Determinants of condom use among intravenous drug users in Spain

Attitudes to and perception of health care delivery are consideredto be important factors for patient compliance in diabetes.To Investigate insulin-treated diabetic patients' use of, experienceof and attitudes to diabetes care a questionnaire was sent to561 patients, 20–50 years old, living in northern Sweden.Four hundred and eighty-eight patients (87%) participated inthe study. Data were analysed against social, medical and geographicalbackground factors. Female patients more often than men hadseen an ophthalmologist (93 versus 87%, p<0.05), a diabetesnurse specialist (74 versus 64%, p<0.05) and a chiropodist(49 versus 30%, p<0.001) at least once during the courseof their diabetes. Women also used the services of a medicalsocial worker (17 versus 10%, p-0.05) or a psychologist (14versus 8%, p<0.01) more often. More men than women were satisfiedwith the health care they had at the onset (65 versus 38%, p<0.001),but no gender difference in attitude to their present care wasfound. Diabetic patients with chronic complications comparedto those without were less satisfied both with the care theyreceived at the onset of diabetes (40 versus 61%, p<0.001)and at the time they answered the questionnaire (59 versus 72%,p<0.01). Patients in the most sparsely populated health districtwere more seldom able to be seen by the same physician (70 versus93% and 94%, p<0.001) and patient-physician continuity waspoorer over a 3 year period (48 versus 80%, p<0.001). Basedon results of this study, we conclude that use of, experienceof and attitudes to diabetes care are primarily related to genderand sickness factors. Living in sparsely populated areas probablyaffects the use and continuity of hearth care depending on themeans available. The differences demonstrated might be an argumentfor planning more individualized care for diabetic patientsin the future.     

Disease-related distress among insulin-treated diabetic patients: Associations with health status, psychosocial factors and self-care practices

Background: Diabetes is a chronic illness that affects manydomains of life. This cross-sectional study examined disease-relateddistress and its associations with health and psychosocial factorsamong insulin-treated diabetic persons. Method: The sample (n=423)was drawn from the Social Insurance Institution's drug registry.Health indicators were duration of diabetes, complications,and glycaemlc control. Psychosocial measures included generaland diabetes-specific social support, diabetes locus of control(DLC), self-efficacy, diabetes health beliefs and self-carepractices and subjective health. Results: Most respondents reportedmoderate diabetes-related distress. In multi-variate analysis,severe diabetes distress was related to lower net benefits ofregimen (ß = –0.29, and p<0.001), poorerperceived health (ß = –0.25, and p<0.001),higher perceived threat of complications (ß = 0.19,and p<0.001), less adequate social support (ß =–0.16, and p<0.01), stronger beliefs in chance (ß= 0.15, and p<0.01) and internal DLC (ß = 0.11,and p<0.05) and more frequent exercising (ß = 0.10,and p<0.05). Conclusions: The results suggest that emotionaladjustment to diabetes is predominantly determined by diabetes-relatedcognitions and subjective health and to a lesser degree by objectivediabetes indlcators, which underlines the Importance of assistingthe patient with adjustment with the disease in health carecentres.     

Continuous quality improvement in primary health care: A five year project

Background: The aim of the study was to determine the feasibilityof a programme of continuous quality improvement (CQI) in threeprimary care teams (PCTs) and to test the effectiveness of correspondenceanalysis (CA) in identifying factors contributing to qualityperformance. Methods: A CQI task force was responsible for coordinatingall aspects of the programme. Six domains of performance weredefined, each having one or more indicators. The statisticalanalysis included comparison of proportions and, in addition,CA was used to further identify which factors were contributingto a performance below the standard. Results: In the domainof infant care, two of the three PCTs reached the 100% goalon immunisation coverage. The third PCT did not attain the standard(85%). However, through CA it was possible to identify the subpopulationat risk. The proportion of pregnant women accessing pre-natalcare during the first trimester increased from the initial 20to 66% (p<0.001). Physicians' compllance with pre-natal careprotocol increased from 70 to 93% (p<0.05). Performance relatedto recording of home health care visits in medical historiesdid not improve at all, nor did the providers reach the standardfor continuing education. The medical records Information improvedfor alcohol and tobacco consumption, allergies (p<0.05),and blood pressure (p<0.05). The patients' satisfaction wasgreater with doctors than nurses. Conclusions: This experienceindicates the feasibllity and benefits of a comprehensive CQIprogramme at the primary care level. CA is considered a usefulstatistical method for locating factors contributing to qualityperformance.     

