize this problem. LIMITATIONS: Qualitative studies are needed to better understand the attitude of health professionals when prescribing PPIs.

Estrategias para mejorar el cumplimiento en la práctica clínica diaria / Strategies to improve adherence in daily clinical practice

Si acude a la consulta un diabético mal controlado antes de modificar el tratamiento para conseguir los objetivos adecuados hay que evaluar el cumplimiento de los regímenes prescritos. La mejor estrategia sería preguntar integrando la pregunta del cumplimiento autocomunicado de Hayness-Sackett en la entrevista con el paciente, potenciando la comunicación eficaz, la empatía, la motivación y la toma de decisiones compartidas. Las estrategias para mejorar el cumplimiento en estos pacientes tienen que ser mixtas (ofrecer conocimiento, más técnicas que modifiquen conductas de incumplimiento) e individualizadas. Para ello, una vez que los profesionales sanitarios identifican incumplimiento tienen que valorar los motivos, las formas de incumplir y los factores que influyen en esta falta de adherencia. A continuación se selecciona una intervención mixta adaptada a la situación de cada paciente. No hay que olvidar que los pacientes diabéticos tipo 2 presentan habitualmente cierta complejidad terapéutica al coexistir otros factores de riesgo cardiovascular que, en cierto grado, pueden dificultar su cumplimiento; de ahí, la importancia de integrar protocolos de mejora de cumplimiento en la práctica clínica diaria de estos pacientes. En este trabajo se analizan dichas estrategias (AU)

When patients with poor diabetic control seek medical attention, adherence to the prescribed regimens must be evaluated before treatment is changed to achieve appropriate targets. The best strategy is probably to elicit self-reported adherence using the Haynes-Sackett method in the patient interview, emphasizing effective communication, empathy, motivation and shared decision making. Strategies to improve adherence in these patients should be mixed (provide knowledge and more techniques that modify non-adherent behaviors) and individually tailored. Consequently, when lack of adherence is detected, health professionals should evaluate the reasons, the forms of non-adherence, and the factors influencing this behavior. A mixed intervention, individually adapted to each patient, should then be selected. The treatment of patients with diabetes mellitus type 2 is usually somewhat complex, since their disease coexists with other cardiovascular risk factors, which may hamper their adherence to some extent - hence the importance of integrating protocols to improve adherence in daily clinical practice. The present article analyzes strategies to achieve this aim (AU)