Differences in parental vaccine confidence and attitudes by health system in Guatemala and their impact on immunization timeliness

ObjectiveThe objectives of this study were to evaluate parental confidence and attitudes towards immunization in urban Guatemala between private versus public health systems and their impact on vaccination timeliness in their children.MethodsA cross-sectional survey was conducted in parents 6–18-month-old children who attended well-child outpatient clinics from two health systems (public employee-based insurance and private health care) in Guatemala City from November 2017 through August 2018. Parental demographics, household characteristics, food insecurity, vaccine hesitancy using the WHO SAGE Vaccine Hesitancy Scale, and information on parental use of social media platforms and vaccine information sources were collected.ResultsFive hundred-three parents were surveyed, most of them mothers. Only 9 parents reported they had previously refused a vaccine for their child: 8 (3.2 %) from private clinics and 1 (0.4 %) from the public clinic (p = 0.02). Significantly more children attending private clinics (226, 90.4 %) were shown to have a delay in any of their vaccines scheduled for the first 2 years of life compared to those in the public clinic (169, 66.8 %; p < 0.01). Children of parents having a college degree (84.5 vs 70.1 %; p < 0.001), earning more than US$ 1,000 per month (81.5 vs 70.7 %; p < 0.001), and having a computer at home (81.4 vs 70.2; p = 0.007) were more likely to have any delays in the scheduled vaccines. Parents seeking care at private clinics were 1.14 times more at risk of delaying a vaccine compared to those at the public clinic, adjusted for other covariates (p = 0.03, 95 % CI: 1.01, 1.28).ConclusionsIn Guatemala, children receiving immunizations at private clinics were significantly more likely than those attending public clinics to be delayed in their immunization schedule and to remain more days without the recommended protection, especially for third doses of the primary vaccine series.     

Realized Access to Physician Services Among the Elderly in West Texas

The purpose of this study is to identify populations in a sparsely populated region that are less likely to obtain medical care. We conducted a cross-sectional survey of more than 5,000 elderly persons who participated in telephone interviews after being identified through more than 65,000 calls to residential listings. Subjects were persons aged 65 years and older who resided in 108 counties in western Texas. The response rate was 72%. The probability of seeing a physician in the last 6 months for urban and rural residents was modeled using multiple logistic regression analysis. Among rural residents, characteristics that were significantly (p < 0.05) associated with not recently visiting a physician when health status is held constant included belief in home remedies, having less than a high school education, lack of health insurance, and low income. Among urban residents, Hispanic ethnicity and skepticism about medical care were negatively associated with having a recent visit, whereas being religious was positively associated. Despite the availability of Medicare coverage, several subgroups of the elderly population have impaired access to medical care in this sparsely populated region. Intensified outreach efforts are indicated.     

Patient willingness to pay for preventive measures in primary care: a study of five GPs in a German community

Summary Objectives:To explore the willingness of patients in a usual primary care setting to pay out-of-pocket fees for their own health promotion, in correlation with risk factors and net income, and compared to patients of an educational programme.Methods:A standardised health survey carried out in five general practices (GPs) of a small community with a special GP-based health education programme was combined with a questionnaire to explore the special attitudes of patients from a practice sample (n=973) and from educational courses (n=202): covering, in addition to cardiovascular risk factors, the sociodemographic factors, net income, and out-of-pocket fees that could be spent for own health promotion.Results:After attending an educational programme, the patients willingness to spend 15–40 €/month for their own health promotion was high but there was no correlation with the income (p<0.56), in contradiction to the patients of the practice sample who would pay more money the more they earn (p<0.001). High levels of cardiovascular risk were associated with low education (p<0.001), but net income and willingness to pay for preventive measures did not significantly correlate with cardiovascular risk factors.Conclusions:Participants of educational courses are willing to pay a rational out-of-pocket fee for preventive measures without correlation with their incomes, thus reducing the social gradient; future preventive measures should take into account that reasonable cost sharing is well accepted by well-informed patients.     

Self-selection of enrollers at the creation of a managed care organization

Factors affecting choice between a managed care organization(MCO) and a fee-for-service insurance plan were examined whenthe University of Geneva health insurance plan was transformedinto an MCO, in October 1992. A case-control study using a mailedquestionnaire (response rate 84%) was conducted to compare formermembers who joined the MCO (joiners, n=421) to former memberswho opted out in order to keep fee-for-service coverage (non-joiners,n=222). Non-joiners were more likely to be women (odds ratio(OR) from multivariate model was 1.15, p=0.50), to be born inSwitzerland (OR=2.04, p<0.01), to have an annual income >75,000Swiss francs (OR=2.00, p<0.01), to have a personal physician(OR=1.96, p<0.01) and to have consulted a specialist (OR=1.69,p=0.02) or used unconventional medicine (OR=4.59, p<0.01)in the past year. During the previous year, non-joiners hadmore health care visits than joiners (14.6 versus 9.1, p=0.01).Non-joiners reported better mental health and fewer complainedof persistent fatigue (OR=2.18, p=0.03). The choice of healthplan was strongly influenced by socio-demographic characteristics,past patterns of health services utilization and health status.The self-selection process was paradoxical: MCO joiners hadused fewer health care visits than non-joiners, but their self-reportedhealth status was worse. The differences we have observed betweenself-selected populations have important implications for thefinancial performance of competing health care delivery systems.     

Nurses’ knowledge and attitudes regarding nutrition in the elderly

Background-aims  Nurses in the community are in contact with the elderly at different levels of care. The aim of this study was to assess nurses’ knowledge and attitudes regarding nutritional-care for the elderly, and the impact of their attitude on the quality of assessment-care they provide to this growing population in need of nutritional-care. Methods  A structured questionnaire was distributed by mail to 600 nurses working in Maccabi-Health-Care-Services (MHS). The questionnaire assessed different aspects of elderly nutrition. Results  The vast majority (91%) of the participants reported treating elderly in their practice. Religious nurses and the nurses with an individual orientation specialty reported more positive attitudes about nutritional-care for the elderly than others did (p=0.05). Nurses with a bachelor’s degree had better attitudes than registered nurses about the importance of nutrition for the elderly (p< 0.01). Younger nurses were found to be more knowledgeable than older ones (p< 0.04). The nurses perceived nutrition as influencing different health conditions, and 85% pointed to the importance of feeding at the end of life. Conclusions  Nurses working in the community recognize the impact of proper nutrition on elderly patients’ health, but need more training in screening for nutritional problems in the elderly.     

UK GPs' and practice nurses' views of continuity of care for patients with type 2 diabetes

BACKGROUND: Continuity of care is widely regarded as a core value of primary care. Type 2 diabetes is a common chronic disease with major health, social and economic impacts. Primary health care professionals in many countries are involved in the management of patients with type 2 diabetes, but their perspectives on continuity remain neglected in research. OBJECTIVE: To explore UK GPs' and nurses' experiences of continuity of care for patients with type 2 diabetes in primary care settings. METHODS: Semi-structured individual interviews were conducted with 16 GPs and 18 practice nurses who manage patients with type 2 diabetes recruited from 20 practices with various organizational structures in Leeds, UK. RESULTS: Three types of continuities were identified: relational continuity from the same health care professional, team continuity from a group of health care professionals and cross-boundary continuity across primary-secondary care settings. Relational continuity was influenced by the quality of the patient-health care professional relationship, policy of the National Health Service (NHS) in the UK (new General Medical Services contract), walk-in centres, the behaviour of receptionists and the structure and systems of the practice. Team and cross-boundary continuities were influenced by the relationship between team members and by effective communication. Relational continuity contributed to more 'personal care', but the usual health care professional might know less about diabetes. Team continuity was important in providing 'physical care', but patients could be confused by conflicting advice from different professionals. Cross-boundary continuity helps to provide 'expert advice', but is dependent upon effective communication. CONCLUSION: GPs and practice nurses dealing with patients with type 2 diabetes identified three types of continuities, each influenced by several factors. Relational continuity deals better with psychosocial care while team continuity promotes better physical care; therefore, imposing one type of continuity may inhibit good diabetic care. Cross-boundary continuity between primary and secondary care is fundamental to contemporary diabetic services and ways should be found to achieve more effective communication.     

The Use of Health Care Services by People With Diabetes in Rural Areas

Abstract: Current standards of health care support the view that diabetes can be managed in an outpatient setting, thereby preventing costly hospitalization. Yet, recent studies on access to care suggest that rural residents do not receive the same services for diabetes care as their urban counterparts. This study identifies differences in use for three types of services-hospital care, home health visits, and physician office visits—by geographical location. Using a sample of 6,698 Medicare beneficiaries, the authors performed multivariate analysis of variance to test the influence of geographical differences on each type of service use after controlling for the other types of service use and individual factors. Results showed significant differences among the geographical categories, with diabetic individuals in the most sparsely populated communities reporting fewer physician office visits and more home health visits than their urban counterparts. Because this pattern may have a negative impact on health outcomes, additional research is needed to determine the optimal array of services necessary to manage chronic diseases, such as diabetes, in rural areas.     

Cachexia and Cognitive Function in the Community-Dwelling Older Adults: Mediation Effects of Oral Health

Background

Cognitive impairment and poor oral health are common problems in older adults and are associated with malnutrition. However, it is unclear how they are related to cachexia in community-dwelling older adults. The aim of this study was to examine the relationships among cachexia, cognitive function, and oral health in community-dwelling older adults.

Methods

This study is a secondary analysis of a data-set. Data were collected in the community setting on older adults who applied for government-funded long-term care services in Hong Kong in 2017. Subjects were community-dwelling and aged ≥60 years. The outcome variable was cachexia. The predictors were cognitive function and oral health. The covariates included demographics and comorbidities associated with cachexia or malnutrition. Path analysis was employed to examine the associations among cachexia, cognitive function, and oral health using the software SAS/STAT and Mplus.

Results

This analysis included 12,940 subjects. The prevalence of cachexia was 1.3%. Cognitive function was also found to have a direct effect on the oral health indicators of chewing problems (OR=1.073, p<0.001), brushing teeth problems (OR=1.349, p<0.001), and swallowing problems (coeff.=0.177, p<0.001). Oral health indicators with a direct effect on cachexia included dry mouth (OR=1.250, p<0.001), brushing teeth problems (OR = 1.185, p<0.01), and swallowing problems (OR=1.231, p<0.001). Cognitive function had no significant direct effect, but had a significant indirect effect on cachexia (OR=1.100, p<0.001) which is mediated by brushing teeth problems (OR=1.052, p<0.001) and swallowing problems (OR=1.038, p<0.001).

Conclusion

Cognitive impairment causes cachexia indirectly through poor oral health. This study recommends adding cognitive function when screening community-dwelling older adults for cachexia. Health policymakers should stress regular oral health screening and interventions, and encourage increased utilization of oral health services by community-dwelling older adults with cognitive problems.

     

Improvement in attitudes toward influenza vaccination in medical students following an integrated curricular intervention

Introduction

Vaccination of health care workers (HCW) reduces transmission of influenza among patients, yet uptake of vaccination remains low. If vaccination education is integrated into the early medical school curriculum, will student attitudes toward the vaccine change? The objectives of the study were to: (1) Determine influenza vaccination rates among entering medical students; (2) Assess the attitudes toward influenza vaccination; (3) Evaluate the effects of a multifaceted educational intervention on attitudes to vaccination.

Methods

Entering medical students were surveyed before and after an intervention at the beginning of the influenza season. This intervention provided by an inter-professional team, included education about influenza, importance of vaccination for HCWs, followed by vaccination administration practice, and ended with students vaccinating consenting classmates.

Results

The pre-intervention surveys and intervention were completed by 124 of 125 (99%) students. Pre-intervention survey revealed 60 (48%) of students had been previously vaccinated. Of the vaccinated students 91% had been recommended vaccination by their healthcare provider compared to 43% of non-vaccinated students. More positive attitudes were noted in the vaccinated students compared to non-vaccinated students: importance of vaccination (p < 0.01); HCWs should be vaccinated (p < 0.01); recommendation of vaccine to family and friends (p < 0.01). 97 (78%) students completed post-intervention surveys. Significant improvement in these attitudes was noted post-intervention compared to pre-intervention: importance of vaccination 93% versus 71% (p < 0.01); HCWs should be vaccinated 95% versus 83% (p < 0.01); recommendation to family and friends 93% versus 73% (p < 0.01); comfort with vaccine counseling 92% versus 41%; comfort with vaccine administration 84% versus 22% (p < 0.01).

Conclusion

Educating medical students and promoting the importance of vaccination early in a medical student's career using such an intervention is relatively simple and easily integrated into the curriculum. This intervention was successful in vaccinating all students, and demonstrated a marked positive shift in attitudes toward influenza vaccination.     

Prevalence of glucosamine and omega-3 fatty acid use and characteristics of users among mid-age women: Analysis of a nationally representative sample of 10,638 women

Background

There has been a dramatic increase in the use of dietary supplements over the last few decades and both omega-3 fatty acids and glucosamine are two of the best-selling dietary supplements in many countries. An understanding of omega-3 fatty acids and glucosamine consumption is of significance to health care providers and for future health promotion activities.

Methods

This research involved analysis of data collected from a nationally-representative sample of Australian women as part of the Australian Longitudinal Study on Women’s Health (ALSWH). Participants’ use of omega-3 fatty acids (FA), glucosamine, their demographics, health status and health care utilisation were measured. Analysis included logistic regression modelling.

Results

Of the 10,638 women in the study, 26.8% reported use of omega-3 FA and 15.9% glucosamine. Women with osteoarthritis (OR=2.529; 95% CI: 2.190, 2.921), other arthritis (OR= 1.618; 95% CI: 1.375, 1.905), and joint pain (OR= 2.699; 95% CI: 2.305, 3.160) were more likely to use glucosamine (all p<0.001). In contrast, those with diabetes (OR= 0.471; 95% CI: 0.343, 0.646) or depression (OR= 0.764; 95% CI: 0.657, 0.887) were less likely to use glucosamine (both p<0.001). Women with osteoarthritis (OR=1.481; 95% CI: 1.297, 1.691) and joint pain (OR= 1.456; 95% CI: 1.306, 1.622) were more likely to use omega-3 FA (all p<0.001).

Conclusions

Substantial prevalence rates for use of glucosamine and omega-3 FA amongst mid-aged women highlights the need for health practitioners and policymakers to be mindful of the possible significant role of such supplement use as part of patient health-seeking behaviours.

     

A controlled intervention study of changing health-providers' attitudes toward personal lifestyle habits and health-promotion skills

ObjectiveData regarding health providers' personal lifestyle and the differential effect of a short-term personal lifestyle experience intervention program on health providers are limited.MethodsWe conducted a controlled study aimed at changing personal attitudes toward lifestyle habits among 323 health professionals: 136 (42%) physicians, 140 (43%) dietitians, and 47 (15%) nurses and health promoters. In the intervention group (n = 209) individuals participated in a 2-d intensive self-experience workshop in an isolated location emphasizing healthy lifestyle and behavior-modifying techniques. Intervention and control groups were followed for 6 mo.ResultsAt baseline, avoidance of salt, trans-fatty acids, saturated fats, and processed meat was more frequent among dietitians (P < 0.05 versus physicians). The physicians reported a lower intake of olive/canola oil, nuts/almonds, dietary fibers, vegetables, and fruits (P < 0.05). Furthermore, physicians reported lower confidence in lifestyle primary prevention and felt less useful engaging in health-promotion activities (P < 0.05 versus other health professionals). After 6 mo, waist circumference decreased in the intervention group (?1.3 versus +1.8 cm in control group, P < 0.01). The effect was more prominent among physicians. A modest differential effect of the intervention program was shown in health-promotion activities.ConclusionApproaches toward primary prevention can be improved by an intervention program focusing on personal changes of health care providers. Physicians who are less likely to personally adhere to and believe in lifestyle primary prevention are more likely to benefit from this platform.     

Vaccination attitudes,beliefs and behaviours among primary health care workers in northern Croatia

Primary health care workers (HCWs) provide almost all vaccine services in Croatia, so they play an essential role in vaccine recommendations and uptake. The aim of this study was to determine the level of vaccine hesitancy among primary HCWs, to identify differences between nurses and physicians in attitudes, beliefs and behaviours towards vaccination, and to determine predictors of vaccine hesitancy among HCWs. We conducted a cross-sectional study from July to December in 2018 among physicians and nurses employed in the services of epidemiology, public health, school medicine, pediatrics and general practice/family medicine in Primorje-Gorski Kotar County, a primarily urban region with a population around 300 000 in the northern part of Croatia. The list of primary HCWs offices was obtained from the Croatian Health Insurance Fond website. We used a self-administered questionnaire on their attitudes, beliefs and behaviours relative to vaccination. Obtained response rate was 65.5% (324/495) of eligible primary HCWs; 64.1% (143/223) of physicians and 66.5% (181/272) of nurses. Seventeen percent of HCWs were identified as vaccine hesitant, and in univariate analysis, we observed an association between HCWs occupation and their own vaccination against flu (p = 0.001), measles (p = 0.016) and HPV (p = 0.025). Nurses and physicians differed (p < 0.001) in their general attitude, beliefs and behaviours towards vaccination, with a higher level of hesitancy among nurses. In multiple logistic regression, those more likely to be vaccine-hesitant were nurses (AOR = 5.73, 95%CI = 2.48–13.24), those who were uncertain or would never receive a vaccine against measles (AOR=11.13; 95%CI=5.37–23.10) and HPV (AOR=5.02; 95%CI=2.60–9.74), as well as those who had encountered a serious adverse event following immunization (AOR=7.55; 95%CI=3.13–19.18). As personal hesitancy may have a negative impact on vaccination education and recommendations, and therefore vaccine coverage, it is necessary to implement interventions to increase vaccination knowledge and confidence among primary health care workers, especially nurses.     

Factors associated with pneumococcal vaccine uptake among vulnerable older adults in the United States primary care setting

Pneumococcal vaccine uptake targets set by Healthy People 2020 were not met by 2019 among vulnerable United States populations, yet research suggests progress can be made in primary care settings. This study assessed factors associated with having gotten a pneumococcal vaccine among vulnerable adults aged 50 and older. This study used the 2018 Medical Expenditure Panel Survey nationally representative dataset. Eligible individuals were aged 50–64 with an ‘at risk’ health condition or ≥65 years and had a primary care provider as their usual source of care (N = 3,760). Binary logistic regression was used to test factors (identified from literature) for a significant association with getting the pneumococcal vaccine. Factors with significant associations were entered into an adjusted multivariable logistic regression model to generate the odds of endorsing a factor given that the respondent got the vaccine. Collinearity among variables was examined with an unacceptable threshold of 0.8 correlation. A significance threshold of 0.05 was used. Those who got the pneumococcal vaccine had 16.7 (p < 0.001), 16.0 (p < 0.001) and 11.0 times (p < 0.001) higher odds of having also gotten the influenza vaccine, the herpes zoster vaccine and a colonoscopy respectively. They had 3.86 times (p = 0.009) higher odds of having diabetes mellitus, 0.036 times (p = 0.019) higher odds of having visited their doctors three times in 2018 and 8.4 times (p = 0.009) higher odds of having seen their doctor within the last year. Concordance statistic for model fit was 0.936. There was a negative association between pneumococcal vaccination and going to three doctor office visits in 2018 vs only once. The strongest positive associations were found between pneumococcal vaccination and getting the herpes zoster vaccine, influenza vaccine and getting a colonoscopy. These results suggest that those who choose to get the pneumococcal vaccine may have higher odds of also getting other vaccines or specific preventative screenings.     

Disordered Eating Behaviors Are Associated with Poorer Diet Quality in Adolescents with Type 1 Diabetes

Disordered eating behaviors may pose a risk for poor long-term health outcomes in patients with type 1 diabetes. This cross-sectional study examined associations of disordered eating behaviors with diet quality, diet-related attitudes, and diabetes management in adolescents with type 1 diabetes (N=151, 48% female). Participants, recruited July 2008 through February 2009, completed 3-day diet records and survey measures, including the Diabetes Eating Problem Survey (DEPS) and measures of eating-related attitudes. Biomedical data were obtained from medical records. Participants scoring more than 1 standard deviation above the mean DEPS were classified as at risk for disordered eating. The Healthy Eating Index-2005 was calculated to assess diet quality. Analysis of covariance was used to test for differences between risk groups in diet quality, eating attitudes, and diabetes management, controlling for age, sex, and body mass index (BMI) percentile. Youth at risk for disordered eating were more likely to be overweight/obese than those at low risk (59.1% vs 31.8%, P=0.01). The at-risk group had poorer diet quality (P=0.003) as well as higher intake of total fat (P=0.01) and saturated fat (P=0.007) compared with the low-risk group. The at-risk group reported lower self-efficacy (P=0.005), greater barriers (P<0.001), and more negative outcome expectations (P<0.001) for healthful eating, as well as worse dietary satisfaction (P=0.004). The at-risk group had lower diabetes adherence (P<0.01), less-frequent blood glucose monitoring (P<0.002), and higher hemoglobin A1c (P<0.001). The constellation of excess weight, poorer dietary intake, and poorer diabetes management associated with youth at risk for disordered eating suggests potential risk of future poor health outcomes. Attention should be given to healthful weight management, especially among overweight youth with type 1 diabetes.     

La población inmigrante controla peor su diabetes que la población autóctona

Introduction

Ethnic differences are known to exist in the prevalence of diabetes, but little is known about possible differences in the degree of diabetes control among ethnic groups. The aim of this study was to determine whether there are differences in diabetes detection and control between immigrants and the autochthonous population in our health region.

Methods

We performed a cross-sectional, observational, population-based study of all patients diagnosed with diabetes mellitus type 2 registered and treated in 2010. We analyzed diabetes quality indicators and used multivariate logistic regression models adjusted for age, sex and number of visits. The adjustment method was forced and the absence of collinearity was identified through the ROC curve and Hosmer and Lemeshow's test.

Results

There were 77,999 autochthonous patients (6,846 diabetics) and 30,748 immigrant patients (415 diabetics). A total of 8.78% of the autochthonous patients were diabetic versus 1.35% of immigrants (p <0.001). HbA1c <7.5% was found in 68.04% of the native population compared with 54.76% of immigrants. The probability of achieving optimal HbA1c control was 27% lower in immigrants (adjusted OR = 0.73), while the probability of achieving good HbA1c control was 30% lower in the immigrant cohort. The model showed moderate discrimination (ROC =0.65 and Hosmer and Lemeshow's contrast, p > 0.05).

Conclusions

Diabetes control and quality indicators are poorer in some immigrant groups.